Functional Back Pain: An Overview

It is important to remember that the nerve is the central component in all cases of back pain and may be the only component in cases of functional back pain.

Functional back pain is a term that is often used to describe back pain without a clearly identifiable surgical cause and may account for up to half of all cases and many of the cases of surgical failure. It is important to remember that even in surgical cases, the pain is always the result of the interaction of extrinsic structure, be it bone, disc, tumor et cetera, and the nerve in question and as such the sensitivity of the nerve to external irritation is every bit as important as the severity of the irritation. We have all seen patients with huge compressing discs who have very little pain and others who complain of intense pain from tiny protrusions. Unfortunately, there is currently no way to measure this type of nerve sensitivity and functional back pain remains to a large extent a diagnosis of exclusion, but a critical one to make correctly. In the first case an accurate diagnosis may prevent unnecessary surgery and secondly we are beginning to be able to modify this and other types of increased neural sensitivity with the use of certain anti-epileptic drugs and a large number of antidepressants.

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