In modern society, chronic low back pain is a common disease and is the most common cause of limiting social and economic activities in the population over the age of 45. Unlike general chronic low back pain patients, there may be cases of complaining of non-specific symptoms. However, it is difficult to diagnose or treat neuropathic chronic low back pain patients because they have a more complex pathophysiology than simple low back pain. Neuropathic chronic low back pain is caused by abnormal pain inducing mechanisms due to damage and dysfunction of the nervous system from the peripheral to the brain. Symptoms can occur anywhere in the vertebral or paravertebral structures where nociceptors are distributed. It is difficult to diagnose neuropathic back pain. Early and appropriate treatment can prevent the nervous system from being improperly adapted to become chronic pain syndrome, so it is very important as a clinician to access and diagnose neuropathic pain as easily as possible and apply general treatment early. Therefore, in this review article, based on literatures and research results on chronic low back pain with neuropathic component, we understand diseases and suggest directions for clinical applications.

Among the complex causes of chronic low back pain, suboptimal injury of ligament in the lumbosacral spine is common. Injured ligaments can become a primary pain source and raise secondary pain with referred pain pattern. Due to the low blood supply to the ligaments, ligaments are notoriously poor healer. In order to compensate the poor healing of ligament, prolotherapy has been introduced and used for more 60 years. To date, no definite recommendations have not been made based on literature available. However, if conventional treatment modalities have failed in patient with chronic back pain in lumbosacral spine, prolotherapy targeted on ligaments around lumbosacral spine should be considered in appropriate patients.