Archive for August, 2008
This is the second part of a blog about back pain. This blog deals with the MBS approach to understanding back pain.
How can back pain occur in the absence of something wrong with the back?
There is a way to explain this based on new research into how the brain changes over time (neuroplasticity). One way is to consider what happens in phantom limb syndrome. In this situation, there is pain in the area of the body that is missing; that has been amputated. Clearly, there is nothing wrong with the area where the pain is felt, yet there can be severe pain. In this case, the pain appears to be due to sensitization of nerve fibers that go back to the brain, amplification of pain in the brain and a conditioned response of nerve fibers going back to the body. The brain and body have in essence learned to have this pain. The nerve connections have gotten fired after the amputation, but then have gotten “wired” and keep sending pain signals, which are felt to be in the amputated limb. It is likely that back pain (and other pain syndromes, including headaches, abdominal and pelvic pain, whiplash, fibromyalgia and TMJ pain) is caused in many people by similar nerve pathways.
What triggers this type of back pain to start and become chronic?
The answer is surprising and even offensive to some people and that is stress and emotional reactions to stressful events. A classic study showed the Boeing employees over four years and found that psychological stress predicted back pain much more than any other variable, including how much they used their back on their job. Other studies in Sweden, Holland, and England showed similar findings. In fact, job satisfaction is the most important factor that appears to determine if someone will develop chronic back pain or return to work after back surgery. Read more »
Conventional “knowledge” tells us that we were not meant to walk upright and that backs typically degenerate over time which leads to chronic back pain. If back pain was caused by degeneration of the back and the discs between the vertebrae, then it would make sense that back pain would increase with age. This is not the case however. Back pain actually drops a bit after age 65. We have been told that back pain will occur more often in people who use their backs more often. However, in studies from around the world, more people have back pain in industrialized, modern societies than in rural, agrarian societies.
What is the cause of back pain? There are several serious medical conditions that can cause back pain, such as a vertebral fracture (usually a compression fracture seen in the elderly or those with osteopenia), cancer of the vertebrae (seen in those with metastatic breast, lung or prostate cancer), serious abdominal conditions such as rupture of an abdominal aortic aneurysm, pancreatic cancer, rupture of a duodenal ulcer, or infections such as osteomyelitis, epidural abscess or diskitis. Fortunately, these conditons are relatively rare and easy to diagnose with modern imaging techniques (X-ray, CT or MRI).