Brisby Helena
Department of Orthopedics, Sahlgrenska University Hospital, Göteborg University, Göteborg 413 45, Sweden.
Orthop Clin North Am. 2003 Apr;34(2):221-30. doi: 10.1016/s0030-5898(03)00002-6.
In conclusion, the nerve roots and the DRG play an important role in the pain mechanisms of patients suffering from chronic low back pain. Signs of demyelination and increased sensitization for stimuli occurs after a direct nerve root trauma, and the plasticity for the DRG also may change the response to a given peripheral stimuli when repeated frequently over a long period of time. The regeneration mechanisms of spinal nerve roots and DRG regarding function are slow, and the final grade of recurrence depends on the degree of injury. The limited regeneration mechanisms for nerve injury and the fact that "established chronic pain centers" are hard to influence after a long pain history favor an aggressive strategy for pain management. Today, a number of treatment strategies exist for chronic low back pain patients (with or without a diagnosed nerve root injury). These strategies include physiotherapy, nonsteroid anti-inflammatory drugs (NSAIDs), steroids, analgesics of different types and administration routes, surgery, and other sorts of invasive treatments. Further knowledge about the nerve root, DRG, and the rest of the nervous system in these patients is necessary; for understanding how and when to treat patients with chronic low back pain, we need to understand more about what we are trying to treat.
总之，神经根和背根神经节在慢性下腰痛患者的疼痛机制中起着重要作用。直接的神经根损伤后会出现脱髓鞘迹象以及对刺激的敏感性增加，并且当长时间频繁重复时，背根神经节的可塑性也可能改变对给定外周刺激的反应。脊髓神经根和背根神经节在功能方面的再生机制缓慢，复发的最终程度取决于损伤程度。神经损伤的再生机制有限，并且在长期疼痛病史后“已建立的慢性疼痛中枢”难以受到影响，这有利于采取积极的疼痛管理策略。如今，针对慢性下腰痛患者（无论是否诊断出神经根损伤）存在多种治疗策略。这些策略包括物理治疗、非甾体抗炎药（NSAIDs）、类固醇、不同类型和给药途径的镇痛药、手术以及其他各种侵入性治疗。进一步了解这些患者的神经根、背根神经节以及神经系统的其他部分是必要的；为了理解如何以及何时治疗慢性下腰痛患者，我们需要更多地了解我们试图治疗的对象。
