Perhaps the most interesting thing about low back pain I’ve come across is that there is much more than just the static and dynamic structures of the spine involved in the pain process. In fact, it seems clear that the nervous system, including the brain, are huge players in low back pain.
I’m big into simple analogies – it is the way that I learn, and it seems others do as well. So consider this analogy to grasp why knowing that the central nervous system is a big player in low back pain is so important:
Let’s think of the spine and the nervous system like the lights in the room you are in. In the spine, we have bones, joints, discs, ligaments that are commonly source of pain. Exiting from these structures are nerves, which eventually are connected to the spinal cord and ultimately to the brain. Similarly, the light bulb is like the spinal structure, the wires are like the nerves, and the generator is like the brain. It is clear to understand how damage to the light bulb, fraying of the wiring, or a malfunction of the generator can cause problems with the lighting. Damage to one structure can compromise the functioning of the other. For example, improper light bulb wattage could short circuit the generator, or a frayed wire could eventually burn out a light bulb.
Well, this can also happen in the spine. We are all aware that damage to the spinal structures can cause pain. Unfortunately, we seem to be excessively fixated on this, which maybe causing clinicians to miss the boat on other contributors to the pain process. It has been postulated, and even proven that the brain is impacted and actually changes in response to chronic pain. Moreover, treatment directed at the brain (behavior modification and education) actually changes pain threshold and physical performance. What is even cooler is that these brain changes are not permanent, and are in fact reversible to some extent. Consider this recent research:
Chronic Pain Causes Brain Shrinkage – But it Can be Reversed!
David A. Seminowicz, et al. The Journal of Neuroscience, 18 May 2011, 31(20)
Researchers looked at 16 people without pain and compared their brains to those of 18 people who had chronic back pain. Those with chronic pain had 6 areas in their brains that were thinner and less densely packed. These areas were involved in attention, judgment, reasoning, as well as processing mood, pain, and judgements about others. What was even more fascinating is that 14 of the pain sufferers where studied a year later, and they were able to show that in those who had reduced symptoms, the brain thickness and their cognitive function had improved. 3 of the 14 had symptoms that were worse than before, and in these people the brain structures had not regenerated at all. Clearly, pain causes changes in the brain.
Why back pain is not to be ignored – and we must focus on the cause!
What we must learn from this is that structural damage can involve more than just obvious damage to the skeletal tissues. This damage will in turn affect the nervous system, especially if it is not resolved relatively quickly. We must appreciate that the damage is often more far reaching than the local pathology of the spine.
Some clinicians may flippantly suggest that acute episodes of low back pain are really no big deal, and that no matter what you do, most cases resolve in a few weeks on their own. And they may even site some research to support this line of thinking. But they are completely wrong. Here’s why:
1. 80-90% low back pain episodes reoccur, and when they do, symptoms are usually more disabling. So while the symptoms may be fleeting, if the cause has not been identified and addressed, odds are that we will experience more severe back pain in the future.
2. A small percentage of cases of acute low back pain become victims of chronic pain. However, research clearly shows that the small percentage of chronic low back pain sufferers account for the overwhelming majority of costs associate with own back pain. And most of those costs are associated with decreased productivity and sick time, while a small percentage of the costs are related to seeing medical providers.
So perhaps we will take the cases of low back pain more seriously, and consider the far reaching impact of chronic pain. Not only does it impact upon our economy and our suffering, but it involves more than discs and bones.
When the brain is involved, it tends to get people’s attention. Hopefully the brains of those who treat back pain will get more involved as well!
Stay tuned for more suggestions on how to treat and prevent low back pain, as well as addressing fallacies of low back pain. In the meantime, if low back pain is holding you back from getting fit, click here.