Root blocks or epidural injections, using corticosteroids, are routine treatments for leg and back symptoms and may support the hypothesis that there is an inflammatory aspect to the patient’s pain. Operative removal of human disc material has been analysed to find increased concentrations of inflammatory mediators which might respond to the steroid treatment. Changes which can occur from inflammatory substances include increasing the sensitivity of sensory nerves in the outer annular walls of the discs, limiting the production of proteoglycan molecules which hold water in the discs and adding to the effects of disc degenerative processes.

The nerve structures which are part of the lumbar motion segment can be sensitised and so become hyper reactive, leading to mechanical stresses which normally would be painless becoming painful. Nerve root or radicular pain is the pain caused by compression, irritation or inflammation of one of the spinal nerves at or close to the area they emerge from the spinal cord. It is not clear exactly what is the pathology underlying severe sciatica, although hypotheses include compression plus dysfunction of the axons, ischaemia, inflammation and biochemical factors. Spinal nerve roots may be more susceptible to compression injuries and to swelling formation inside their structure than other nerves.

The nerve may suffer from excessive inflow of fluid secondary to compression, which results in internal nerve swelling from the increased pressure. This can slow the flow through capillaries and allow fibrosis to develop in the nerve. Nutrition to the spinal nerve roots comes via the cerebrospinal fluid to the tune of about 60% and nerve fibrosis interferes with this, making the nerve more responsive and perhaps more likely to suffer compression symptoms due to the increased reactivity of the nerves. Blocking or reducing the blood supply can cause pain in these nerves, unlike the more usual loss of motor and sensory functions in compression of peripheral nerves.

If the nerve and its vascular supply are compromised quickly then nerve root symptoms are more likely than with a slow onset, perhaps giving a clue to why older people do not suffer such symptoms despite compromise of the nerve exits. Disc material has been experimentally placed in the epidural space of dogs and found to generate a significant inflammatory reaction and may cause damage to nerves when in contact with them. If TNF (tumour necrosis factor) is injected into a nerve it causes similar changes to those which ensue after nerve root compromise. An auto-immune reaction to the internal disc material, which is not normally accessible, has also been proposed but it is likely that many aspects are relevant.

The facet joints are synovial joints, like our finger joints, and are formed from articular processes on an upper and a lower vertebra. Facet joints react to injury and damage in the same way as our other joints react, with pain, stiffness, loss of movement, muscle spasm and eventually degeneration. As the discs degenerate the facet joints follow by becoming osteoarthritic. The fibrous capsules which surround the facet joints are rich in nerve endings and injections into the joints have been shown to refer pain into the arms, upper back and legs. Facet joints are capable of generating pain and have been shown experimentally to be involved in significant percentages of patients with neck, thoracic and lumbar pain.

The main posterior joints between the pelvis and the sacrum are the sacroiliac joints, large synovial joints which have been shown to refer pain to the buttock, low back, leg and groin. Chronic low back pain sufferers, in an experimental setting, were shown to have this joint involved in their pain production in 2-30% of cases. Muscular tissue also has pain receptors which react to pressure and stretching as well as other stimuli. If muscles are stretched suddenly under pressure or are overworked over a period of time they will become painful, shortened and exhibit

In posturally abnormal or injured muscles a pain syndrome (myofascial pain syndrome) can occur whereby the muscle becomes tight, painful and exhibits trigger points. Palpation of muscle tissue can identify trigger points as firm and tender nodular areas which refer pain out into nearby defined regions.

• Cell Phone Elbow - 2 Steps to Staying Connected Without Pain
• Ways You Can Cure Angular Cheilitis - Follow These Tips | ArticlesBase.com
• Morning Heel Pain - 20 Tips For Treatment
• Chronic Kidney Stones - Get the Relief By Drinking Lots of Water
• The Cures For Cold Sores
• Best Herbs For Treating Diabetes | ArticlesBase.com
• Vertical Jump Training - Jumper's Knee
• What Are Natural Options For Joint Pain Relief?
• What is Diabetic Neuropathy?
• Cure for Lower Back Pain - Food Groups that Can Provide Cure for Back Pain | ArticlesBase.com

No Comments »

No comments yet.

RSS feed for comments on this post. TrackBack URL

Leave a comment

You must be logged in to post a comment.