Sciatica and Lower Back Pain

Low back pain can be put into three categories with subcategories. They are:

1. Neurophysiological
   • peripheral
   • peripheral to central
2. Psychological
   • behavioral
   • cognitive-affective
   • psychophysiological
3. Barriers to recovery
   • medical
   • surgical
   • neuropsychological
   • social
   • physical

The barriers to recovery are further broken up, but those will be presented later on.

Neurophysiological

Peripheral mechanisms can reinforce the stimulation if the pain is persistent at the source. Chronic low back pain can cause the nerves to normal stimuli, or the mild stimuli that may have otherwise resulted in a light or mild pain.

Peripheral-to be honest, and also have continuous loops of pain in the spinal cord that causes the self-sustaining loop. The signal from the nerves reverberates and there it is. The inhibition or dampening of such a signal could be less or not present at all if the myelinated fibers are damaged, malfunctioning, or diseased.

A theory for this kind of pain was proposed by Wall and Gutnick and is called ectoo strong. This hypersensitivity can then cause chronic misfiring patterns in the neurons.

Signal bias can occur in three places: the spinal cord, brainstem, or in the cortex of the brain. This directs attention towards the peripheral or central stimuli.

Recovery Barriers

These recovery barriers stem from three different categories: premorbid factors. Chronicity and prognosis can be impacted by these, and therefore can make a patient a poorer or better candidate for rehab or surgery.

The capacities for exercise differ in each patient. Reduction of physical activity due to the chronic low back pain can create deconditioning syndrome. This means that the muscle strength, mobility of the joints, and even fitness in the cardiovascular system can be reduced over time. This could be part of a self-sustaining cycle of illness in the musculoskeletal system.

Recovery barriers could include:

1. Premorbid factors
   • depression
   • personality disorders/traits
   • childhood sexual abuse
   • psychosis
   • a predisposition toform pain disorder
   • dysthymia and
   • anxiety disorders and panic disorder
2. Traumatic factors
   • fear
   • a loss of control
   • abnormal dependencies
   • anxiety
   • pain
     and
   • psychophysiological responses
3. Posttraumatic factors
   • depression
   • Post Traumatic Stress Disorder (PTSD)
   • anger
   • hostility
   • disability mindsets
   • somatoform pain disorder
   • panic
   • anxiety
   • symptom magnifications
   • time since injury
     and
   • latrogenic substance abuse

Personality disorders are a large facto treatments. Chronic pains could also be influenced by avoidance, passive-aggressive, or paranoid disorders as well.

Role models might have an effect as well. A tendency to selectively attend, overgeneralize, personalize, etc. could be extremely influential in how successful the treatments could be. These kind of responses could also be affected by nightmares, headaches, fatigue, and other conditions. They usually feel as if they have lost control and depend on others in abnormal ways.

The more barriers a person has, the less clear the prognosis will be. Pre Existing facto make decisions on the patient’s end.

Other barriers to recovery can include:

• family or spousal conflicts
• financial security
• age
• education
• brain injury
• unemployment compensation
• legal influences