Sympathetic Nervous System activity – a new concept of the complicated etiology of low back pain radiates distally at the extremities
Varied and complicated etiology of low back pain radiates distally at the extremities is still causing disagreement and controversies around the issue of its diagnosis and treatment. New research data demonstrated that almost one in five persons with back pain experience symptoms indicative of neuropathic pain component. The neuropathic involvement is not completely understood, and different mechanisms are thought to play important role. A combination of nociceptive and neuropathic pain-generating mechanism is thought to be involved, which established the term mixed pain syndrome. In the pathomechanism of neuropathic pain the lesion, trauma or overloading of the disc is thought to be a primary source of the neuropathic pain but the concept of neuropathic component of pain is more probable for chronic stage than acute. Assessment of neuropathic pain involves a systematic approach which includes a series steps; past and present history, detailed description of pain distribution, quality, pain intensity and neurological examination with emphasis on sensory testing. The sensory examinations need often to be supply neurophysiological testing and quantitate sensory testing. Some groups of the drugs are thought to be useful e.g. tricyclic antidepressant, sodium channel blockers (e.g. carbamazepine), gabapentin, opioids, NMDA (N-methyl-D-aspartate) receptor blockers and others for neuropathic pain treatment. The use of specific kind of the drugs depends on the symptoms and examinations findings.