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Pain Generators in Lower Back

The document discusses the complexities of diagnosing pain generators in the lumbar spine, highlighting that over 80% of back pain cases lack a specific diagnosis. It outlines various potential pain generators, including discs, facet joints, sacroiliac joints, muscles, ligaments, vertebral bodies, bursae, and hip joints, along with their causes. The document emphasizes the importance of identifying nociceptive pain sources and acknowledges challenges such as false positives and central pain syndromes in diagnosis.

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soorajdesai57
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97 views20 pages

Pain Generators in Lower Back

The document discusses the complexities of diagnosing pain generators in the lumbar spine, highlighting that over 80% of back pain cases lack a specific diagnosis. It outlines various potential pain generators, including discs, facet joints, sacroiliac joints, muscles, ligaments, vertebral bodies, bursae, and hip joints, along with their causes. The document emphasizes the importance of identifying nociceptive pain sources and acknowledges challenges such as false positives and central pain syndromes in diagnosis.

Uploaded by

soorajdesai57
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Pain Generators in

Lumbar Spine
Past Present Future

Mysteries in back Concept of pain Other factors


pain diagnosis generators
>80% back had no >80% situation we can
identify nociceptive
specific diagnosis
pain source
It must have a
physiological nociceptive
innervation
Who can be a
pain generator? OR
It may have pathological
innervation or sensitization
Significant reduction of
pain on injection of LA into
to supplying nerve
How to confirm a
pain generator? OR

Into the structure


Pain Generators for Back Pain
Pain Generators for Back Pain
Back Pain
Causes
Generators
Facet
Disc
joints
Sacro-iliac
Muscles
joint
Pain generators
Vertebral
Ligaments
body

Bursae Hip Joint


Where is the pain
generator?
Where?
Why??? Why is it a pain
generator?
Why? Where?
• Internal disc disruption
• Disc prolapse
• Canal stenosis
Disc as pain
generator
Why? Where?
• Degeneration
• Inflammation
• Trauma
Facet as pain
generator
Why? Where?
• Degeneration
• Inflammation
• Infection
• Trauma
SI joint as pain
• Malignancy generator
Why? Where?
• Repetitive stress injury
• Trauma Muscles as
• Prolonged muscle
spasm
pain
• Malignancy generator
Why? Where?
• Sprain/Trauma
• Enthesitis Ligaments as
pain
generator
Why? Where?
• Trauma/Fracture
• Malignancy Vertebral
body as pain
generator
Why? Where?
• Trauma
• Inflammation
Bursae as pain
generator
Why? Where?
• Trauma
• Inflammation Hip joint as
• Degeneration
pain
generator
Searching pain generators
with LA is a good way towards
diagnosis… but..

False positive
Central pain
results

Also search
Somatization
for why?
Past Present Future

Mysteries in back pain Concept of pain generators Central pain


diagnosis In >80% situation, we can Somatization
>80% back pain had no identify nociceptive pain False positive results
specific diagnosis source
ICRA-PAIN 2019
NAGPUR

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