Scar Tissue (Fibrosis and Chronic Pain)

Chronic neck and back pain leads to abnormal neck and trunk muscle activity and limited range of motion. This pattern of abnormal movement sets the stage for abnormal connective tissue remodeling, persistent inflammation and contributes to sensitization of the nervous system thus lowering an individual’s pain threshold.  The increase in perceived pain further leads to limitation of movement setting the stage for a viscous cycle of compromise and abnormal tissue repair and remodeling. Research has shown that reduced tissue mobility (hyomobility) and an abnormal increase in tissue or joint mobility influences the remodeling of connective tissue. Both hypomobility and hypermobility can result in tissue atrophy or scar tissue (fibrosis) development. The presence of inflammation promotes fibrosis. Fibrosis leads to increased tissue stiffness which sets the stage for abnormal tugging and pulling type stresses during movement.

If connective tissue is laid down in a disorganized pattern it will contribute to compromise of blood and lymphatic flow which leads to inflammation. This process may also increase the distance between cells and their blood supply. Abnormal connective tissue remodeling plays an important role in the development of chronic back pain.  This process can not be visualized using current diagnostic imaging technology like computerized tomography (CT) or magnetic resonance imaging (MRI).

A change in the connective tissue architecture alters both the chemical and physical relationships surrounding specialized nerve endings which carry the signal which trigger the perception of discomfort or pain. If the tissue changes cause increased sensitivity or more easily stimulated nerve endings it will take less of a stimulus to cause or magnify pain. As stated above the increase in pain will lead to conscious and unconscious limitation or alteration of movement of the involved area.

The Evaluation of Scar Tissue

The diagnosis of scar tissue in the spine requires assessment with the use of one or more of the following, history, clinical examination, and specialized imaging procedures.  Diagnostic imaging is the best way to confirm the presence of fibrosis.  One of the most accurate methods of imaging scar requires the use of magnetic resonance imaging (MRI) with and without the use of a contrast agent.  Epidurography can also be used to help identify the location of scar.  Epiduroscopy can be used for direct visualization of peri-dural or epidural scar and its relationship to adjacent anatomical structures.