A model for personalized diagnostics for non-specific low back pain: the role of the myofascial unit.

IF 2.5 Q2 CLINICAL NEUROLOGY Frontiers in pain research (Lausanne, Switzerland) Pub Date : 2023-10-13 eCollection Date: 2023-01-01 DOI:10.3389/fpain.2023.1237802
Siddhartha Sikdar, John Srbely, Jay Shah, Yonathan Assefa, Antonio Stecco, Secili DeStefano, Marta Imamura, Lynn H Gerber
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Abstract

Low back pain (LBP) is the leading cause of disability worldwide. Most LBP is non-specific or idiopathic, which is defined as symptoms of unknown origin without a clear specific cause or pathology. Current guidelines for clinical evaluation are based on ruling out underlying serious medical conditions, but not on addressing underlying potential contributors to pain. Although efforts have been made to identify subgroups within this population based on response to treatment, a comprehensive framework to guide assessment is still lacking. In this paper, we propose a model for a personalized mechanism-based assessment based on the available evidence that seeks to identify the underlying pathologies that may initiate and perpetuate central sensitization associated with chronic non-specific low back pain (nsLBP). We propose that central sensitization can have downstream effects on the "myofascial unit", defined as an integrated anatomical and functional structure that includes muscle fibers, fascia (including endomysium, perimysium and epimysium) and its associated innervations (free nerve endings, muscle spindles), lymphatics, and blood vessels. The tissue-level abnormalities can be perpetuated through a vicious cycle of neurogenic inflammation, impaired fascial gliding, and interstitial inflammatory stasis that manifest as the clinical findings for nsLBP. We postulate that our proposed model offers biological plausibility for the complex spectrum of clinical findings, including tissue-level abnormalities, biomechanical dysfunction and postural asymmetry, ecological and psychosocial factors, associated with nsLBP. The model suggests a multi-domain evaluation that is personalized, feasible and helps rule out specific causes for back pain guiding clinically relevant management. It may also provide a roadmap for future research to elucidate mechanisms underlying this ubiquitous and complex problem.

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非特异性腰痛的个性化诊断模型:肌筋膜单位的作用。
腰痛(LBP)是全世界致残的主要原因。大多数LBP是非特异性或特发性的,其定义为来源不明的症状,没有明确的具体原因或病理。目前的临床评估指南是基于排除潜在的严重疾病,而不是解决潜在的疼痛因素。尽管已经努力根据对治疗的反应来确定这一人群中的亚组,但仍然缺乏指导评估的全面框架。在本文中,我们提出了一种基于现有证据的个性化机制评估模型,旨在确定可能引发和持续与慢性非特异性腰痛(nsLBP)相关的中枢敏化的潜在病理。我们提出,中枢增敏可能对“肌筋膜单元”产生下游影响,肌筋膜单元被定义为一个完整的解剖和功能结构,包括肌纤维、筋膜(包括肌内膜、肌周和肌外膜)及其相关神经支配(自由神经末梢、肌梭)、淋巴管和血管。组织水平的异常可以通过神经源性炎症、筋膜滑动受损和间质炎症停滞的恶性循环持续存在,这些表现为nsLBP的临床表现。我们假设,我们提出的模型为复杂的临床发现提供了生物学合理性,包括与nsLBP相关的组织水平异常、生物力学功能障碍和姿势不对称、生态和心理社会因素。该模型提出了一种个性化、可行的多领域评估,有助于排除背痛的具体原因,指导临床相关管理。它还可能为未来的研究提供一个路线图,以阐明这一普遍而复杂的问题背后的机制。
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2.10
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0.00%
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0
审稿时长
13 weeks
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