Neural-Immune Interactions: Implications for Pain Management in Patients with Low-Back Pain and Sciatica Angela Starkweather, PhD, ACNP, RN Linda Witek-lanusek, RN, PhD I I erbert L. Mathews, PhD Bidirectional communication between the immune system and the brain and the implications of this com- munication are emerging concepts in pain research. Although representing a small portion of the disc degeneration syndromes, lumbar herniated discs can cause significant symptoms that may persist even after surgical interventions. Evolving evidence demon- strates that proinflammatory cytokines are a key medi- ator in the process of disc degeneration as well as in the pain experienced by those afflicted with lumbar herniated discs. Activated immune cells release proinflammatory cytokines, which signal the brain through humoral and neural routes. The brain responds by altering neural activity and promoting further production of pminfiammatory cytokines within the brain and spinal cord. Increased local cytokine production by disc tissue irritates spinal nerve roots, resulting in pain and functional changes in neural activity. This review of the current literature explores the importance of cytokine production within the context of lumbar disc degeneration and lumbar spine pain. Furthermore, the significance of the neural-immune interaction will be examined as it relates to pain management and to patient treatment. Key words: proinflammatory cytokines, nucleus pulposus, lumbar herniated disc, disc degeneration Back pain remains an elusive clinical problem. Low- back pain is considered one of the most widely experi- BIOLOGICAL RESEARCH FOR NURSING Vol. 6. No. 3. January 2005. 196-206 DOI: '0.1 I7M09980010427222I Copyright 0 2005 Sage Publications enced health problems in the United States and is the 2nd most frequent condition, after the common cold, for which people see a physician or lose days from work. Low-back pain and sciatica are common