New hypothesis of chronic back pain: low pH promotes nerve ingrowth into damaged intervertebral disks

Abstract

The pathogenesis of low back pain is still elusive. Here, we proposed a new hypothesis that low pH is a possible cause of the development and progression of low back pain. We propose that low pH promotes the production of the inflammatory mediators and the depletion of proteoglycan in the damaged intervertebral disk. The inflammation response, evoked by the dorsal root ganglia, changes the delicate nutrient balance in the nucleus, resulting in a vicious cycle and leading to choronic back pain. Our hypothesis may explain many of the available clinical and experimental data on low back pain, thus it may help elucidate the pathogenesis of low back pain and improve clinical management.

Detection of low back pain using pH level-dependent imaging of the intervertebral disc using the ratio of R1ρdispersion and −OH chemical exchange saturation transfer (RROC)

“…The higher RROC values in painful discs suggested a lower pH level. This finding was in line with predictions from LBP pathogenesis theories and studies . ROC analysis had an AUC of 0.76, indicating it is a fair predictor for painful discs.…”

Clinical Significance of Tumor Necrosis Factor-α Inhibitors in the Treatment of Sciatica: A Systematic Review and Meta-Analysis

“…(2) The anti-inflammatory effect of TNF-α inhibitors is not parallel to their pain-controlling effect. The mechanisms underlying leg pain and lower back pain remain unclear [39]. Scholars generally believe the pain might result from the mechanical, chemical and inflammatory irritation of sinuvertebral nerves [40], [41], while the pain might be associated with unstable lumbar spine or spinal stenosis in addition to inflammatory responses in a portion of patients.…”

Effects of proinflammatory cytokines on axonal outgrowth from adult rat lumbar dorsal root ganglia using a novel three-dimensional culture system

“…Although the precise mechanisms are not well understood, various factors have been posited to regulate nerve ingrowth into the lumbar IVD [9][10][11][12][13][14]. In terms of biochemical stimulation, it is widely held that causal links between proinflammatory cytokines and neurotrophic factors, particularly nerve growth factor (NGF), influence the growth potential of DRG neurons into the IVDs [15,16].…”