“Shooting pain” in lumbar radiculopathy and trigeminal neuralgia, and ideas concerning its neural substrates

Patients with radicular low back pain (radicular LBP, sciatica) frequently describe their pain as “shooting” or “radiating.” The dictionary meaning of these words implies rapid movement, and indeed, many sufferers report feeling pain moving rapidly from the lower back or buttock into the leg. But, others do not. Moreover, the sensation of movement is paradoxical; it is neither predicted nor accounted for by current ideas about the pathophysiology of radicular LBP. We have used a structured questionnaire to evaluate the sensory qualities associated with “shooting” and “radiating” in 155 patients, 98 with radicular LBP and 57 with trigeminal neuralgia, a second chronic pain condition in which shooting/radiating are experienced. Results indicated a spectrum of different sensations in different people. Although many sciatica patients reported rapid downward movement of their pain, even more reported downward expansion of the area of pain, some reported upward movement, and for some, there was no spatial dynamic at all. The velocity of movement or expansion was also variable. By cross-referencing sensations experienced in the sciatica and trigeminal neuralgia cohorts with known signal processing modes in the somatosensory system, we propose testable hypotheses concerning the pathophysiology of the various vectorial sensations reported, their direction and velocity, and the structures in which they are generated. Systematic evaluation...
Source: Pain - Category: Anesthesiology Tags: Research Paper Source Type: research

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It’s been a while since I last posted on my blog, as I’ve had other projects on the go this summer. Over this time I’ve been pondering, as I usually do, why pain management/rehabilitation has so many problems. Conceptually, I can understand that pain is a complex experience that we’re a long way from understanding. I get that it’s a philosophically challenging subject. That because it’s subjective (like love, disgust, fatigue or hunger) it’s difficult to examine dispassionately. I also get that it’s big business. Pain is one aspect of being human that captures the entrepr...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: Low back pain Pain conditions Professional topics Science in practice Source Type: blogs
Several interactive pelvic axes occur during activities of weight-bearing and ambulation. Flexion and extension of the symmetrical innominates occur on the sacral x-axis with weight-bearing. Normal asymmetric innominate rotation occurs on the innominate axis at the pubic symphysis during weight-bearing with normal ambulation. Oblique sacral movement occurs on an oblique sacral axis concurrent with asymmetric innominate movement. Acute and chronic low back pain is commonly caused by a bilateral symmetrical or oblique anterior innominate rotation on the sacrum on an acetabular axis, usually while lifting, bending, lowering, ...
Source: Topics in Geriatric Rehabilitation - Category: Geriatrics Tags: Thieves' Market Source Type: research
Conclusions: The present study evaluated the anti-inflammatory and regenerative efficiencies of Nar and NG in degenerated human NP cells. Altered gene expressions of cytokines, metalloproteases, extracellular proteins, apoptotic genes were dose responsive. The molecular docking (in silico) studies showed effective binding of these native ligands (Nar and NG) with genes identified as potent inhibitors of inflammation. Thus, these natural flavonoids could serve as anti-inflammatory agents in the treatment of low back pain and sciatica. PMID: 31575107 [PubMed - as supplied by publisher]
Source: Asian Spine Journal - Category: Orthopaedics Tags: Asian Spine J Source Type: research
Study Design. Prospective research in middle-aged and elderly people. Objective. To investigate low back pain (LBP) and neuropathic pain (NeP); spinal alignment and range of motion (ROM); spinal degenerative changes in plain radiography; osteoporosis; muscle strength; and physical ability as possible risk factors for poor quality of life (QOL). Summary of Background Data. The aging of society has led to an increase in elderly people with chronic pain, including LBP and NeP. However, there has been no analysis of NeP and spinal sagittal alignment as potential risk factors for decreased QOL in the healthy general pop...
Source: Spine - Category: Orthopaedics Tags: CLINICAL CASE SERIES Source Type: research
ConclusionsThis incidence of SD sustained by Granulicatella adiances could be underestimated due to their particular microbiological conditions requested for their cultures. However, this infection should be suspected in cases of culture-negative SD, especially when associated with endocarditis.
Source: Journal of Clinical Orthopaedics and Trauma - Category: Orthopaedics Source Type: research
This is a long…… readooops, sorry, not. Low back pain is, we know, the greatest contributor to days lived with disability (Rice, Smith &Blyth, 2016). And no-one anywhere in the world has found a good mix of services to reduce the number of days lived with disability as a result of this problem. And yet billions of dollars are used to fund research into the many contributors to a shift from acute low back pain to ongoing disability associated with low back pain. At the same time, treatments that directly target disability, rather than pain (a target considered the most important outcome by Sullivan a...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: Chronic pain Low back pain Pain conditions Research Science in practice health funding health systems models of care Source Type: blogs
​BY JENNIFER TUONG; IVAN KHARCHENKO; JEAN LUC AGARD; &AHMED RAZIUDDIN, MDA 65-year-old man who had HIV well-controlled with highly active antiretroviral therapy, hypertension, sciatica, and restless leg syndrome presented to the emergency department with left leg pain. He also had had chemotherapy and radiation for anal cancer. The patient said the pain had started 45 minutes earlier when he was sitting on the toilet.He described the pain as sore in quality and 10/10 on the pain scale. He reported that it had started in his lower back and radiated to his left leg. He said he had had no trauma or weakness to the regio...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
Intrinsic Therapeutics said today that it raised $52 million in a new round of equity financing to support the U.S. commercialization of its Barricaid annulus seal. The Boston-based company’s Barricaid implant is a polymeric mesh that is designed to sit at the posterior intervertebral disc space and is connected to a metal anchor that is attached to the vertebral body. The device is intended as an adjunct for lumbar limited discectomy to replace missing or damaged parts of the annulus to prevent re-herniation, disc collapse, the return of sciatica and potentially to help stave off low back pain. Intrinsic Therapeutic...
Source: Mass Device - Category: Medical Devices Authors: Tags: Business/Financial News Featured Spinal Wall Street Beat Intrinsic Therapeutics Source Type: news
Abstract OBJECTIVESymptomatic perineural or Tarlov cysts (TCs) are a rare cause of chronic low-back pain. Given the rarity of the disease, there is no literature consensus regarding the optimal management of these cysts.METHODSThe authors conducted a systematic comparative outcome analysis of symptomatic TCs treated with surgery (group A, 32 studies, n = 333) or percutaneous interventions (group B, 6 studies, n = 417) analyzing the demographic characteristics, baseline characteristics of the cysts, clinical presentations, types of interventions, complication rates, and the recurrence rate in both treatment groups....
Source: Journal of Neurosurgery.Spine - Category: Neurosurgery Authors: Tags: J Neurosurg Spine Source Type: research
This article, based on existing systematic reviews, concludes that psychological stress is one of the risk factors for a future episode of LBP or sciatica. However, this association is not new. An early description of the association between psychological stress and chronic bone pain is found in a Book of the Old Testament, called “Book of Psalms” or “Psalter”. This book is an anthology of individual psalms (150 or 151) and most of them are linked to the name of King David of Israel.
Source: The Spine Journal - Category: Orthopaedics Authors: Tags: LETTER TO THE EDITOR Source Type: research
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