Dysafferentation is the prolonged bombardment of afferent signals to the DRG resulting in habituation of central sensitization and peripheralization of symptoms to muscles and joints. In other words, prolonged local or systemic inflammation (unresolved healing process related to LBP) can lead to symptomatic response (centralization) causing irritation or degradation of the nerve sheath. Changes in the nerve sheath causes an infiltration of nerves into adjacent tissues known as Wide Dynamic Range cells (WDR) that then interpret any signal (joint position, muscle tone, load) as pain. Increase in acetylcholine (Ach) causes the muscles to increase static tone; the low back muscles become chronically contracted, and can produce trigger points (TrPs). Trigger points are oxygen-starved tissue due to chronic tone. Imagine ringing out a wet rag… the same occurs with TrPs, the rag is an overly tensioned muscle (TrP), and all of the blood is squeezed out, and therefore oxygen is removed from the muscle. This tensioned muscle feature dominates the life of the LBP patient… chronic history of brief-sudden shock-like episodes of radical locking-up of the spinal muscles (seconds to minutes) sometimes requiring 911 hospitalization. This feature occurs with dysafferentation, and presents as a co-contraction of the spinal agonist and antagonists, including the deeper column muscles, as well as the multifidi, rotatores, and intertransversii. This co-contraction event is called Sympatheticotonia.
The result of dysafferentation is Altered Reflex Arc (ARA); the proprioceptive afferent pathway (post lateral spinothalamic tract) that normally sense-signals the muscle tone and joint position is hijacked by nociceptive signaling, and joint position/muscle contraction sense signaling inputs are converted to a ‘pain’ pathway signal at the cortex. Movement becomes painful for no other reason than dysafferentation, not a bulging disc, not spinal cord compression, not by a loss in disc height, and not by the formation of osteogenic remodeling… by something you can’t see on plain film or advanced imaging.
Note that dysafferentation occurs among the muscles innervated by the dorsal horn nerve roots and includes only those signals, none from the disc.
The main features of dysafferentation are: (1) an unresolved inflammatory ‘process’ (I put that in quotes since the ‘process’ has failed so many times, and now it is impossible to restore tissues to a healthy state), (2) Altered Arc Reflex, and (3) Peripheral Modulation (damaged muscles that do not heal.) These three features describe almost every LBP that I have seen.
Contributors to dysafferentation include sympathetic amplification: neuroendocrine mechanisms that influence psychosocial stresses on the sympathetic nervous system chemical links between emotions and the immune response (HPA Axis.) Increased experiential stress produces glucocorticoids (natural anti-inflammatory mediators) and dis-regulation of cortisol-serotonin leading back to stress and the inability to adapt (chemically speaking.)
Patient experience examples related to unresolved LBP:
Anger + Irritability = increased blood pressure & resting heart rate
Anxiety + Panic = headache, nervous habits, eating habits, shingles
Depression = sleep disturbance, decreased libido, exhaustion, disinterest
Clinical observations related to unresolved LBP:
Body tension, spasm, trigger points (sympatheticotonia)
Heightened sense of survival; emergency-state decisions, over-reacting, brashness
Coping delays & sacrifices
Approval seeking while attempting to demonstrate command
Delayed healing, symptom magnification, inability to re-set
Organic changes: cortisone overproduction, GI inflammation, altered gene expression
Causes for sympathetic amplification:
Death, divorce, unexpected changes in relationship, family drama, abuse
Job-loss, job dissatisfaction, job-recognition, financial survival or decay, solvency, late-ness
Chronic illness in self or others, depression, easy-to-anger, poor self-esteem, catastrophizing
‘Appearances’, ‘class’ lifestyle (Keeping up with the Joneses)
Dehumanization, discrimination, feeling trapped, feeling invisible
This article expresses the importance of recognizing that ‘pain is not the only problem.’ Unresolved LBP can be caused by prolonged bombardment to the sense-signal nervous system, and amplified by inflammation and life situations that stir the sympathetic pathways. Advocate for you patients by taking a good look at a complaint of on-going low-back muscle tension combined with an amplified sympathetic lifestyle.
LBP Blog General information
These articles intend to (1) re-evaluate the prevailing clinical practices thought to manage low back ‘pain’, (2) submit and debate novel low back ‘pain’ contributors and mechanisms, (3) meet patient expectations & satisfaction and clinically meaningful results, (4) recommend a conservative non-surgical course of care to over-ride ‘pain’ instantly, and (5) restore ADLs and patient confidence on the first visit at low cost. This article has a companion podcast.
Dr. Dean Bio
Forester Dean is a chiropractic and physiotherapy sports medicine doctor practicing in Los Angeles, California. Dr. Dean is a lifetime athlete, and currently teaches tennis, track, boxing, yoga. The Core X System™ Campus flagship location was opened by Dr. Dean in 2020. www.preformancecxs.org
© Copyright 2021 SpineSync, Forester Dean, DC
Duplication with permission only