Nociceptive Pathway and Pathology of Low Back Pain
Despite the various classical works, the mechanism of chronic low back pain has not been fully understood. Recent improvement of neuroanatomical techniques has enabled discrimination of fine neural elements as well as exact tracing of the neural projection. Use of these techniques to elucidate the fine innervation of the vertebral column has provided numerous original findings. The present article reviews those studies that contributed to the improvement of our understanding on the mechanism of chronic low back pain. Meanwhile, recent development of molecular biological techniques has also elucidated participation of cellular mediators in the local and central sensitization of nociceptors. The cellular components as well as their chemical mediators may represent an attractive therapeutic target of near future.
Keywords: low back pain, intervertebral disc, posterior longitudinal ligament, acetylcholinesterase, calcitonin gene-related peptide, tyrosine hydroxylase
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