eMedicine Specialties > Neurology > Headache and Pain

Pathophysiology of Chronic Back Pain: Multimedia

Author: Anthony H Wheeler, MD, Pain and Orthopedic Neurology, Charlotte, North Carolina
Contributor Information and Disclosures

Updated: Jun 30, 2009

Multimedia

Algorithm for the management of low back pain and...Media file 1: Algorithm for the management of low back pain and sciatica.
Algorithm for the management of low back pain and...

Algorithm for the management of low back pain and sciatica.

More on Pathophysiology of Chronic Back Pain

References

References

  1. Kuslich SD, Ulstrom CL, Michael CJ. The tissue origin of low back pain and sciatica: a report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia. Orthop Clin North Am. Apr 1991;22(2):181-7. [Medline].

  2. Mooney V. Presidential address. International Society for the Study of the Lumbar Spine. Dallas, 1986. Where is the pain coming from?. Spine. Oct 1987;12(8):754-9. [Medline].

  3. Wall PD, Gutnick M. Ongoing activity in peripheral nerves: the physiology and pharmacology of impulses originating from a neuroma. Exp Neurol. Jun 1974;43(3):580-93. [Medline].

  4. [Guideline] Chou R, Loeser JD, Owens DK, Rosenquist RW, Atlas SJ, Baisden J, et al. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine. May 1 2009;34(10):1066-77. [Medline].

  5. [Best Evidence] Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: a review of the evidence for an american pain society clinical practice guideline. Spine. May 1 2009;34(10):1078-93. [Medline].

  6. Weber H. Lumbar disc herniation. A controlled, prospective study with ten years of observation. Spine. Mar 1983;8(2):131-40. [Medline].

  7. Manchikanti L, Staats PS, Singh V, Schultz DM, Vilims BD, Jasper JF, et al. Evidence-based practice guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician. Jan 2003;6(1):3-81. [Medline].

  8. Wheeler Ah, Murrey DB. Spinal pain: pathogenesis, evolutionary mechanisms and management. In: Pappagallo M, ed. The Neurological Basis of Pain. 421-52. New York: McGraw-Hill; 2003.

  9. Carette S, Marcoux S, Truchon R, Grondin C, Gagnon J, Allard Y, et al. A controlled trial of corticosteroid injections into facet joints for chronic low back pain. N Engl J Med. Oct 3 1991;325(14):1002-7. [Medline].

  10. Marks RC, Houston T, Thulbourne T. Facet joint injection and facet nerve block: a randomised comparison in 86 patients with chronic low back pain. Pain. Jun 1992;49(3):325-8. [Medline].

  11. Nash TP. Facet joints. Intra-articular steroids or nerve blocks?. Pain Clinic. 77-82;3:1990.

  12. Lilius G, Laasonen EM, Myllynen P, Harilainen A, Gronlund G. Lumbar facet joint syndrome. A randomised clinical trial. J Bone Joint Surg Br. Aug 1989;71(4):681-4. [Medline].

  13. Barnsley L, Lord SM, Wallis BJ, Bogduk N. Lack of effect of intraarticular corticosteroids for chronic pain in the cervical zygapophyseal joints. N Engl J Med. Apr 14 1994;330(15):1047-50. [Medline].

  14. Lippitt AB. The facet joint and its role in spine pain. Management with facet joint injections. Spine. Oct 1984;9(7):746-50. [Medline].

  15. Lau LS, Littlejohn GO, Miller MH. Clinical evaluation of intra-articular injections for lumbar facet joint pain. Med J Aust. Dec 9-23 1985;143(12-13):563-5. [Medline].

  16. Jackson RP, Jacobs RR, Montesano PX. 1988 Volvo award in clinical sciences. Facet joint injection in low-back pain. A prospective statistical study. Spine. Sep 1988;13(9):966-71. [Medline].

  17. Manchikanti L, Pampati V, Bakhit CE, Rivera JJ, Beyer CD, Damron KS, et al. Effectiveness of lumbar facet joint nerve blocks in chronic low back pain: a randomized clinical trial. Pain Physician. Jan 2001;4(1):101-17. [Medline].

  18. Nash TP. Facet joints. Intra-articular steroids or nerve blocks?. Pain Clinic. 3:77-82.

  19. Barnsley L, Bogduk N. Medial branch blocks are specific for the diagnosis of cervical zygapophyseal joint pain. Reg Anesth. Nov-Dec 1993;18(6):343-50. [Medline].

  20. Manchikanti L, Pampati V, Fellows B, Bakhit CE. The diagnostic validity and therapeutic value of lumbar facet joint nerve blocks with or without adjuvant agents. Curr Rev Pain. 2000;4(5):337-44. [Medline].

  21. North RB, Han M, Zahurak M, Kidd DH. Radiofrequency lumbar facet denervation: analysis of prognostic factors. Pain. Apr 1994;57(1):77-83. [Medline].

  22. Manchikanti L, Singh V, Vilims BD, Hansen HC, Schultz DM, Kloth DS. Medial branch neurotomy in management of chronic spinal pain: systematic review of the evidence. Pain Physician. Oct 2002;5(4):405-18. [Medline].

  23. Lord SM, Barnsley L, Bogduk N. Percutaneous radiofrequency neurotomy in the treatment of cervical zygapophysial joint pain: a caution. Neurosurgery. Apr 1995;36(4):732-9. [Medline].

  24. Hammer M,. Meneese W: Principles and practice of radiofrequency neurolysis. Cur Rev Pain. 1998;2:267-78.

  25. Breivik H, Hesla PE, Molnar I, et al. Treatment of chronic low back pain and sciatica. Comparison of caudal epidural injections of bupivacaine and methylprednisolone with bupivacaine followed by saline. In: Bonica JJ, Albe-Fessard D, eds. Advances in pain research and therapy. Vol 1. New York: Raven Press; 1976:927-32.

  26. Bush K, Hillier S. A controlled study of caudal epidural injections of triamcinolone plus procaine for the management of intractable sciatica. Spine. 16(5):572-5. [Medline].

  27. Manchikanti L, Pampati V, Rivera JJ, Beyer C, Damron KS, Barnhill RC. Caudal epidural injections with sarapin or steroids in chronic low back pain. Pain Physician. Oct 2001;4(4):322-35. [Medline].

  28. Helsa PE, Breivik H:. Epidural analgesia and epidural steroid injection for treatment of chronic low back pain and sciatica. Tidsskr Nor Laegeforen. 1979;99:936-9.

  29. Revel M, Auleley GR, Alaoui S, Nguyen M, Duruoz T, Eck-Michaud S, et al. Forceful epidural injections for the treatment of lumbosciatic pain with post-operative lumbar spinal fibrosis. Rev Rhum Engl Ed. Apr 1996;63(4):270-7. [Medline].

  30. Mathews JA, Mills SB, Jenkins VM, Grimes SM, Morkel MJ, Mathews W, et al. Back pain and sciatica: controlled trials of manipulation, traction, sclerosant and epidural injections. Br J Rheumatol. Dec 1987;26(6):416-23. [Medline].

  31. Manchikanti L, Singh V, Rivera JJ, Pampati V, Beyer C, Damron K. Effectiveness of caudal epidural injections in discogram positive and negative chronic low back pain. Pain Physician. Jan 2002;5(1):18-29. [Medline].

  32. Yates DW. A comparison of the types of epidural injection commonly used in the treatment of low back pain and sciatica. Rheumatol Rehabil. Aug 1978;17(3):181-6. [Medline].

  33. Waldman SD. The caudal epidural administration of steroids in combination with local anesthetics in the palliation of pain secondary to radiographically documented lumbar herniated disc: A prospective outcome study with 6-months follow-up. Pain Clinic. 1998;11:43-9.

  34. Hauswirth R, Michot F:. Caudal epidural injection in the treatment of low back pain. Ischweizerische Medizinische Wochenschrift. 1982;112:222-5.

  35. Manchikanti L, Pakanati RR, Pampati V. Comparison of three routes of epidural steroid injections in low back pain. Pain Digest. 1999;9:277-85.

  36. Goebert HW, Jallo SJ, Gardner WJ, Wasmuth CE. Painful radiculopathy treated with epidural injections of procaine and hydrocortisone acetate: results in 113 patients. Anesth Analg. Jan-Feb 1961;40:130-4. [Medline].

  37. Clocon JO, Galindo-Clocon D, Amarnath L, et al. Caudal epidural blocks for elderly patients with lumbar canal stenosis. J Am Geriatr Soc. 1994;42:593-6.

  38. Koes BW, Scholten RJ, Mens JM, Bouter LM. Efficacy of epidural steroid injections for low-back pain and sciatica: a systematic review of randomized clinical trials. Pain. Dec 1995;63(3):279-88. [Medline].

  39. Watts RW, Silagy CA. A meta-analysis on the efficacy of epidural corticosteroids in the treatment of sciatica. Anaesth Intensive Care. Oct 1995;23(5):564-9. [Medline].

  40. van Tulder MWV, Koes BW, Bouter LM. Conservative treatment of acute and chronic nonspecific low back pain. A systematic review of randomized controlled trials of the most common interventions. Spine. 1997;22:2128-56.

  41. McQuay HJ, Moore RA. Epidural corticosteroids for sciatica. In: An Evidence-Based Resource for Pain Relief. New York: Oxford University Press; 1998:216-8.

  42. Vroomen PC, de Krom MC, Slofstra PD, Knottnerus JA. Conservative treatment of sciatica: a systematic review. J Spinal Disord. Dec 2000;13(6):463-9. [Medline].

  43. Racz GB, Holubec JT. Lysis of adhesions in the epidural space. In: Racz GB, ed. Techniques of Neurolysis. Boston: Kluwer Academic Press; 57-72.

  44. Manchikanti L, Singh V. Epidural lysis of adhesions and myeloscopy. Curr Pain Headache Rep. Dec 2002;6(6):427-35. [Medline].

  45. Anderson SR, Racz GB, Heavner J. Evolution of epidural lysis of adhesions. Pain Physician. Jul 2000;3(3):262-70. [Medline].

  46. Racz GB, Sabonghy M, Gintautas J, Kline WM. Intractable pain therapy using a new epidural catheter. JAMA. Aug 6 1982;248(5):579-81. [Medline].

  47. Manchikanti L, Saini B, Singh V. Lumbar epidural adhesiolysis. In: Manchikanti L, Slipman CW, Fellows B, eds. Interventional Pain Management: Low Back Pain – Diagnosis and Treatment. Paducah, KY: ASIPP Publishing; 2002:353-90.

  48. Manchikanti L, Singh V. Lumbar endoscopic adhesiolysis. In: Manchikanti L, Slipman CW, Fellows B, eds. Interventional Pain Management: Low Back Pain – Diagnosis and Treatment. Paducah, KY: ASIPP Publishing; 2002:391-410.

  49. Manchikanti L, Saini B, Singh V. Spinal endoscopy and lysis of epidural adhesions in the management of chronic low back pain. Pain Physician. Jul 2001;4(3):240-65. [Medline].

  50. Lewandowski EM. The efficacy of solutions used in caudal neuroplasty. Pain Digest. 1997;7:323-30.

  51. Saberski LR, Kitahata LM. Direct visualization of the lumbosacral epidural space through the sacral hiatus. Anesth Analg. Apr 1995;80(4):839-40. [Medline].

  52. Heavner JE, Chokhavatia S, Kizelshteyn G:. Percutaneous evaluation of the epidural and subarachnoid space with the flexible fiberscope. Reg Anesth. 1991;15S1:85.

  53. Saberski KR, Kitahata L:. Review of the clinical basis and protocol for epidural endoscopy. Connecticut Med. 1995;50:71-3.

  54. Saberski LR, Brull S. Fiberoptic visualization of the spinal cord. A histroical review and report of current methods. Yale Biol Med. 1995;68:7-16.

  55. Manchikanti L, Pampati V, Fellows B, Rivera J, Beyer CD, Damron KS. Role of one day epidural adhesiolysis in management of chronic low back pain: a randomized clinical trial. Pain Physician. Apr 2001;4(2):153-66. [Medline].

  56. Manchikanti L, Pakanati R, Bakhit CE, et al.:. Role of adhesiolysis and hypertonic saline neurolysis in management of low back pain. Evaluation of modification of Racz protocol. Pain Digest. 1999;9:91-6.

  57. Manchikanti L, Pampati V, Bakhit CE, Pakanati RR. Non-endoscopic and endoscopic adhesiolysis in post-lumbar laminectomy syndrome: a one-year outcome study and cost effectiveness analysis. Pain Physician. Oct 1999;2(3):52-8. [Medline].

  58. Geurts JW, Kaliewaard JW, Richardson J, et al. Targeted methylprednisoione acetate/hyaluronidase/clonidine injection after diagnostic epiduroscopy for chronic sciatica: A prospective, 3-year follow-up study. Reg Anesth Pain Med. 2002;27:343-52. [Medline].

  59. Richardson J, McGurgan P, Cheema S, Prasad R, Gupta S. Spinal endoscopy in chronic low back pain with radiculopathy. A prospective case series. Anaesthesia. May 2001;56(5):454-60. [Medline].

  60. Manchikanti L:. The value and safety of epidural endoscopic adhesiolysis. Amer J Anesthesiol. 2000;275-278.

  61. Kim RC, Porter RW, Choi BH, Kim SW. Myelopathy after the intrathecal administration of hypertonic saline. Neurosurgery. May 1988;22(5):942-5. [Medline].

  62. Aldrete JA, Zapata JC, Ghaly R. Arachnoiditis following epidural adhesiolysis with hypertonic saline report of two cases. Pain Digest. 1996;6:368-70.

  63. Lou L, Racz G, Heavner J. Percutaneous epidural neuroplasty. In: Waldman SD. Interventional Pain Management. 2nd ed. Philadelphia: WB Saunders; 2000:434-45.

  64. Manchikanti L, Bakhit CE. Removal of a torn Racz catheter from lumbar epidural space. Reg Anesth. Nov-Dec 1997;22(6):579-81. [Medline].

  65. Simmons JW, McMillin JN, Emery SF, Kimmich SJ. Intradiscal steroids. A prospective double-blind clinical trial. Spine. Jun 1992;17(6 Suppl):S172-5. [Medline].

  66. Pinzon EG:. Treating lumbar back pain. Practical. Pain Manag,. April/May: 2001.;14-20,.

  67. Karasek M, Bogduk N. Twelve-month follow-up of a controlled trial of intradiscal thermal anuloplasty for back pain due to internal disc disruption. Spine. Oct 15 2000;25(20):2601-7. [Medline].

  68. Bogduk N, Karasek M. Two-year follow-up of a controlled trial of intradiscal electrothermal anuloplasty for chronic low back pain resulting from internal disc disruption. Spine J. Sep-Oct 2002;2(5):343-50. [Medline].

  69. Wetzel FT, McNally TA, Phillips FM. Intradiscal electrothermal therapy used to manage chronic discogenic low back pain: new directions and interventions. Spine. Nov 15 2002;27(22):2621-6. [Medline].

  70. Pauza K, Howell S, Dreyfuss P, et al. A randomized, double-blink placebo controlled trial evaluating the efficacy of intradiscal electothermal anuloplasty (IDET) for the treatment of chronic discogenic low back pain: 6 month outcomes. Proc Int Spinal Injection Soc. Sept 7 2002.

  71. Saal JA, Saal JS. Nonoperative treatment of herniated lumbar intervertebral disc with radiculopathy. An outcome study. Spine. Apr 1989;14(4):431-7. [Medline].

  72. Derby R, Eek B, Chen Y, et al. Intradiscal electrothermal anuloplasty (IDET): A novel approach for treating chronic discogenic back pain. Neuromodulation. 2000;3:82-88.

  73. Singh V. Intradiscal electrothermal therapy: a preliminary report. Pain Physician. Oct 2000;3(4):367-73. [Medline].

  74. Endres SM, Fiedler GA, Larson KL. Effectiveness of intradiscal electrothermal therapy in increasing function and reducing chronic low back pain in selected patients. WMJ. 2002;101(1):31-4. [Medline].

  75. Gerszten PC, Welch WC, McGrath PM, Willis SL. A Prospective Outcomes Study Of Patients Undergoing Intradiscal Electrothermy (IDET) For Chronic Low Back Pain. Pain Physician. Oct 2002;5(4):360-4. [Medline].

  76. Saal JA, Saal JS. Intradiscal electrothermal treatment for chronic discogenic low back pain: a prospective outcome study with minimum 1-year follow-up. Spine. Oct 15 2000;25(20):2622-7. [Medline].

  77. [Best Evidence] Sertpoyraz F, Eyigor S, Karapolat H, Capaci K, Kirazli Y. Comparison of isokinetic exercise versus standard exercise training in patients with chronic low back pain: a randomized controlled study. Clin Rehabil. Mar 2009;23(3):238-47. [Medline].

  78. Ahlgren SA, Hansen T. The use of lumbosacral corsets prescribed for low back pain. Prosthet Orthot Int. Aug 1978;2(2):101-4. [Medline].

  79. Anderssen GBJ. The epidemiology of spinal disorders. In: Frymoyer JW, ed. The Adult Spine: Principles and Practice. New York, NY: Raven Press;1997:93-141.

  80. Aprill C, Dwyer A, Bogduk N. Cervical zygapophyseal joint pain patterns. II: A clinical evaluation. Spine. Jun 1990;15(6):458-61. [Medline].

  81. Argoff C, Nicholson B, Moskowitz M, et al. Effectiveness of lidocaine patch 5% (Lidoderm) in the treatment of low back pain (LBP). In: Program and Abstracts of the IASP 10th World Congress on Pain. August 17-22, 2002; San Diego, Calif. [Abstract] 176:172.

  82. Argoff CA, Wheeler AH. Spinal and radicular pain disorders. Neurol Clin. Nov 1998;16(4):833-50. [Medline].

  83. Ashton IK, Ashton BA, Gibson SJ, et al. Morphological basis for back pain: the demonstration of nerve fibers and neuropeptides in the lumbar facet joint capsule but not in ligamentum flavum. J Orthop Res. Jan 1992;10(1):72-8. [Medline].

  84. Auld AW, Maki-Jokela A, Murdoch DM. Intraspinal narcotic analgesia in the treatment of chronic pain. Spine. Oct 1985;10(8):777-81. [Medline].

  85. Axelsson P, Johnsson R, Stromqvist B. Effect of lumbar orthosis on intervertebral mobility. A roentgen stereophotogrammetric analysis. Spine. Jun 1992;17(6):678-81. [Medline].

  86. Backonja M, Beydoun A, Edwards KR, et al. Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: a randomized controlled trial. JAMA. Dec 2 1998;280(21):1831-6. [Medline].

  87. Barrera P, Blom A, van Lent PL, et al. Synovial macrophage depletion with clodronate-containing liposomes in rheumatoid arthritis. Arthritis Rheum. Sep 2000;43(9):1951-9. [Medline].

  88. Bats-Baril WL, Frymoyer JW. The economics of spinal disorders. In: Frymoyer JW, ed. The Adult Spine: Principles and Practice. New York, NY: Raven Press;1991:85-105.

  89. Battie MC, Bigos SJ, Fisher LD, et al. A prospective study of the role of cardiovascular risk factors and fitness in industrial back pain complaints. Spine. Feb 1989;14(2):141-7. [Medline].

  90. Battie MC, Bigos SJ, Fisher LD, et al. Isometric lifting strength as a predictor of industrial back pain reports. Spine. Aug 1989;14(8):851-6. [Medline].

  91. Battie MC, Videman T, Gill K, et al. 1991 Volvo Award in clinical sciences. Smoking and lumbar intervertebral disc degeneration: an MRI study of identical twins. Spine. Sep 1991;16(9):1015-21. [Medline].

  92. Bennett RM. Emerging concepts in the neurobiology of chronic pain: evidence of abnormal sensory processing in fibromyalgia. Mayo Clin Proc. Apr 1999;74(4):385-98. [Medline].

  93. Bergquist-Ullman M, Larsson U. Acute low back pain in industry. A controlled prospective study with special reference to therapy and confounding factors. Acta Orthop Scand. 1977;(170):1-117. [Medline].

  94. Berry H, Hutchinson DR. A multicentre placebo-controlled study in general practice to evaluate the efficacy and safety of tizanidine in acute low-back pain. J Int Med Res. Mar-Apr 1988;16(2):75-82. [Medline].

  95. Berry H, Hutchinson DR. Tizanidine and ibuprofen in acute low-back pain: results of a double-blind multicentre study in general practice. J Int Med Res. Mar-Apr 1988;16(2):83-91. [Medline].

  96. Biering-Sorensen F. Low back trouble in a general population of 30-, 40-, 50-, and 60-year-old men and women. Study design, representativeness and basic results. Dan Med Bull. Oct 1982;29(6):289-99. [Medline].

  97. Biering-Sorensen F. Physical measurements as risk indicators for low-back trouble over a one-year period. Spine. Mar 1984;9(2):106-19. [Medline].

  98. Bigos SJ, Battie MC, Spengler DM, et al. A prospective study of work perceptions and psychosocial factors affecting the report of back injury [published erratum appears in Spine 1991 Jun;16(6):688]. Spine. Jan 1991;16(1):1-6. [Medline].

  99. Blazer DG. Narcissism and the development of chronic pain. Int J Psychiatry Med. 1980-81;10(1):69-77. [Medline].

  100. Blumer D, Heilbronn M. Chronic pain as a variant of depressive disease: the pain-prone disorder. J Nerv Ment Dis. Jul 1982;170(7):381-406. [Medline].

  101. Bogduk N. The zygapophyseal joints. In: Clinical Anatomy of the Lumbar Spine and Sacrum. 3rd ed. New York, NY: Churchill Livingstone; 1997:34-41.

  102. Bonabello A, Galmozzi MR, Bruzzese T, Zara GP. Analgesic effect of bisphosphonates in mice. Pain. Apr 2001;91(3):269-75. [Medline].

  103. Bonica JJ. General considerations of chronic pain. The Management of Pain. In: Bonica JJ, ed. 2nd ed. Philadelphia, Pa: Lea & Febiger;1990:180-6.

  104. Bonica JJ. Multidisciplinary/Interdisciplinary pain program. In: Bonica JJ, ed. The Management of Pain. 2nd ed. Philadelphia, Pa: Lea & Febiger; 1990:197-202.

  105. Boshuizen HC, Verbeek JH, Broersen JP, Weel AN. Do smokers get more back pain?. Spine. Jan 1993;18(1):35-40. [Medline].

  106. Browning R, Jackson JL, O''Malley PG. Cyclobenzaprine and back pain: a meta-analysis. Arch Intern Med. Jul 9 2001;161(13):1613-20. [Medline].

  107. Burke SA, Harms-Constas CK, Aden PS. Return to work/work retention outcomes of a functional restoration program. A multi-center, prospective study with a comparison group. Spine. Sep 1 1994;19(17):1880-5. [Medline].

  108. Carette S, Marcoux S, Truchon R, et al. A controlled trial of corticosteroid injections into facet joints for chronic low back pain. N Engl J Med. Oct 3 1991;325(14):1002-7. [Medline].

  109. Carlton SM, Zhou S, Coggeshall RE. Evidence for the interaction of glutamate and NK1 receptors in the periphery. Brain Res. Apr 20 1998;790(1-2):160-9. [Medline].

  110. Cavanaugh JM, Weinstein JN. Low back pain: epidemiology, anatomy and neurophysiology. In: Wall PD, Melzack R, eds. Textbook of Pain. 3rd ed. London: Churchill Livingstone; 1994:441-55.

  111. Chaffin DB, Herrin GD, Keyserling WM. Preemployment strength testing: an updated position. J Occup Med. Jun 1978;20(6):403-8. [Medline].

  112. Cherkin DC, Deyo RA, Loeser JD, et al. An international comparison of back surgery rates. Spine. Jun 1 1994;19(11):1201-6. [Medline].

  113. Chevlen E. Morphine with dextromethorphan: conversion from other opioid analgesics. J Pain Symptom Manage. Jan 2000;19(1 Suppl):S42-9. [Medline].

  114. Cochran J. Efficacy of zonisamide in the treatment of neuropathic pain. Paper presented at: 21st Annual Scientific Meeting of the American Pain Society. 2002.

  115. Cuckler JM, Bernini PA, Wiesel SW, et al. The use of epidural steroids in the treatment of lumbar radicular pain. A prospective, randomized, double-blind study. J Bone Joint Surg Am. Jan 1985;67(1):63-6. [Medline].

  116. Cui JG, Holmin S, Mathiesen T, et al. Possible role of inflammatory mediators in tactile hypersensitivity in rat models of mononeuropathy. Pain. Dec 1 2000;88(3):239-48. [Medline].

  117. Cunningham LS, Kelsey JL. Epidemiology of musculoskeletal impairments and associated disability. Am J Public Health. Jun 1984;74(6):574-9. [Medline].

  118. Damkot DK, Pope MH, Lord J, Frymoyer JW. The relationship between work history, work environment and low-back pain in men. Spine. May-Jun 1984;9(4):395-9. [Medline].

  119. Deleo JA, Colburn RW. The role of cytokines in nociception and chronic pain. In: Weinstein JN, Gordan SL, eds. Low Back Pain: A Scientific and Clinical Overview. Rosemount, Ill: American Academy of Orthopedic Surgeons; 1996:163-85.

  120. Destouet JM, Gilula LA, Murphy WA, Monsees B. Lumbar facet joint injection: indication, technique, clinical correlation, and preliminary results. Radiology. Nov 1982;145(2):321-5. [Medline].

  121. Devulder J, De Laat M. Lamotrigine in the treatment of chronic refractory neuropathic pain. J Pain Symptom Manage. May 2000;19(5):398-403. [Medline].

  122. Deyo RA. Back pain revisited: newer thinking on diagnosis and therapy. Consultant. 1993;33:88-100.

  123. Deyo RA. Drug therapy for back pain. Which drugs help which patients?. Spine. Dec 15 1996;21(24):2840-9; discussion 2849-50. [Medline].

  124. Deyo RA. Nonoperative treatment of low back disorders: differentiated useful from useless therapy. In: Frymoyer JW, Ducker TB, Hadler NM, et al, eds. The Adult Spine: Principles and Practice. Philadelphia, Pa: Lippincott-Raven; 1997:1777-93.

  125. Deyo RA, Bass JE. Lifestyle and low-back pain. The influence of smoking and obesity. Spine. May 1989;14(5):501-6. [Medline].

  126. Deyo RA, Diehl AK, Rosenthal M. How many days of bed rest for acute low back pain? A randomized clinical trial. N Engl J Med. Oct 23 1986;315(17):1064-70. [Medline].

  127. Di Rosa M, Calignamo A, Carnuccio R. Multiple control of inflammation by glucocorticoids. Agents Action. 1986;17:284-9.

  128. Dwyer A, Aprill C, Bogduk N. Cervical zygapophyseal joint pain patterns. I: A study in normal volunteers. Spine. Jun 1990;15(6):453-7. [Medline].

  129. Eisenberg E, Alon N, Ishay A, et al. Lamotrigine in the treatment of painful diabetic neuropathy. Eur J Neurol. Mar 1998;5(2):167-173. [Medline].

  130. Eisenberg E, Lurie Y, Braker C, et al. Lamotrigine reduces painful diabetic neuropathy: a randomized, controlled study. Neurology. Aug 14 2001;57(3):505-9. [Medline].

  131. Elan Corporation, plc. Ziconamide. Feb 29, 2000.

  132. Farago F. Trigeminal neuralgia: its treatment with two new carbamazepine analogues. Eur Neurol. 1987;26(2):73-83. [Medline].

  133. Felder M. Tizanidine in the treatment of neck and low back pain. Aids Int. 1990;1-9.

  134. Fields HL. Pain. New York, NY: McGraw-Hill; 1987.

  135. Fordyce WE. Behavioral Methods for Chronic Pain and Illnesses. St Louis, Mo: CV Mosby Company; 1975.

  136. Fortin JD, Aprill CN, Ponthieux B, Pier J. Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique. Part II: Clinical evaluation. Spine. Jul 1 1994;19(13):1483-9. [Medline].

  137. Fortin JD, Dwyer AP, West S, Pier J. Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique. Part I: Asymptomatic volunteers. Spine. Jul 1 1994;19(13):1475-82. [Medline].

  138. Fortin JD, Kissling RO, O''Connor BL, Vilensky JA. Sacroiliac joint innervation and pain. Am J Orthop. Dec 1999;28(12):687-90. [Medline].

  139. Frith JC, Monkkonen J, Auriola S, et al. The molecular mechanism of action of the antiresorptive and antiinflammatory drug clodronate: evidence for the formation in vivo of a metabolite that inhibits bone resorption and causes osteoclast and macrophage apoptosis. Arthritis Rheum. Sep 2001;44(9):2201-10. [Medline].

  140. Frost FA, Jessen B, Siggaard-Andersen J. A control, double-blind comparison of mepivacaine injection versus saline injection for myofascial pain. Lancet. Mar 8 1980;1(8167):499-500. [Medline].

  141. Fryda-Kaurimsky Z, Muller-Fassbender H. Tizanidine (DS 103-282) in the treatment of acute paravertebral muscle spasm: a controlled trial comparing tizanidine and diazepam. J Int Med Res. 1981;9(6):501-5. [Medline].

  142. Frymoyer JW. Back pain and sciatica. N Engl J Med. Feb 4 1988;318(5):291-300. [Medline].

  143. Frymoyer JW, Pope MH, Clements JH, et al. Risk factors in low-back pain. An epidemiological survey. J Bone Joint Surg [Am]. Feb 1983;65(2):213-8. [Medline].

  144. Fujiwara A, Lim TH, An HS, et al. The effect of disc degeneration and facet joint osteoarthritis on the segmental flexibility of the lumbar spine. Spine. Dec 1 2000;25(23):3036-44. [Medline].

  145. Fujiwara A, Tamai K, An HS, et al. The relationship between disc degeneration, facet joint osteoarthritis, and stability of the degenerative lumbar spine. J Spinal Disord. Oct 2000;13(5):444-50. [Medline].

  146. Fukui S, Ohseto K, Shiotani M, et al. Distribution of referred pain from the lumbar zygapophyseal joints and dorsal rami. Clin J Pain. Dec 1997;13(4):303-7. [Medline].

  147. Garvey TA, Marks MR, Wiesel SW. A prospective, randomized, double-blind evaluation of trigger-point injection therapy for low-back pain. Sep 1989;14(9):962-4. [Medline].

  148. Gatchel RJ, Mayer TG, Hazard RG, et al. Functional restoration. Pitfalls in evaluating efficacy. Spine. Aug 1992;17(8):988-95. [Medline].

  149. Giles LG, Harvey AR. Immunohistochemical demonstration of nociceptors in the capsule and synovial folds of human zygapophyseal joints. Br J Rheumatol. Oct 1987;26(5):362-4. [Medline].

  150. Gilron I, Booher SL, Rowan JS, Max MB. Topiramate in trigeminal neuralgia: a randomized, placebo-controlled multiple crossover pilot study. Clin Neuropharmacol. Mar-Apr 2001;24(2):109-12. [Medline].

  151. Goicoechea C, Porras E, Alfaro MJ, Martin MI. Alendronate induces antinociception in mice, not related with its effects in bone. Jpn J Pharmacol. Apr 1999;79(4):433-7. [Medline].

  152. Grob KR, Neuhuber WL, Kissling RO. [Innervation of the sacroiliac joint of the human]. Z Rheumatol. Mar-Apr 1995;54(2):117-22. [Medline].

  153. Gross RJ, Doerr H, Caldirola D, et al. Borderline syndrome and incest in chronic pelvic pain patients. Int J Psychiatry Med. 1980-81;10(1):79-96. [Medline].

  154. Haldeman S. North American Spine Society: failure of the pathology model to predict back pain. Spine. Jul 1990;15(7):718-24. [Medline].

  155. Hall H, Iceton JA. Back school. An overview with specific reference to the Canadian Back Education Units. Clin Orthop. Oct 1983;(179):10-7. [Medline].

  156. Hambly MF, Mooney V. Effect of smoking and pulsed electromagnetic fields on intradiscal pH in rabbits. Spine. Jun 1992;17(6 Suppl):S83-5. [Medline].

  157. Harkins S, Linford J, Cohen J, et al. Administration of clonazepam in the treatment of TMD and associated myofascial pain: a double-blind pilot study. J Craniomandib Disord. 1991;5(3):179-86. [Medline].

  158. Hazard RG, Fenwick JW, Kalisch SM, et al. Functional restoration with behavioral support. A one-year prospective study of patients with chronic low-back pain. Spine. Feb 1989;14(2):157-61. [Medline].

  159. Heavner JE, Racz GB, Raj P. Percutaneous epidural neuroplasty: prospective evaluation of 0.9% NaCl versus 10% NaCl with or without hyaluronidase. Reg Anesth Pain Med. May-Jun 1999;24(3):202-7. [Medline].

  160. Helfgott SM. Sensible approach to low back pain. Bull Rheum Dis. 2001;50(3):1-4. [Medline].

  161. Hicks GS, Duddleston DN, Russell LD, et al. Low back pain. Am J Med Sci. Oct 2002;324(4):207-11. [Medline].

  162. Hubbard DR. Chronic and recurrent muscle pain: pathophysiology and treatment, and review of pharmacologic studies. J Musculoskeletal Pain. 1996;4:123-43.

  163. Indahl A, Kaigle AM, Reikeras O, Holm SH. Interaction between the porcine lumbar intervertebral disc, zygapophysial joints, and paraspinal muscles. Spine. Dec 15 1997;22(24):2834-40. [Medline].

  164. Ingram RE, Atkinson JH, Slater MA, et al. Negative and positive cognition in depressed and nondepressed chronic-pain patients. Health Psychol. 1990;9(3):300-14. [Medline].

  165. Inman VT, Saunders JB. Referred pain from skeletal structures. J Nerv Mont Dis. 1944;99:660.

  166. Iwabuchi M, Rydevik B, Kikuchi S, Olmarker K. Effects of anulus fibrosus and experimentally degenerated nucleus pulposus on nerve root conduction velocity: relevance of previous experimental investigations using normal nucleus pulposus. Spine. Aug 1 2001;26(15):1651-5. [Medline].

  167. Jackson RP. The facet syndrome. Myth or reality?. Clin Orthop. Jun 1992;(279):110-21. [Medline].

  168. Jacobson LO, Bley K, Hunter JC, et al. Anti-thermal hyperalgesic properties of antidepressants in a rat model of neuropathic pain [Abstract]. American Pain Society. 1995.

  169. Jain KK. An evaluation of intrathecal ziconotide for the treatment of chronic pain. Expert Opin Investig Drugs. Oct 2000;9(10):2403-10. [Medline].

  170. Jensen MC, Brant-Zawadzki MN, Obuchowski N, et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. Jul 14 1994;331(2):69-73. [Medline].

  171. Kang JD, Evans CH. Cytokines, nitric oxide, prostaglandin E2, and idiopathic low back pain. In: Weinstein JN, Gordan SL, eds. Low Back Pain: A Scientific and Clinical Overview. Rosemount, Ill: American Academy of Orthopedic Surgeons; 1996:529-38.

  172. Kang JD, Georgescu HI, McIntyre-Larkin L, et al. Herniated lumbar intervertebral discs spontaneously produce matrix metalloproteinases, nitric oxide, interleukin-6, and prostaglandin E2. Spine. Feb 1 1996;21(3):271-7. [Medline].

  173. Kaplan M. Zonisamide: benefits in chronic pain patients. Paper presented at: AAPM&R. 2002.

  174. Karppinen J, Korhonen T, Malmivaara A, et al. Tumor necrosis factor-alpha monoclonal antibody, infliximab, used to manage severe sciatica. Spine. Apr 15 2003;28(8):750-3; discussion 753-4. [Medline].

  175. Katz NP. MorphiDex (MS:DM) double-blind, multiple-dose studies in chronic pain patients. J Pain Symptom Manage. Jan 2000;19(1 Suppl):S37-41. [Medline].

  176. Kawakami, Chatenia K, Weinstein JN. Anatomy, biochemistry, and physiology of low back pain. In: White AH, Schofferman JA, eds. Spine Care: Diagnosis and Conservative Treatment. 1995:84-103.

  177. Keefe FJ, Bedcham JC, Fillingim. The psychology of chronic back pain In: Frymoyer JW, ed. The Adult Spine: Principles and Practice. 1991:185-197.

  178. Keefe FJ, Gil K, Rose SC. Behavioral approaches in programs and issues. Clin Psychol Rev. 1986;6:87-113.

  179. Keefe FJ, Gil MK, Rose SC. Behavioral approaches in the multidisciplinary management of chronic pain: programs and issues. Clin Psychol Rev. 1986;6:878-113.

  180. Kellgren JH. The anatomical source of back pain. Rheumatol Rehab. 1977;16:3-12.

  181. Kelsey JL, Githens PB, O''Conner T, et al. Acute prolapsed lumbar intervertebral disc. An epidemiologic study with special reference to driving automobiles and cigarette smoking. Spine. Sep 1984;9(6):608-13. [Medline].

  182. Kelsey JL, Githens PB, White AA 3d, et al. An epidemiologic study of lifting and twisting on the job and risk for acute prolapsed lumbar intervertebral disc. J Orthop Res. 1984;2(1):61-6. [Medline].

  183. Kelsey JL, White AA 3d. Epidemiology and impact of low-back pain. Spine. Mar-Apr 1980;5(2):133-42. [Medline].

  184. Killian LE. Psychological barriers to recovery. In: Isernhagen SH, ed. Work Injury Management and Prevention. 18. Gaithersburg Aspe; 1998:66-71.

  185. Klaber Moffett JA, Chase SM, Portek I, Ennis JR. A controlled, prospective study to evaluate the effectiveness of a back school in the relief of chronic low back pain. Spine. Mar 1986;11(2):120-2. [Medline].

  186. Koes BW, Scholten R, Mens JMA et al:. Epidural steroid injections for low back pain and sciatica: An updated systematic review of randomized clinical trials. Pain Digest. 1999;9:241-247.

  187. Krusz J. Levetiracetam: novel agent for refractory neuropathic pain (abstract). Advanced Studies in Medicine. 2001;1:463.

  188. Kunz J, Backonja M. Use of zonisamide in patients with neuropathic pain [Abstract]. Paper presented at: 10th World Congress on Pain. 2002.

  189. Lee PW, Chow SP, Lieh-Mak F, et al. Psychosocial factors influencing outcome in patients with low-back pain. Spine. Aug 1989;14(8):838-43. [Medline].

  190. Lilius G, Laasonen EM, Myllynen P, et al. Lumbar facet joint syndrome. A randomised clinical trial. J Bone Joint Surg [Br]. Aug 1989;71(4):681-4. [Medline].

  191. Lindblom K, Hultqvist G. Absorption of protruded disc tissue. J Bone Joint Surg Am. Jul 1950;32-A(3):557-60. [Medline].

  192. Lindstrom P. The analgesic effect of carbamazepine in trigeminal neuralgia. Pain. (Suppl 4) 1987;S85.

  193. Liu GZ, Ishihara H, Osada R, et al. Nitric oxide mediates the change of proteoglycan synthesis in the human lumbar intervertebral disc in response to hydrostatic pressure. Spine. Jan 15 2001;26(2):134-41. [Medline].

  194. Liu T, van Rooijen N, Tracey DJ. Depletion of macrophages reduces axonal degeneration and hyperalgesia following nerve injury. Pain. May 2000;86(1-2):25-32. [Medline].

  195. Lopez-Trigo J, Serra J, Ortiz P, Sancho J. Topiramate vs amitriptyline on diabetic peripheral neuropathic pain [Abstract]. Advanced Studies in Medicine. 2001;1:460-1.

  196. Lord SM, Barnsley L, Wallis BJ, et al. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med. Dec 5 1996;335(23):1721-6. [Medline].

  197. Lunardi G, Leandri M, Albano C, et al. Clinical effectiveness of lamotrigine and plasma levels in essential and symptomatic trigeminal neuralgia. Neurology. Jun 1997;48(6):1714-7. [Medline].

  198. Maigne JY, Aivaliklis A, Pfefer F. Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain. Spine. Aug 15 1996;21(16):1889-92. [Medline].

  199. Manchikanti L, Pampati V, Fellows B, et al. Prevalence of lumbar facet joint pain in chronic low back pain. Pain Physician. 1999;2:59-64.

  200. Manchikanti L, Singh V, Pampati S, et al. Evaluation of the prevalence of facet joint pain in chronic thoracic pain. Pain Physician. 2002;5:354-9.

  201. Manchikanti L, Singh V, Pampati S, et al. Evaluation of the relative contributions of various structures in chronic low back pain. Pain Physician. 2002;4:308-16.

  202. Marks R. Distribution of pain provoked from lumbar facet joints and related structures during diagnostic spinal infiltration. Pain. Oct 1989;39(1):37-40. [Medline].

  203. Matsui H, Olmarker K, Cornefjord M. Local electrophysiologic stimulation in experimental double level cauda equina compression. Spine. Sep 1992;17(9):1075-8. [Medline].

  204. Mayer TG, Gatchel RJ. Functional restoration for spinal disorders. The Sports Medicine Approach. Philadelphia, Pa: Lea & Febiger;1988.

  205. Mayer TG, Gatchel RJ, Mayer H, et al. A prospective two-year study of functional restoration in industrial low back injury. An objective assessment procedure. JAMA. Oct 2 1987;258(13):1763-7. [Medline].

  206. McCall IW, Park WM, O''Brien JP. Induced pain referral from posterior lumbar elements in normal subjects. Spine. Sep-Oct 1979;4(5):441-6. [Medline].

  207. McCarron RF, Wimpee MW, Hudkins PG, Laros GS. The inflammatory effect of nucleus pulposus. A possible element in the pathogenesis of low-back pain. Spine. Oct 1987;12(8):760-4. [Medline].

  208. McNeill T, Warwick D, Andersson G, Schultz A. Trunk strengths in attempted flexion, extension, and lateral bending in healthy subjects and patients with low-back disorders. Spine. Nov-Dec 1980;5(6):529-38. [Medline].

  209. Mendell LM, Wall PD. Responses of single dorsal cord cells to peripheral cutaneous unmyelinated fibers. Nature. Apr 3 1965;206:97-9. [Medline].

  210. Mense S. Biochemical pathogenesis of myofascial pain. J Musculoskeletal Pain. 1996;4:145-62.

  211. Messenheimer J, Mullens EL, Giorgi L, Young F. Safety review of adult clinical trial experience with lamotrigine. Drug Saf. Apr 1998;18(4):281-96. [Medline].

  212. Million R, Nilsen KH, Jayson MI, Baker RD. Evaluation of low back pain and assessment of lumbar corsets with and without back supports. Ann Rheum Dis. Oct 1981;40(5):449-54. [Medline].

  213. Mooney V, Robertson J. The facet syndrome. Clin Orthop. Mar-Apr 1976;(115):149-56. [Medline].

  214. Moore RJ, Crotti TN, Osti OL, et al. Osteoarthrosis of the facet joints resulting from anular rim lesions in sheep lumbar discs. Spine. Mar 15 1999;24(6):519-25. [Medline].

  215. Murata Y, Takahashi K, Yamagata M, et al. Origin and pathway of sensory nerve fibers to the ventral and dorsal sides of the sacroiliac joint in rats. J Orthop Res. May 2001;19(3):379-83. [Medline].

  216. Murphey F. Sources and patterns of pain in disc disease. Clin Neurosurg. 1968;15:343-51. [Medline].

  217. Murtagh FR. Computed tomography and fluoroscopy guided anesthesia and steroid injection in facet syndrome. Spine. Jun 1988;13(6):686-9. [Medline].

  218. Myers RR. The pathogenesis of neuropathic pain. Reg Anesth. 1962;31:91-114.

  219. Nachemson A, Schultz A, Andersson G. Mechanical effectiveness studies of lumbar spine orthoses. Scand J Rehabil Med Suppl. 1983;9:139-49. [Medline].

  220. Nachemson AL. Intradiscal measurements of pH in patients. Acta Orthop Scand. 1969;40:23-41.

  221. North American Spine Society's Ad Hoc Committee, Diagnostic and Therapeutic Procedures. Common diagnostic and therapeutic procedures of the lumbosacral spine. The North American Spine Society's Ad Hoc Committee on Diagnostic and Therapeutic Procedures. Spine. Oct 1991;16(10):1161-7. [Medline].

  222. Novak V, Kanard R, Kissel JT, Mendell JR. Treatment of painful sensory neuropathy with tiagabine: a pilot study. Clin Auton Res. Dec 2001;11(6):357-61. [Medline].

  223. Olmarker K, Brisby H, Yabuki S, et al. The effects of normal, frozen, and hyaluronidase-digested nucleus pulposus on nerve root structure and function. Spine. Mar 1 1997;22(5):471-5; discussion 476. [Medline].

  224. Olmarker K, Holm S, Rosenqvist AL, Rydevik B. Experimental nerve root compression. A model of acute, graded compression of the porcine cauda equina and an analysis of neural and vascular anatomy. Spine. Jan 1991;16(1):61-9. [Medline].

  225. Olmarker K, Holm S, Rydevik B. Importance of compression onset rate for the degree of impairment of impulse propagation in experimental compression injury of the porcine cauda equina. Spine. 1990;35:416-9.

  226. Olmarker K, Nordborg C, Larsson K, Rydevik B. Ultrastructural changes in spinal nerve roots induced by autologous nucleus pulposus. Spine. Feb 15 1996;21(4):411-4. [Medline].

  227. Olmarker K, Rydevik B. Pathophysiology of spinal nerve roots as related to sciatica and disc herniation. In: Herkowitz HN, Garfin SR, Balderston RA, et al, eds. Rothman-Simeone Studies: The Spine. Philadelphia, Pa: WB Saunders; 1999:159-72.

  228. Olmarker K, Rydevik B, Holm S. Edema formation in spinal nerve roots induced by experimental, graded compression. An experimental study on the pig cauda equina with special reference to differences in effects between rapid and slow onset of compression. Spine. Jun 1989;14(6):569-73. [Medline].

  229. Olmarker K, Rydevik B, Nordborg C. Autologous nucleus pulposus induces neurophysiologic and histologic changes in porcine cauda equina nerve roots. Spine. Sep 1 1993;18(11):1425-32. [Medline].

  230. Pancrazio JJ, Kamatchi GL, Roscoe AK, Lynch C 3rd. Inhibition of neuronal Na+ channels by antidepressant drugs. J Pharmacol Exp Ther. Jan 1998;284(1):208-14. [Medline].

  231. Parke WW, Watanabe R. The intrinsic vasculature of the lumbosacral spinal nerve roots. Spine. Jul-Aug 1985;10(6):508-15. [Medline].

  232. Penn RD, Paice JA. Chronic intrathecal morphine for intractable pain. J Neurosurg. Aug 1987;67(2):182-6. [Medline].

  233. Polatin PB, Kinney RK, Gatchel RJ, et al. Psychiatric illness and chronic low-back pain. The mind and the spine--which goes first?. Spine. Jan 1993;18(1):66-71. [Medline].

  234. Polfliet MM, van de Veerdonk F, Dopp EA, et al. The role of perivascular and meningeal macrophages in experimental allergic encephalomyelitis. J Neuroimmunol. Jan 2002;122(1-2):1-8. [Medline].

  235. Powell MC, Wilson M, Szypryt P, et al. Prevalence of lumbar disc degeneration observed by magnetic resonance in symptomless women. Lancet. Dec 13 1986;2(8520):1366-7. [Medline].

  236. Praemer A, Furnes S, Rice D. Musculoskeletal Conditions in the United States. Park Ride, Ill: American Academy of Orthopedic Surgeons; 1992:1-199.

  237. Probert L, Akassoglou K, Kassiotis G, et al. TNF-alpha transgenic and knockout models of CNS inflammation and degeneration. J Neuroimmunol. Feb 1997;72(2):137-41. [Medline].

  238. Racz GB, Heavner JE, Diede JH. Lysis of epidural adhesions utilizing the epidural approach. In: Waldeman SD, Winnie AP, eds. Interventional Pain Management. 1996:339-51.

  239. Racz GB, Heavner JE, Singleton W, et al. Hypertonic saline and corticosteroid injected epidurally for pain control. In: Racz GB, ed. Techniques of Neurology. 1989:73-86.

  240. Redford EJ, Hall SM, Smith KJ. Vascular changes and demyelination induced by the intraneural injection of tumour necrosis factor. Brain. Aug 1995;118 (Pt 4):869-78. [Medline].

  241. Remillard G. Oxcarbazepine and intractable trigeminal neuralgia. Epilepsia. 1994;35:S50-S53.

  242. Rice AS, Maton S; Postherpetic Neuralgia Study Group. Gabapentin in postherpetic neuralgia: a randomised, double blind, placebo controlled study. Pain. Nov 2001;94(2):215-24. [Medline].

  243. Riihimaki H. Back disorders in relation to heavy physical work. [Thesis]. Institute of Occupational Health, Helinski, Finland. 1989;415-23.

  244. Riihimaki H, Wickstrom G, Hanninen K, Luopajarvi T. Predictors of sciatic pain among concrete reinforcement workers and house painters--a five-year follow-up. Scand J Work Environ Health. Dec 1989;15(6):415-23. [Medline].

  245. Rivner MH. The neurophysiology of myofascial pain syndrome. In: Fields HL, ed. Pain. 5. New York, NY: McGraw-Hill; 2000:432-40.

  246. Rizzo JA, Abbott TA 3rd, Berger ML. The labor productivity effects of chronic backache in the United States. Med Care. Oct 1998;36(10):1471-88. [Medline].

  247. Roberts WJ. A hypothesis on the physiological basis for causalgia and related pains. Pain. Mar 1986;24(3):297-311. [Medline].

  248. Rosenberg JM, Harrell C, Ristic H, et al. The effect of gabapentin on neuropathic pain. Clin J Pain. Sep 1997;13(3):251-5. [Medline].

  249. Rowbotham M, Harden N, Stacey B, et al. Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. JAMA. Dec 2 1998;280(21):1837-42. [Medline].

  250. Royal M. Retrospective case series of zonisamide in the treatment of neuropathic pain [Abstract]. Paper presented at: 4th International Conference on the Mechanisms and Treatment of Neuropathic Pain. 2000.

  251. Russell IJ. Neurochemical pathogenesis of fibromyalgia syndrome. J Musculoskeletal Pain. 1996;4:61-92.

  252. Rydevik BL. The effects of compression on the physiology of nerve roots. J Manipulative Physiol Ther. 1992;1:62-6.

  253. Rydevik D, Holm S, Brown MD, et al. Nutrition of spinal nerve roots: the role of diffusion from the cerebral spinal fluid. Trans Orthop Res Soc. 1984;9:276.

  254. Saal JA. The role of inflammation in lumbar pain: physical medicine and rehabilitation. State of the Art Reviews. 1990;4:191-99.

  255. Saal JA, Saal JS, Herzog RJ. The natural history of lumbar intervertebral disc extrusions treated nonoperatively. Spine. Jul 1990;15(7):683-6. [Medline].

  256. Saal JA, Saal JS. Intradiscal electrothermal treatment for chronic discogenic low back pain: prospective outcome study with a minimum 2-year follow-up. Spine. May 1; 2002;27(9):966-73; discussion 973-4. [Medline].

  257. Saal JS, Franson RC, Dobrow R, et al. High levels of inflammatory phospholipase A2 activity in lumbar disc herniations. Spine. Jul 1990;15(7):674-8. [Medline].

  258. Saberski LR. Spinal endoscopy: current concepts. In: Waldman SD, ed. Interventional Pain Management. 2nd ed. Philadelphia: WB Saunders Company; 2000:143-161.

  259. Saberski LR, Brull SJ. Spinal and epidural endoscopy: a historical review. 1: Yale J Biol Med. Jan-Apr 1995;68(1-2):7-15. [Medline].

  260. Sakamoto N, Yamashita T, Takebayashi T, et al. An electrophysiologic study of mechanoreceptors in the sacroiliac joint and adjacent tissues. Spine. Oct 15 2001;26(20):E468-71. [Medline].

  261. Sang CN. NMDA-receptor antagonists in neuropathic pain: experimental methods to clinical trials. J Pain Symptom Manage. Jan 2000;19(1 Suppl):S21-5. [Medline].

  262. Schofferman J. Use and abuse of medications. Non-operative care of lumbar pain syndromes. North American Spine Society and Seton Medical Center, Boston, MA. 1992;97-100.

  263. Schofferman JA. Applied neurophysiology of pain. In: White AH, Schofferman JA, eds. Spine Care: diagnosis and conservative treatment. St Louis, Mo: Mosby Press;. 1995: 23-6.

  264. Schwarzer AC, Aprill CN, Bogduk N. The sacroiliac joint in chronic low back pain. Spine. Jan 1 1995;20(1):31-7. [Medline].

  265. Schwarzer AC, Aprill CN, Derby R, et al. Clinical features of patients with pain stemming from the lumbar zygapophysial joints. Is the lumbar facet syndrome a clinical entity?. Spine. May 15 1994;19(10):1132-7. [Medline].

  266. Schwarzer AC, Aprill CN, Derby R, et al. The relative contributions of the disc and zygapophyseal joint in chronic low back pain. Spine. Apr 1 1994;19(7):801-6. [Medline].

  267. Schwarzer AC, Wang SC, Bogduk N, et al. Prevalence and clinical features of lumbar zygapophysial joint pain: a study in an Australian population with chronic low back pain. Ann Rheum Dis. Feb 1995;54(2):100-6. [Medline].

  268. Selby DK. The structural degenerative cascade: The lumbar spine. In: White AH, Schofferman JA, eds. Spine Care: Diagnosis and Conservative Treatment. 1995:8-16.

  269. Shekelle PG. Spinal manipulation. Spine. Apr 1 1994;19(7):858-61. [Medline].

  270. Simmons JW, Avant WS, Demski J, Parisher D. Determining successful pain clinic treatment through validation of cost effectiveness. Spine. Mar 1988;13(3):342-4. [Medline].

  271. Simons DG, Travell JG, Simons LS. Myofascial pain and dysfunction: the trigger point manual. 2nd ed. 1999.

  272. Simpson DM, Olney R, McArthur JC, et al. A placebo-controlled trial of lamotrigine for painful HIV-associated neuropathy. Neurology. Jun 13 2000;54(11):2115-9. [Medline].

  273. Sindrup SH, Jensen TS. Efficacy of pharmacological treatments of neuropathic pain: an update and effect related to mechanism of drug action. Pain. Dec 1999;83(3):389-400. [Medline].

  274. Slipman CW, Huston CW. Diagnostic sacroiliac joint injections. In: Manchikanti L, Slipman CW, Fellows B, eds. Interventional Pain Management: Low Back Pain - Diagnosis and Treatment. Paducah, KY: ASIPP Publishing; 2002:269-74.

  275. Slipman CW, Jackson HB, Lipetz JS, et al. Sacroiliac joint pain referral zones. Arch Phys Med Rehabil. Mar 2000;81(3):334-8. [Medline].

  276. Smith PA, Moran TD. The nociceptin receptor as a potential target in drug design. Drug News Perspect. Aug 2001;14(6):335-45. [Medline].

  277. Snook SH. Low back pain in industry. American Academy of Orthopaedic Surgeons Symposium on Idiopathic Low Back Pain. 1982:23-38.

  278. Sorkin LS, Xiao WH, Wagner R, et al. TNF-alpha applied to the sciatic nerve trunk elicits background firing in nociceptive primary afferents fibers. 8th world congress for pain, IASP abstracts, Vancouver, IASP Press. Aug 1996;354.

  279. Tai Q, Kirshblum S, Chen B, et al. Gabapentin in the treatment of neuropathic pain after spinal cord injury: a prospective, randomized, double-blind, crossover trial. J Spinal Cord Med. 2002;25(2):100-5. [Medline].

  280. Taylor K, Rowbotham MC. Venlafaxine for chronic pain. American Pain Society Annual meeting 1995; 95726 [Abstract].

  281. Thompson RE, Pearcy MJ, Downing KJ, et al. Disc lesions and the mechanics of the intervertebral joint complex. Spine. Dec 1 2000;25(23):3026-35. [Medline].

  282. Thompson TL, Byyny RL. Pain problems in primary care medical practice. Handbook of Chronic Pain Management. 1989:532-59.

  283. Tse FLS, Jaffe JM, Bhuta S. Pharmacokinetics of tizanidine in health volunteers. Fundam Clin Pharmacol. 1987;1:479-88.

  284. Tunali D, Jefferson JW, Geist JH. Depression and Antidepressants: A Guide. Madison, WI: Information Centers, Madison Institute of Medicine; 1999.

  285. van Tulder MW, Scholten RJ, Koes BW, Deyo RA. Nonsteroidal anti-inflammatory drugs for low back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine. Oct 1 2000;25(19):2501-13. [Medline].

  286. van Tulder MW, Touray T, Furlan AD, et al. Muscle relaxants for nonspecific low back pain: a systematic review within the framework of the cochrane collaboration. Spine. Sep 1 2003;28(17):1978-92. [Medline].

  287. Vestergaard K, Andersen G, Gottrup H, et al. Lamotrigine for central poststroke pain: a randomized controlled trial. Neurology. Jan 23 2001;56(2):184-90. [Medline].

  288. Vilensky JA, O''Connor BL, Fortin JD, et al. Histologic analysis of neural elements in the human sacroiliac joint. Spine. Jun 1 2002;27(11):1202-7. [Medline].

  289. Waddell G. 1987 Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain. Spine. Sep 1987;12(7):632-44. [Medline].

  290. Waddell G, McCulloch JA, Kummel E, Venner RM. Nonorganic physical signs in low-back pain. Spine. Mar-Apr 1980;5(2):117-25. [Medline].

  291. Wagner R, Myers RR. Endoneurial injection of TNF-alpha produces neuropathic pain behaviors. Neuroreport. Nov 25 1996;7(18):2897-901. [Medline].

  292. Wagstaff AJ, Bryson HM. Tizanidine. A review of its pharmacology, clinical efficacy and tolerability in the management of spasticity associated with cerebral and spinal disorders. Drugs. Mar 1997;53(3):435-52. [Medline].

  293. Waldman SD. Recent advances in analgesic therapy - tizanidine. Pain Digest. 1999;9:40-3.

  294. Watson CP. The treatment of neuropathic pain: antidepressants and opioids. Clin J Pain. Jun 2000;16(2 Suppl):S49-55. [Medline].

  295. Weinreb JC, Wolbarsht LB, Cohen JM, et al. Prevalence of lumbosacral intervertebral disk abnormalities on MR images in pregnant and asymptomatic nonpregnant women. Radiology. Jan 1989;170(1 Pt 1):125-8. [Medline].

  296. Weinstein J, Claverie W, Gibson S. The pain of discography. Spine. Dec 1988;13(12):1344-8. [Medline].

  297. Weinstein JN. The role of neurogenic and non-neurogenic mediators as they relate to pain and the development of osteoarthritis. A clinical review. Spine. Oct 1992;17(10 Suppl):S356-61. [Medline].

  298. Wheeler AH. Diagnosis and management of low back pain and sciatica. Am Fam Physician. Oct 1995;52(5):1333-41, 1347-8. [Medline].

  299. Wheeler AH. Evolutionary mechanisms in chronic low back pain and rationale for treatment. Am J Pain Management. 1995;5:62-66.

  300. Wheeler AH, Aaron GW. Muscle pain due to injury. Curr Pain Headache Rep. Oct 2001;5(5):441-6. [Medline].

  301. Wheeler AH, Hanley EN Jr. Nonoperative treatment for low back pain. Rest to restoration. Spine. Feb 1 1995;20(3):375-8. [Medline].

  302. Wheeler AH, Murrey DB. Chronic lumbar spine and radicular pain: pathophysiology and treatment. Curr Pain Headache Rep. Apr 2002;6(2):97-105. [Medline].

  303. Wickstrom G, Hanninen K, Lehtinen M, Riihimaki H. Previous back syndromes and present back symptoms in concrete reinforecment workers. Scand J Work Environ Health. 1978;4 Suppl 1:20-9. [Medline].

  304. Wiesel SW, Tsourmas N, Feffer HL, et al. A study of computer-assisted tomography. I. The incidence of positive CAT scans in an asymptomatic group of patients. Spine. Sep 1984;9(6):549-51. [Medline].

  305. Windsor RE, King FJ, Roman SJ, et al. Electrical Stimulation Induced Lumbar Medial Branch Referral Patterns. Pain Physician. 2002;5:405-18.

  306. Wu WP, Hao JX, Ongini E, et al. A nitric oxide (NO)-releasing derivative of gabapentin, NCX 8001, alleviates neuropathic pain-like behavior after spinal cord and peripheral nerve injury. Br J Pharmacol. Jan 2004;141(1):65-74. [Medline].

  307. Yao MZ, Gu JF, Wang JH, et al. Interleukin-2 gene therapy of chronic neuropathic pain. Neuroscience. 2002;112(2):409-16. [Medline].

  308. Zakrzewska JM, Chaudhry Z, Nurmikko TJ, et al. Lamotrigine (lamictal) in refractory trigeminal neuralgia: results from a double-blind placebo controlled crossover trial. Pain. Nov 1997;73(2):223-30. [Medline].

  309. Zakrzewska JM, Patsalos PN. Oxcarbazepine: a new drug in the management of intractable trigeminal neuralgia. J Neurol Neurosurg Psychiatry. Apr 1989;52(4):472-6. [Medline].

  310. Zeilhofer HU, Calo G. Nociceptin/orphanin FQ and its receptor--potential targets for pain therapy?. J Pharmacol Exp Ther. Aug 2003;306(2):423-9. [Medline].

Further Reading

Keywords

back pain, chronic back pain, lower back pain, LBP, chronic low back pain, cLBP, chronic lumbar pain, lumbar pain, lumbar spine pain, degeneration of the spine, spinal degeneration, back trauma, spine trauma, trauma of the spine, spinal trauma, chronic lumbago, chronic lumbar muscle spasm, lumbar disc degeneration and spondylosis, lumbar segmental degeneration and instability with concomitant soft tissue dysfunction, myofascial pain syndrome, fibrositis, inflammatory spondyloarthropathy, metabolic bone disease

Contributor Information and Disclosures

Author

Anthony H Wheeler, MD, Pain and Orthopedic Neurology, Charlotte, North Carolina
Anthony H Wheeler, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, North American Spine Society, and North Carolina Medical Society
Disclosure: Allergan Grant/research funds Other; King Pharmaceuticals None Speaking and teaching

Medical Editor

Michael J Schneck, MD, Associate Professor, Departments of Neurology and Neurosurgery, Stritch School of Medicine, Loyola University; Associate Director, Stroke Program, Director, Neurology Intensive Care Program, Medical Director, Neurosciences ICU, Loyola University Medical Center
Michael J Schneck, MD is a member of the following medical societies: American Academy of Neurology, American Society of Neuroimaging, Neurocritical Care Society, and Stroke Council of the American Heart Association
Disclosure: boehringer-ingelheim Honoraria Speaking and teaching; sanofi/bms Honoraria Speaking and teaching; pfizer Honoraria Speaking and teaching; genentech Honoraria Speaking and teaching; ucb pharma Honoraria Speaking and teaching; talecris Consulting fee Other; nmt medical  Independent contractor; NIH Grant/research funds Independent contractor; vernalis Grant/research funds Independent contractor; sanofi Grant/research funds Independent contractor

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

James H Halsey, MD, Professor, Department of Neurology, University of Alabama Medical Center
James H Halsey, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neuroimaging, Medical Association of the State of Alabama, New York Academy of Sciences, Pan American Medical Association, Sigma Xi, Society for Neuroscience, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Matthew J Baker, MD, Consulting Staff, Collier Neurologic Specialists, Naples Community Hospital
Matthew J Baker, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Chief Editor

Robert A Egan, MD, Director of Neuro-Ophthalmology, St Helena Hospital
Robert A Egan, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, North American Neuro-Ophthalmology Society, and Oregon Medical Association
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.