Month: September 2019

Nociplastic Pain, Small Fiber Neuropathy & Chronic Low Back Pain

Nociplastic pain is “pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain” (Kosek et al 2016). Central sensitization is a central process to this experience. Central sensitization encompasses impaired functioning of inhibitory, descending anti-nociceptive mechanisms (Meeus et al., 2008), and over activation of descending and ascending pain facilitatory pathways (Staud et al., 2007, Meeus...

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The Iliolumbar Ligament and Chronic Low Back Pain: Anatomy, Causation, Assessment & Treatment

Iliolumbar ligament Anatomy Figure 1. The Sacroiliac Ligaments from Grays Anatomy The location of the iliolumbar ligaments is between the iliac crest to transverse process of L4 and L5. The nerves from the L4 and L5 ventral rami pass around the Iliolumbar ligaments as shown in figure 2. Kim (2017) examined 14 fixed cadavers and found huge variation in the routes of the L4 and L5 lumbosacral trunks relative to the inferior and superior bands of the iliolumbar ligaments. With both passing anteriorly or posteriorly variously in multiple combinations amongst different cadavers. IB=...

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