Vernon Howard
Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada.
Chiropr Man Therap. 2012 Jul 5;20(1):22. doi: 10.1186/2045-709X-20-22.
The mechanisms subserving deep spinal pain have not been studied as well as those related to the skin and to deep pain in peripheral limb structures. The clinical phenomenology of deep spinal pain presents unique features which call for investigations which can explain these at a mechanistic level.
Targeted searches of the literature were conducted and the relevant materials reviewed for applicability to the thesis that deep spinal pain is distinctive from deep pain in the peripheral limb structures. Topics related to the neuroanatomy and neurophysiology of deep spinal pain were organized in a hierarchical format for content review.
Since the 1980's the innervation characteristics of the spinal joints and deep muscles have been elucidated. Afferent connections subserving pain have been identified in a distinctive somatotopic organization within the spinal cord whereby afferents from deep spinal tissues terminate primarily in the lateral dorsal horn while those from deep peripheral tissues terminate primarily in the medial dorsal horn. Mechanisms underlying the clinical phenomena of referred pain from the spine, poor localization of spinal pain and chronicity of spine pain have emerged from the literature and are reviewed here, especially emphasizing the somatotopic organization and hyperconvergence of dorsal horn "low back (spinal) neurons". Taken together, these findings provide preliminary support for the hypothesis that deep spine pain is different from deep pain arising from peripheral limb structures.
This thesis addressed the question "what is different about spine pain?" Neuroanatomic and neurophysiologic findings from studies in the last twenty years provide preliminary support for the thesis that deep spine pain is different from deep pain arising from peripheral limb structures.
与皮肤及外周肢体结构的深部疼痛相关机制相比，人们对脊髓深部疼痛机制的研究较少。脊髓深部疼痛的临床现象学具有独特特征，这需要开展能够从机制层面进行解释的研究。
对文献进行定向检索，并对相关材料进行审查，以判断其是否适用于“脊髓深部疼痛与外周肢体结构的深部疼痛不同”这一论点。将与脊髓深部疼痛的神经解剖学和神经生理学相关的主题以分层形式组织起来进行内容审查。
自20世纪80年代以来，脊髓关节和深部肌肉的神经支配特征已得到阐明。在脊髓内一种独特的躯体定位组织中已确定了与疼痛相关的传入连接，由此脊髓深部组织的传入神经主要终止于外侧背角，而外周深部组织的传入神经主要终止于内侧背角。文献中已出现了关于脊柱牵涉痛、脊髓疼痛定位不佳和脊柱疼痛慢性化等临床现象的潜在机制，并在此进行综述，特别强调背角“腰（脊髓）神经元”的躯体定位组织和超汇聚。综上所述，这些发现为“脊髓深部疼痛不同于外周肢体结构产生的深部疼痛”这一假说提供了初步支持。
本论文探讨了“脊柱疼痛有何不同？”这一问题。过去二十年研究中的神经解剖学和神经生理学发现为“脊髓深部疼痛不同于外周肢体结构产生的深部疼痛”这一论点提供了初步支持。
