This 2004 narrative review by Biyani and Andersson examines the molecular pathophysiology of low back pain — focusing on intervertebral disk degeneration, the cytokine mediators of pain and matrix destruction, and the emerging biologic strategies (gene therapy, growth factors, TNF-α inhibition) being developed to intercept the degenerative cascade.
When evaluating a patient with discogenic back pain out of proportion to imaging findings, recall that chemical sensitization of annular nociceptors and dorsal root ganglia — not just structural compression — drives symptoms; this is the mechanistic basis for why anti-inflammatory approaches (including TNF-α inhibitors) and emerging biologics are being tested as adjuncts to or alternatives for surgical decompression.
This 2004 narrative review by Biyani and Andersson examines the molecular pathophysiology of low back pain — focusing on intervertebral disk degeneration, the cytokine mediators of pain and matrix destruction, and the emerging biologic strategies (gene therapy, growth factors, TNF-α inhibition) being developed to intercept the degenerative cascade.
When evaluating a patient with discogenic back pain out of proportion to imaging findings, recall that chemical sensitization of annular nociceptors and dorsal root ganglia — not just structural compression — drives symptoms; this is the mechanistic basis for why anti-inflammatory approaches (including TNF-α inhibitors) and emerging biologics are being tested as adjuncts to or alternatives for surgical decompression.