As an orthopedic doctor, I frequently see patients with chronic back pain from a variety of causes – sciatica, herniated discs, fractures, muscle sprains, etc.  Although the pain these patients feel is real, caused by physical conditions in their back, new light has recently been shed on the brain as a reason why their back pain may persist.  The findings open new doors to treating back pain so that it does not become a chronic, lifelong, debilitating condition.  I think it’s pretty exciting and I’d like to tell you about it.

Pain In Your Back – and Your Brain 

As my back-pain patients could tell you, their pain negatively affects many aspects of their lives such as the following:

• Work – it can cause temporary or permanent disability so that someone may no longer be able to work.
• Relationships – associated depression and irritability are often associated with it that can impact relationships with family, friends, and coworkers.
• Activity – may not be able to engage in exercise or other leisure activities which can lead to other complications like weight gain and muscle weakness.
• Finances – back pain can become very expensive to treat.

You may not know this, but treating chronic pain has become one of the most expensive health care conditions in the United States today, with costs upward of $600 billion.  It affects about 30-40 million people a day with back pain being the most common chronic pain condition.  Fortunately, researchers out of Northwestern University feel they’ve found some answers to soon change our methods of dealing with back pain.

The researchers sought to answer the question of why some people with similar injuries/conditions wound up with chronic pain and others did not. In the study, using longitudinal brain imaging, the researchers found that early brain changes in certain people can predict which patients are going to develop chronic pain from an injury or condition.

The study, funded by the National Institute of Neurological Disorders and Stroke out of the National Institute of Health, was 10 years in the making.  It tracked 40 people with a new back injury of 4-16 weeks, but no prior back pain history.  All had been clinically diagnosed with back pain.  Brain scans were used both at entry into the study and 3 times more during the study.

They found that the injury itself was not enough to account for the chronic pain – rather the state of the brain was also involved.  There are two sections of the brain involved in creating chronic pain – the nucleus accumbens and the frontal cortex – which are related to emotional and motivational behavior.  The nucleus accumbens teaches the rest of the brain how to evaluate and react to the world.  It may use the pain signal to teach the frontal cortex how to develop chronic pain by “talking” to it at the onset of the back injury/condition.  The more these two parts of the brain communicate, the more likely it is that that person will develop chronic back pain.  The participants also lost gray matter density which can result in fewer synapse connections – synapses provide the ability to send messages to nerve cells.

Based on the level of interaction between these two parts of the brain, the researchers were able to know, with up to 88% accuracy, the patients who would go on to develop chronic back pain. Seems that the more emotionally the brain reacts to the initial injury/onset of condition, the more likely that the person will develop chronic pain even after the condition has healed. The researchers thought it likely these two sections of the brain are more excitable in certain people or that there may be genetic/environmental issues that cause the hyperexcitability in these brain regions.  The researchers felt their findings would lead to better ways to treat back, and other pain, to keep it from becoming a chronic, disabling condition.

How To Manage Back Pain On Your Own

Until further research prescribes methods to treat back pain conditions, here’s what I recommend my patients do to manage their back pain

• Stay active.  Your muscles, joints, and spinal discs will only become stiffer and more painful if you sit or lie down most the time.  Do mild, slow stretching exercises everyday – even yoga.  Get up and move around every 20-30 minutes – re-stretch.
• Ice.  Putting ice on an injury within the first 24-48 hours can keep it from swelling and/or developing inflammation.  Heat, in the form of heating pads, or hot compresses, can actually create inflammation and more pain.
• Ergonomics/posture.  Be sure you’re using good posture while sitting or standing. Slumping forward causes your back to curl and your stomach to protrude, putting strain on the lower back area. Keep a normal weight as excess fat can create spinal pressure.
• Natural anti-inflammatory/pain relievers. Drugstore pain reliever/anti-inflammatories work but carry side effects the longer you use them. Try some natural substances first:  bromelain, capsaicin, white willow bark, olive leaf extract, Omega-3 oils from fish or krill, black cherry extract, Boswellia, turmeric root extract.

There’s no doubt about it.  Back pain, chronic or acute, can be a very uncomfortable situation to live with. If you injure your back by a fall, muscle sprain, impact to your spine, do see a doctor immediately.  The sooner the damage is diagnosed and treated, the less likely it will result in chronic back pain that can negatively impact on your life.

Stay Well,
Mark Bromson, M.D.

The Best Natural Anti-Inflammatory Supplements, http://rheumatoidarthritisdiagnosis.org/rheumatoid-arthritis-treatments/the-best-natural-anti-inflammatory-supplements/

10 Ways to Manage Low Back Pain, http://www.webmd.com/back-pain/features/manage-low-back-pain-home?page=2

First Study To Show Early Brain Changes Predict Which Patients Develop Chronic Pain, http://www.medicalnewstoday.com/releases/247323.php