Potential Nociceptive Role of the Thoracolumbar Fascia: A Scope Review Involving In Vivo and Ex Vivo Studies

Larissa Sinhorim; Mayane Dos Santos Amorim; Maria Eugênia Ortiz; Edsel Balduino Bittencourt; Gianluca Bianco; Fabiana Cristina da Silva; Verônica Vargas Horewicz; Robert Schleip; William R Reed; Leidiane Mazzardo-Martins; Daniel F Martins

doi:10.3390/jcm10194342

Potential Nociceptive Role of the Thoracolumbar Fascia: A Scope Review Involving In Vivo and Ex Vivo Studies

J Clin Med. 2021 Sep 24;10(19):4342. doi: 10.3390/jcm10194342.

Authors

Larissa Sinhorim^{1

2}, Mayane Dos Santos Amorim^{1

3}, Maria Eugênia Ortiz^{1

2}, Edsel Balduino Bittencourt^{1

4}, Gianluca Bianco^{1

5

6}, Fabiana Cristina da Silva⁷, Verônica Vargas Horewicz^{1

2}, Robert Schleip^{8

9}, William R Reed^{10

11}, Leidiane Mazzardo-Martins¹², Daniel F Martins^{1

2}

Affiliations

¹ Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-272, Brazil.
² Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça 88137-272, Brazil.
³ Human Movement Sciences Graduate Program, College of Health and Sport Science at Santa Catarina State University, Florianópolis 88080-350, Brazil.
⁴ Coastal Health Institute, Jacksonville, FL 32224, USA.
⁵ Research Laboratory of Posturology and Neuromodulation RELPON, Department of Human Neuroscience, Sapienza University, 00147 Rome, Italy.
⁶ Istituto di Formazione in Agopuntura e Neuromodulazione IFAN, 00147 Roma, Italy.
⁷ Cirklo Health Education, Porto Alegre 90150-003, Brazil.
⁸ Department of Sport and Health Sciences, Technical University of Munich, 80799 Munich, Germany.
⁹ Department for Medical Professions, DIPLOMA University of Applied Sciences, 37242 Bad Sooden-Allendorf, Germany.
¹⁰ Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
¹¹ Rehabilitation Science Program, Departments of Physical and Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
¹² Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis 88040-900, Brazil.

Abstract

Nociceptive innervation of the thoracolumbar fascia (TLF) has been investigated over the past few decades; however, these studies have not been compiled or collectively appraised. The purpose of this scoping review was to assess current knowledge regarding nociceptive innervation of the TLF to better inform future mechanistic and clinical TLF research targeting lower back pain (LBP) treatment. PubMed, ScienceDirect, Cochrane, and Embase databases were searched in January 2021 using relevant descriptors encompassing fascia and pain. Eligible studies satisfied the following: (a) published in English; (b) preclinical and clinical (in vivo and ex vivo) studies; (c) original data; (d) included quantification of at least one TLF nociceptive component. Two-phase screening procedures were conducted by a pair of independent reviewers, after which data were extracted and summarized from eligible studies. The search resulted in 257 articles of which 10 met the inclusion criteria. Studies showed histological evidence of nociceptive nerve fibers terminating in lower back fascia, suggesting a TLF contribution to LBP. Noxious chemical injection or electrical stimulation into fascia resulted in longer pain duration and higher pain intensities than injections into subcutaneous tissue or muscle. Pre-clinical and clinical research provides histological and functional evidence of nociceptive innervation of TLF. Additional knowledge of fascial neurological components could impact LBP treatment.

Keywords: ex vivo; fascia; in vivo; innervation; lower back pain; nociceptor; pain; scoping review; thoracolumbar fascia.

Publication types

Review