Pain Generators of the Lumbar Spine

Sizer, Phillip S.; Phelps, Valerie; Matthijs, Omer

doi:10.1111/j.1533-2500.2001.01027.x

Cited by 19 publications

(8 citation statements)

References 96 publications

(171 reference statements)

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“…52 Similarly, a detailed discussion of pathology, testing, and treatment of these areas is available. [17][18][19]53 Specifically, disc, joint, muscular, and neurologic pathologies can contribute to pelvic pain. Sacral spinal nerves innervate the pelvic floor structures, where afflictions in this region can potentially produce buttock and or perineal pain that accompanies local pelvic pain.…”

Section: General Neuroanatomical Considerationsmentioning

confidence: 99%

“…A complete examination sequence and the differential diagnostics for the lumbar spine have been previously described. 18 When screening the lumbar spine, the patient is asked to denote any symptom provocation during the following movements; (1) lumbar active flexion, with addition of neck flexion; (2) lumbar extension; (3) lumbar side bend to each side; and (4) slump or straight leg raise testing. 105 If none of these tests provokes the patient's familiar pain, then assessment of other musculoskeletal structures is warranted.…”

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confidence: 99%

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Chronic Female Pelvic Pain—Part 1: Clinical Pathoanatomy and Examination of the Pelvic Region

et al. 2011

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Chronic pelvic pain is defined as the presence of pain in the pelvic girdle region for over a 6-month period and can arise from the gynecologic, urologic, gastrointestinal, and musculoskeletal systems. As 15% of women experience pelvic pain at some time in their lives with yearly direct medical costs estimated at $2.8 billion, effective evaluation and management strategies of this condition are necessary. This merits a thorough discussion of a systematic approach to the evaluation of chronic pelvic pain conditions, including a careful history-taking and clinical examination. The challenge of accurately diagnosing chronic pelvic pain resides in the degree of peripheral and central sensitization of the nervous system associated with the chronicity of the symptoms, as well as the potential influence of the affective and biopsychosocial factors on symptom development as persistence. Once the musculoskeletal origin of the symptoms is identified, a clinical examination schema that is based on the location of primary onset of symptoms (lumbosacral, coccygeal, sacroiliac, pelvic floor, groin or abdominal region) can be followed to establish a basis for managing the specific pain generator(s) and manage tissue dysfunction.

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Section: General Neuroanatomical Considerationsmentioning

confidence: 99%

mentioning

confidence: 99%

Chronic Female Pelvic Pain—Part 1: Clinical Pathoanatomy and Examination of the Pelvic Region

et al. 2011

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“…91,92 The assessment and treatment of these areas has been well described elsewhere and will not be further described in this article. [93][94][95][96][97] Pelvic ring hypermobility affects between 7% and 14% of all pregnant women. 21 Prolonged pelvic girdle pain, lasting beyond 6 months postpartum, is estimated in 3% to 30% of women.…”

Section: Pelvic Pain Originating From the Musculoskeletal Systemmentioning

confidence: 99%

Chronic Female Pelvic Pain—Part 2: Differential Diagnosis and Management

et al. 2011

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Pelvic pain is a common condition. Treatment interventions have traditionally targeted biomedical conditions with variable success. Utilizing a systematic approach to examination of the pelvic girdle and related organ systems contained within the pelvis will aid the clinician in identifying the painful structure(s) as well as the associated impairments limiting functional recovery. From this, a complete management program can be instituted. The following description of gynecologic, urologic, gastrointestinal, musculoskeletal, and neurologic conditions that can cause or are associated with chronic pelvic pain leads to conservative management proposals based on the available evidence. Finally, nonoperative interventional strategies are described, which target the pain system from a cognitive behavioral perspective, address movement dysfunctions, and address interventional pain technique possibilities.

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“…27 There are multiple potential pain generators in the spine, including the intervertebral disc itself (discogenic pain) and the surrounding boney structures (the facet joints and vertebral endplate), as well as compression of the adjacent neural structures due to loss of disc height, bulging or herniation. 28 While its origins are still not fully understood, spine pain places a significant social and economic burden on modern society. Back pain is the number one contributor to years lived with disability for adults in the United States.…”

Section: Intervertebral Disc Degeneration and Treatmentmentioning

confidence: 99%

Promise, progress, and problems in whole disc tissue engineering

Gullbrand

Smith

et al. 2018

JOR Spine

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Intervertebral disc degeneration is frequently implicated as a cause of back and neck pain, which are pervasive musculoskeletal complaints in modern society. For the treatment of end stage disc degeneration, replacement of the disc with a viable, tissue-engineered construct that mimics native disc structure and function is a promising alternative to fusion or mechanical arthroplasty techniques. Substantial progress has been made in the field of whole disc tissue engineering over the past decade, with a variety of innovative designs characterized both in vitro and in vivo in animal models. However, significant barriers to clinical translation remain, including construct size, cell source, culture technique, and the identification of appropriate animal models for preclinical evaluation. Here we review the clinical need for disc tissue engineering, the current state of the field, and the outstanding challenges that will need to be addressed by future work in this area. K E Y W O R D Sanimal models, biomaterials, biomechanics, disc degeneration, mesenchymal stem cells | INTRODUCTIONBack and neck pain place a significant social and economic burden on modern society, affecting nearly 1 in 2 individuals annually. In the United States alone, these conditions are associated with an estimated $194 billion in yearly medical costs and lost wages. Back pain is commonly associated with degenerative disc disease, a progressive condition with complex underlying etiology, during which component tissues undergo an array of cellular and structural changes that ultimately compromises biomechanical function.Although the pathological manifestations of disc degeneration are well characterized, the underlying causes and the origins of discogenic pain are still not well understood, impeding the development of effective therapies. Current treatments for disc degeneration do not restore native disc structure and function, and thus exhibit limited long-term efficacy. Tissue engineering offers the promise of generating de novo, living structures that recapitulate the form, function, and biology of healthy host tissues with the potential to treat a variety musculoskeletal disorders, including disc degeneration. Here, we review recent progress in the field of whole disc tissue engineering as well as the barriers that will need to be addressed for the successful clinical translation of engineered discs. | INTERVERTEBRAL DISC STRUCTURE AND MECHANICAL FUNCTIONThe intervertebral discs of the spine are composite structures composed of the central nucleus pulposus (NP), the peripheral annulus fibrosus (AF), and the superior and inferior cartilaginous end plates.The extracellular matrix (ECM) of the NP is composed primarily of proteoglycans and type II collagen; the high proteoglycan content of | INTERVERTEBRAL DISC DEGENERATION AND TREATMENTDegeneration of the intervertebral discs may occur with aging or following injury. While the exact pathophysiology of disc degeneration remains unclear, it is known to involve a progressive cascade of cellular,...

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Pain Generators of the Lumbar Spine

Cited by 19 publications

References 96 publications

Chronic Female Pelvic Pain—Part 1: Clinical Pathoanatomy and Examination of the Pelvic Region

Chronic Female Pelvic Pain—Part 1: Clinical Pathoanatomy and Examination of the Pelvic Region

Chronic Female Pelvic Pain—Part 2: Differential Diagnosis and Management

Promise, progress, and problems in whole disc tissue engineering

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