Neurol. praxi. 2011;12(2):104-109

Neuropathic component of chronic low back pain

MUDr.Tomáš Nedělka^1,2,3, MUDr.Jiří Nedělka², Ing.Jakub Schlenker³, MUDr.Radim Mazanec, Ph.D.¹

¹ Neurologická klinika UK 2. LF a FN Motol, Praha

² Oddělení pro léčebnou rehabilitaci a léčbu bolesti Praha 6 –, Řepy

³ ČVUT v Praze, Fakulta biomedicínského inženýrství, Společné biomedicínské pracoviště ČVUT FBMI a UK 1. LF

Chronic low back pain (CBBP) is a common symptom affecting around 10 % of adult population in Western societies. Neuropathic component

is common, affecting around 1/3 of CBBP patients. It consists of local neuropathic pain within the degenerated intervertebral disc

and surrounding soft tissues as well as radicular pain which is caused by local nerve root compression, swelling or inflamation. Clinical

manifestation of neuropathic low back pain depends on affected nerve structures. Compression of nerve root or ventral rami of spinal

nerve usually causes sciatica. Symptoms of local neuropathic pain vary from latent trigger points or segmental tenderness (myofascial

pain syndrome) to abnormal skin sensations within the low back area. Presence of neuropathic pain has important impact upon analgetic

treatment, first line non-steroid antiflogistics (NSA) are effective in nociceptive pain only and does not have significant effect on

neuropathic component. Adjunct of tricyclic antidepressants, 3rd generation anticonvulsants such as pregabaline or gabapentine or

local anesthetic/steroid blocks can be beneficial in patients who do not respond to NSA in monotherapy. Non-pharmacotherapeutical

procedures – manipulation techniques, back school, physical therapy, accupuncture or psychotherapy are no less effective therapeutic

approaches, that can be used for complex treatment of chronic low back pain.

Keywords: chronic low back pain, neuropathic pain, degenerative spine disease

Published: June 1, 2011  Show citation