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Regional Pain Syndromes of Spinal Origin: Pathophysiology, Symptomatology and Proposed Classification, Diagnostics and Treatment

Jan Zbigniew Szopinski

Any pain in the body triggers a nervous reflex arch, which results in the strong contraction of all muscles in the area, including the local vasoconstriction. This self-defense mechanism is to localize the problem and to prevent a blood loss in the case of trauma. Therefore, the pain caused by back injury or course of micro injuries will result in the strong spasm of back muscles and in turn an increased mechanical pressure applied to the intervertebral discs. The pressure will flatten the discs what initially might be hardly seen on X-rays/scans, leading to the narrowing of neural foraminae and thereby compression of the nerve roots. The functional vicious circle is thus created with its all consequences: pain muscle spasm (sore on its own, if prolonged) increased mechanical pressure on intervertebral discs and thereby nerve roots more pain. This proposed pathomechanism may explain why people without any radio logically visible spinal changes, especially the young ones or those after technically correct spinal surgeries, might still suffer from severe chronic back pains and vice-verse-many, especially elderly people with proven degenerative spinal changes on X-rays/scans, might not have any back pains because they did not trigger that vicious circle. Based on the symptomatology specific for varies affected levels of the spine, the classification of various Regional Pain Syndromes of Spinal Origin (RPSSO) is proposed: lower back RPSSO with/without sciatica (including so-called piriformis syndrome), L2-3 neuralgia, or L1 neuralgia; dorsal back RPSSO with/without T11-12 neuralgia or intercostal neuralgia; upper back RPSSO with/without brachialgia, C3 neuralgia, or occipital neuralgia with/without cervicogenic migraine; so-called fibromyalgia syndrome. RPSSO diagnostics is discussed and therapeutic methods reviewed, based on their ability to stop/slow down the vicious circle: physiotherapy, chiropractic manipulations/ manual medicine, pharmacotherapy/neural blocks, radiofrequency rhizotomy, reflexive physical therapies (including direct spinal cord electro stimulation), and surgical interventions.