Characteristics of Neuropathy & Chronic Back Pain

Chronic back pain is a very common problem in people with varying degrees of physical activity. The term "chronic" describes a condition that has been constant or recurring over a period of months or years. Whether it involves the neck, lower back or thoracic area, chronic pain can dramatically change a person's life. This is particularly true when neuropathy is at the root of back pain.
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Description

• Clinicians usually describe two categories of chronic pain: nociceptive and neuropathic pain. The same groups apply to chronic back pain. In a 2006 issue of the "Current Medical Research & Opinions" journal, researchers reported that the stimulation of specific nociceptors---or pain receptors---leads to nociceptive pain. Pain due to neuropathy, on the other hand, results from damage to, or disease
  of, the nerve tissue itself. In neuropathy, nerves malfunction and can no longer accurately process the signals they receive.

Spinal Nerves

• Vertebra and Discs with Openings for Spinal Nerves

  Nerves are essentially cordlike bundles of axon fibers. Axons are long, tubular structures that transmit signals from nerve cells. Spine Health physician Peter Ullrich notes that 31 pairs of nerves occur along the vertebral column, from the neck to the lower back. Nerves leave the spinal cord at a point called the nerve root, and send smaller branches named peripheral nerves, to various areas of the body. Any of the 31 pairs of spinal nerves may become damaged, leading to neuropathic back pain.

Types

• The "Current Medical Research and Opinion" journal article notes different types of chronic back pain due to neuropathy. For example, it points out that lesions of pain receptor sprouts in a degenerated vertebral disc lead to local neuropathic pain. The compression of the nerve root, on the other hand, causes mechanical neuropathic root pain. A third type, called inflammatory neuropathic root pain, occurs as degenerative discs trigger inflammation along the spine. Inflammation is normally a defensive reaction of the body's immune system to injury, infection or irritation.

Causes

• The Robbins & Cotran Pathologic Basis of Disease lists various possible sources of temporary or permanent nerve damage: inflammation, trauma, toxins, metabolic disturbances, genetic defects and tumors. However, the most common identifiable causes of neuropathic back pain are degenerative conditions and nerve compression. Spinal nerves can be compressed or pinched by a slipped, herniated, ruptured or bulging disc, as well as by bone spurs.

Clinical Features

• According to Spine Health, patients usually describe neuropathic back pain as sharp, severe, deep, burning or cold. In addition to the typical persistent numbness or tingling, the "Current Medical Research & Opinions" journal notes that depression and sleeplessness often accompany chronic back pain. Thirdly, the path of an affected nerve may cause neuropathic back pain to radiate to the arms, hands, legs or feet. Finally, Spine Universe includes chronic allodynia and hyperalgesia as hallmark features of neuropathy. In allodynia, ordinarily painless stimuli, such as bed sheets or light touch, produce pain upon contact. Hyperalgesia, on the other hand, refers to a heightened sensitivity to normally painful stimuli.

Diagnosis and Treatment

• The diagnostic process for neuropathic chronic back pain involves a thorough patient history and physical examination, as well as imaging studies and nerve tests. Successful treatment largely depends on the early recognition and aggressive management of neuropathic pain, says "Spine Universe" physician Steven Richeimer. Treatment often requires a combination of options, including medical procedures, such as steroid injections and surgery; psychological therapies, such as behavior modification and relaxation training; and physical rehabilitation. Spine Health particularly advocates active back pain exercises and individualized rehabilitation programs to reduce the frequency, severity and duration of episodes of chronic back pain.

Prevention

• Injury, aging, general health status and lifestyle influence the risk of developing chronic back pain. Although physical exercise helps improve and maintain good health, the wrong types or methods of exercises can place excessive strain on the spine and increase the risk of back pain. Proper technique and protection are thus particularly important when engaging in high-impact activities. To help prevent back pain, eMedicine Health recommends such low-impact activities as swimming, walking and bicycling.