Why is non specific low back pain prone to chronicity? A new hypothesis speculated from the neuroanatomical findings of pain

Abstract

We present a new hypothesis regarding the causes of chronic low back pain based on the neuroanatomy of the sensory and emotional aspects of pain. Of the neuroanatomical components involved in pain signaling, spatial discrimination is highest in the skin, lower in musculoskeletal tissue, and lowest in the lumbar spinal canal tissues. Nociceptive signaling in the lumbar intra spinal canal tissue is transmitted by sympathetic afferent fibers projecting into the deep laminae of the spinal dorsal horn. The pain experience consists of sensory and emotional aspects. Emotional components originate in the deep laminae of the spinal dorsal horn and are transmitted to and processed in the limbic system of the brain. Thus, pain sensation originating inside the lumbar spinal canal, where there is low spatial discrimination, projects relatively strongly to the emotional system of the brain, where it may lead to chronicity.