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Anatomy of Back Pain
The Autonomic Nervous System

The autonomic nervous system comprises:
  1. Sensory neurons that convey information from the body’s internal organs to the central nervous system. The resulting sensations are not normally consciously perceived (they relate, for example, to the level of carbon dioxide in the blood), although pain is an exception to this rule.


  2. Motor neurons, that regulate visceral activities (those of the internal organs) by either increasing (exciting) or decreasing (inhibiting) organ function – for example, autonomic motor neurons can either increase, or decrease, heart rate.

The output (motor) component of the ANS can be divided further – into the sympathetic and parasympathetic nervous systems. Generally speaking, the two systems innervate (or provide a nerve supply to) exactly the same organs – they simply regulate them in different – mainly opposite – ways:

  • the sympathetic nerves increase visceral activity (e.g. heart rate up)
  • the parasympathetic nerves decrease activity (e.g. heart rate down)

As a result of this, the sympathetic nervous system is most active during periods of exercise – conversely, the parasympathetic nervous system is most active during periods of rest and relaxation.

Sympathetic Nervous System

The sympathetic nervous system originates in the spinal cord – the nerves themselves exit the column at vertebrae T1 through to L2 – the system (shown opposite) is therefore known as the thoraco-lumbar outflow.

Compression of the facet joints (T1-L2) will almost certainly lead to back pain (conveyed by the sensory neurons). However, like all spinal nerves, the sympathetic nerves are mixed (that is, they contain both sensory and motor neurons) – as a result, compression of the facet joints can also lead to problems in the excitation of visceral organs.

For example, the sympathetic nervous system stimulates the production of glucagon via the pancreas – glucagon is a hormone that increases blood sugar levels, increasing the amount of energy available to the body (for example, during exercise).

If the sympathetic nerves to the pancreas are compressed, glucagon production may be impaired – something which may lead to hypoglycaemia.

Referred pain can also occur – for example, compression from T1-T4 can lead to pseudo angina (heart pain) and chest pain.

Parasympathetic Nervous System

The parasympathetic nervous system (so called because some of the nerves run alongside those of the sympathetic nervous system) originates in both the spinal cord and the brain.

It therefore comprises both spinal and cranial nerves – specifically, cranial nerves III, VII, IX and X, and the spinal nerves that exit the cord from the vertebrae at S2 through to S4 – the system is therefore known as the cranio-sacral outflow (shown opposite).

The exit points of the parasympathetic nerves are not directly susceptible to facet joint compression. The sacrum, for example, comprises a number of vertebrae (S1-S5) that are fused, or welded, together – as a result, the sacrum doesn’t contain any facet joints.

However, the nerves are obviously connected to the spinal cord and are therefore indirectly susceptible to facet joint compression (the effects – including pain, and visceral dysfunction – are simply referred).



Next >>> The Enteric Nervous System

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Anatomy of Back Pain

Spinal Column

Vertebrae

Facet Joints

Nervous System
Introduction
Somatic
Autonomic
Enteric