title: Mechanisms of low back pain: a guide for diagnosis and therapy.
abstract: Chronic low back pain (CLBP) is a chronic pain syndrome in the lower back region, lasting for at least 3 months. CLBP represents the second leading cause of disability worldwide being a major welfare and economic problem. The prevalence of CLBP in adults has increased more than 100% in the last decade and continues to increase dramatically in the aging population, affecting both men and women in all ethnic groups, with a significant impact on functional capacity and occupational activities. It can also be influenced by psychological factors, such as stress, depression and/or anxiety. Given this complexity, the diagnostic evaluation of patients with CLBP can be very challenging and requires complex clinical decision-making. Answering the question "what is the pain generator" among the several structures potentially involved in CLBP is a key factor in the management of these patients, since a mis-diagnosis can generate therapeutical mistakes. Traditionally, the notion that the etiology of 80% to 90% of LBP cases is unknown has been mistaken perpetuated across decades. In most cases, low back pain can be attributed to specific pain generator, with its own characteristics and with different therapeutical opportunity. Here we discuss about radicular pain, facet Joint pain, sacro-iliac pain, pain related to lumbar stenosis, discogenic pain. Our article aims to offer to the clinicians a simple guidance to identify pain generators in a safer and faster way, relying a correct diagnosis and further therapeutical approach.
authors: Department of Surgical Sciences, University of Parma, Parma, Italy; Anaesthesia, Intensive Care and Pain Therapy Service, Azienda Ospedaliera Universitaria Parma Hospital, Parma, Italy.
authors: Massimo
authors: 0000-0002-8201-980X
authors: M
authors: Allegri
authors: Department of Surgical Sciences, University of Parma, Parma, Italy.
authors: Silvana
authors: S
authors: Montella
authors: Department of Surgical Sciences, University of Parma, Parma, Italy.
authors: Fabiana
authors: F
authors: Salici
authors: Anaesthesia, Intensive Care and Pain Therapy Service, Azienda Ospedaliera Universitaria Parma Hospital, Parma, Italy.
authors: Adriana
authors: A
authors: Valente
authors: Anaesthesia, Intensive Care and Pain Therapy Service, Azienda Ospedaliera Universitaria Parma Hospital, Parma, Italy.
authors: Maurizio
authors: M
authors: Marchesini
authors: Anaesthesia, Intensive Care and Pain Therapy Service, Azienda Ospedaliera Universitaria Parma Hospital, Parma, Italy.
authors: Christian
authors: C
authors: Compagnone
authors: Department of Surgical Sciences, University of Parma, Parma, Italy; Anaesthesia, Intensive Care and Pain Therapy Service, Azienda Ospedaliera Universitaria Parma Hospital, Parma, Italy.
authors: Marco
authors: M
authors: Baciarello
authors: Anaesthesia, Intensive Care and Pain Therapy Service, Azienda Ospedaliera Universitaria Parma Hospital, Parma, Italy.
authors: Maria Elena
authors: ME
authors: Manferdini
authors: Department of Surgical Sciences, University of Parma, Parma, Italy; Anaesthesia, Intensive Care and Pain Therapy Service, Azienda Ospedaliera Universitaria Parma Hospital, Parma, Italy.
authors: Guido
authors: G
authors: Fanelli
keywords: CLBP; back; low back pain; spine