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A Practical Approach to the Diagnosis and Understanding of Chronic Low Back Pain, Based on Its Pathophysiology

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Surgery of the Spine and Spinal Cord

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Abstract

Patients with chronic low back pain (CLBP) are among the most frequent visitors of the practice of general practitioners, orthopedic surgeons, neurologists, neurosurgeons, and specialized pain treatment centers. Although nowadays the perception and expression of pain and individual reaction to pain are considered to be the result of psychological, social, and cultural factors, at the beginning of the symptom, nociceptive and/or neuropathic processes predominate. Although we accept terms as peripheral and central sensitization of pain, most of this recently acquired knowledge about the pathophysiology of CLBP is based upon experimental animal work only; its extrapolation to humans is not clear yet. While under experimental circumstances all parameters can be scrutinized, in patients we have to rely upon the patient’s history, signs, and symptoms and the outcome of tests and medical imaging. Unfortunately, in most cases, there is still no correlation between advanced medical imaging, including functional imaging findings and patient’s symptoms and clinical signs. Local anesthetic blocks can be helpful, although their significance should not be overestimated. Therefore, in more than 80 % of patients with chronic low back pain, no evident pain generator can be identified. It may be hard to admit, but, in these patients, we especially have to rely on their history and on our clinical findings, more than on advanced medical diagnostic tools, in order to understand not only where the pain comes from but also what kind of pain they are suffering from.

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Authors and Affiliations

  1. Department of Anesthesiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands

    Gerbrand J. Groen MD, PhD, Uli H. Beese MD, PhD & Rob J. M. Groen MD, PhD

  2. Department of Neurosurgery, AZ Nikolaas, Sint Niklaas, Belgium

    Erik Van de Kelft MD, PhD

Authors
  1. Gerbrand J. Groen MD, PhD
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  2. Uli H. Beese MD, PhD
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  3. Erik Van de Kelft MD, PhD
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  4. Rob J. M. Groen MD, PhD
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Correspondence to Gerbrand J. Groen MD, PhD .

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Editors and Affiliations

  1. Dept. of Neurosurgery, AZ Nikolaas, Sint-Niklaas, Belgium

    Erik van de Kelft

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Groen, G.J., Beese, U.H., Van de Kelft, E., Groen, R.J.M. (2016). A Practical Approach to the Diagnosis and Understanding of Chronic Low Back Pain, Based on Its Pathophysiology. In: van de Kelft, E. (eds) Surgery of the Spine and Spinal Cord. Springer, Cham. https://doi.org/10.1007/978-3-319-27613-7_22

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  • DOI: https://doi.org/10.1007/978-3-319-27613-7_22

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