Chronic lower back pain linked to atrophy in pain-related brain regions(medicalxpress.com)
medicalxpress.com
Chronic lower back pain linked to atrophy in pain-related brain regions
https://medicalxpress.com/news/2022-03-chronic-pain-linked-atrophy-pain-related.html
61 comments
The submitted article is poached from https://www.newswise.com/articles/chronic-low-back-pain-link.... (This page also links to the study in question.) The current link is sketchy, full of ads, and doesn’t link to the source article in Pain.
As someone with chronic back pain stemming from a clear event (car accident), I still have the feeling that a substantial amount of my pain is reflecting a change in my brain. It almost feels like my brain’s processing of pain was recalibrated, so that I now notice other forms of pain which might’ve flown under the radar previously. And that baseline of pain, in my back and elsewhere, certainly tracks with my overall level of depression/anxiety.
I crushed my ribcage & sternum 20+ years ago & still live with pain in my shoulders and the vertebrae below my neck. When my day is running well(enough), the pain is present but barely registers in my consciousness. When non-physical tasks are a chore &/or I am depressed, they burn hotter than the sun. Physical activities seem to be the only remedy to abate it. I've found nothing beyond exercise relieves the pain when it's lit up: anti-inflams / pain killers don't do anything, chiropractors didn't help and imaging indicated no trauma to my spine. Perhaps it's some sort of arthritis or psychosomatic reminder, IDK, it's just another item on my 'getting old sucks' list.
I’ve had far too many injuries in my life due to enjoyment of adrenaline sports, and like you exercise is the only thing that seems to clear out the pain.
Funny enough, letting my six year old beat the crap out of me while wrestling with her has been some of the best PT I’ve had.
Funny enough, letting my six year old beat the crap out of me while wrestling with her has been some of the best PT I’ve had.
That describes exactly the neurological theories and approach of the physical therapy office I go to. The idea is that after traumatic events, the brain can recalibrate its pain registration threshold. Through the process of pushing to the edge of that boundary (and just barely beyond), over time it teaches your brain to reset back to a normal level. I have been to many physical therapists and this was very unique and compelling for me, and several months in I am on a good path.
I get occasional mild toothaches, but when I took psychedelics the feeling was amplified 50x. I think the body is sending these kinds of signals continuously and the brain just filters them out if they're mild enough. Psychedelics seem to lower the "volume" it takes to notice something.
After reading "Back Mechanic," I've had a profound shift in my understanding of -- what used to be -- my own back pain: the usual cause is muscle imbalance.
Something to the tune of: our back and torso muscles are responsible for keeping our spines (and all their structures) aligned in a healthy, mechanically-sound position. Things start to go wrong when the muscles are weak/atrophied/unbalanced, and no longer "hold" the vertebrae in their proper positions, which can lead to the disks bulging out and other mechanical issues that lead to low-intensity damage.
With this in mind, I started stretching my back, and focusing on getting into a "neutral," or healthy, posture on a day-to-day (to remove the muscle tightness caused by me unconsciously hunching, and exacerbating the problem -- after having a herniated disc). In theory, this remedies the muscles pulling my vertebrae in the "wrong" directions and intensities.
Coupled with weight training (squats, deadlifts, OHP, and bench), I believe I've managed to strengthen my back muscles, and "realigned" their efforts into the way my spine should be held up (instead of the way it was held up, due to sitting around all day).
It's gotten much better, and I don't have pain or unintended tightness anymore.
N.B. I've also relieved myself of knee pain, by focusing on the way my hips are "held" during walking. It seemed like mine were tilting too much forward (and not holding my body in place properly), so knee pain manifested (and perhaps was even the catalyst for my herniated disc). Once I straightened them out, I was able to walk pain-free.
Something to the tune of: our back and torso muscles are responsible for keeping our spines (and all their structures) aligned in a healthy, mechanically-sound position. Things start to go wrong when the muscles are weak/atrophied/unbalanced, and no longer "hold" the vertebrae in their proper positions, which can lead to the disks bulging out and other mechanical issues that lead to low-intensity damage.
With this in mind, I started stretching my back, and focusing on getting into a "neutral," or healthy, posture on a day-to-day (to remove the muscle tightness caused by me unconsciously hunching, and exacerbating the problem -- after having a herniated disc). In theory, this remedies the muscles pulling my vertebrae in the "wrong" directions and intensities.
Coupled with weight training (squats, deadlifts, OHP, and bench), I believe I've managed to strengthen my back muscles, and "realigned" their efforts into the way my spine should be held up (instead of the way it was held up, due to sitting around all day).
It's gotten much better, and I don't have pain or unintended tightness anymore.
N.B. I've also relieved myself of knee pain, by focusing on the way my hips are "held" during walking. It seemed like mine were tilting too much forward (and not holding my body in place properly), so knee pain manifested (and perhaps was even the catalyst for my herniated disc). Once I straightened them out, I was able to walk pain-free.
I'm in a similar boat. I was mountain biking 3x+ a week (6+ mi. climb at avg 6% grade) - I was getting fitter and losing weight. But my back would hurt on the down hill. Every jostle was teeth gritting.
I started weight training and stretching and my regular back pain is a thing of the past. My backs squat went from around body weight to 2x body weight. When ever a pain shows up anywhere for me (knee, shoulder, wrist, back, etc), it is because of a muscle pulling on it out of balance. I stretch the muscle, the opposing muscle, and related muscles. Generally if my back is sore these days it is because I need to stretch my hips. A few minutes of stretching and I'm good to go.
I started weight training and stretching and my regular back pain is a thing of the past. My backs squat went from around body weight to 2x body weight. When ever a pain shows up anywhere for me (knee, shoulder, wrist, back, etc), it is because of a muscle pulling on it out of balance. I stretch the muscle, the opposing muscle, and related muscles. Generally if my back is sore these days it is because I need to stretch my hips. A few minutes of stretching and I'm good to go.
Same here; doing weight-lifting exercises so I can increasingly lift with my back (instead of coddling it with workarounds) means my abdominal muscles (pelvic girdle?) are better at supporting my back in a forward bend. I'm thankful to the physical therapist who both noticed the wrong ways I was holding my body and got through to me the importance of changing (others PTs perhaps had noticed and suggested, but nothing stuck; probably due to my own bullheadedness). It feels like I'll live at least a few extra years now, thanks to increased mobility with minimal pain.
My back pain is also less in the morning if I didn't eat anything the day before. From what I've read, autophagy doesn't really kick in until ~48 hours after starting a fast, but something's going on that reduces pain.
My back pain is also less in the morning if I didn't eat anything the day before. From what I've read, autophagy doesn't really kick in until ~48 hours after starting a fast, but something's going on that reduces pain.
Similar for me, I had herniated a disc about a decade ago and never quite got the pain to go away. I finally sorted out that I was carrying a lot of it in my hips instead. In spite of the overall vibe of it, https://www.youtube.com/watch?v=eC_KukvZ_Co has been a huge help with that.
Still haven't gotten all the grip strength back in my foot though and that annoys the hell out of me.
Still haven't gotten all the grip strength back in my foot though and that annoys the hell out of me.
I started triathlon training and the swimming helped bring my back and knee pain into line such that I could actually run again and I haven’t had a reinjury of the back disc (previously every 12-18 months like clockwork for 10 years) in 7 years. I don’t even swim much anymore, just light maintenance through running. Swimming is magic.
The bird-dog pose, yoga and just improving core strength has helped me.
There are certain mind-altering substances that make my back hurt, I wonder if they're unsuppressing the pain that I would be feeling all the time if not for this mechanism.
Anecdotally, cannabis seems to do that for me. Pain/soreness that I normally dont feel from a few previous injury becomes magnified and noticeable.
I thought me and my cousin were the only ones with this issue. Cannabis makes my bones ache like nothing else and it feels like my tendons are being torn apart. I don't understand why. I used to smoke heavily between 2010-2013 without issue. I stopped and didn't try it again until 2017 or so, but it's never been the same since. It doesn't take much either. Just one mild hit and it's pain city.
Same here, but it happens when it wears off. If i just don't use it, there's no pain.
Same here.
All my friends thought I was crazy when I pointed this out the first time I tried it.
I hear all the time about how cannabis helps with pain management. Opposite with me.
That seems like a freebie for a study, feed patients psychedelics and see if that region of the brain activates.
I’ve noticed this with alcohol. 1 or 2 drinks will create/intensify the pain. But a couple more will put it down. It’s curbed my drinking since I rarely want to get drunk.
My back pain is significantly better now, but it comes back any time I take psychedelics. Have often wondered the same.
I'm suffering from severe chronical lower back pain.
> Yet approximately 90% of patients with CLBP cannot identify any clear specific cause or origin of their pain.
Same here.
More than once in my life I seemed to not feel any pain unless my injury get to the point of damage preventing proper physical operations.
It feels like I was doing something wrong and didn't get feedback from my body until it was too late.
Learning from this article about correlation between lower back pain and with lower brain volumes in pain-related brain areas strikes home.
> Yet approximately 90% of patients with CLBP cannot identify any clear specific cause or origin of their pain.
Same here.
More than once in my life I seemed to not feel any pain unless my injury get to the point of damage preventing proper physical operations.
It feels like I was doing something wrong and didn't get feedback from my body until it was too late.
Learning from this article about correlation between lower back pain and with lower brain volumes in pain-related brain areas strikes home.
You might have heard about this or tried it, but if not: There's some very promising studies from last year regarding treatment of CLBP that doesn't seem to have a physiological cause[1]. This type of "treatment" helped me turn around my backpain (both upper and lower) which had been getting worse and worse over ~6 months (not very long, I know), and after a few months I was virtually pain free.
This type of therapy is not new, but it's only very recently that proper big and reputable studies have been done. Most people don't even need to see a professional, reading online and doing it on your own is enough for the majority (including me).
[1]: https://www.colorado.edu/today/2021/09/29/how-therapy-not-pi...
This type of therapy is not new, but it's only very recently that proper big and reputable studies have been done. Most people don't even need to see a professional, reading online and doing it on your own is enough for the majority (including me).
[1]: https://www.colorado.edu/today/2021/09/29/how-therapy-not-pi...
This is an interesting article. I would like to hear more information about how the therapy is actually done. This reminds me of techniques like Edmund Jacobson's "Progressive Relaxation". I'm also reading a book called, "A Headache in the Pelvis", which claims that essential to healing is this idea that we must learn to properly relax and accept the pain we feel. I've found it hard to collect actual instruction about how to do this though.
Yeah I'm very curious to know how this Pain Reprocessing Therapy (PRT) from the article is done.
I haven't read the book you mentioned, but I'd say from my personal experience a physical yoga practice helps teach you to properly relax into what can sometimes be extreme discomfort. I remember when I first started practicing, whenever we'd get to long holds of poses (e.g. splits, pigeon, ustrasana), my body would start panicking and want me to come out of it immediately. But if you just keep bringing your awareness to the breath and meditate through the sensations that arise, the body starts relaxing and accepts where it's at.
I can imagine the PRT therapy probably includes some subset of the four foundations of mindfulness [1].
[1] https://en.wikipedia.org/wiki/Satipatthana
I haven't read the book you mentioned, but I'd say from my personal experience a physical yoga practice helps teach you to properly relax into what can sometimes be extreme discomfort. I remember when I first started practicing, whenever we'd get to long holds of poses (e.g. splits, pigeon, ustrasana), my body would start panicking and want me to come out of it immediately. But if you just keep bringing your awareness to the breath and meditate through the sensations that arise, the body starts relaxing and accepts where it's at.
I can imagine the PRT therapy probably includes some subset of the four foundations of mindfulness [1].
[1] https://en.wikipedia.org/wiki/Satipatthana
See my reply to denvaar for an example!
It has much in common with mindfulness I'd say, with some extra "simplified" techniques and learnings. It's easy to dismiss this type of therapy (even more so before there were studies on it), but the mindset changes which it advocates are very wholesome and are likely to increase quality of life even if it would fail to lessen the pain, so there's very little to lose!
It has much in common with mindfulness I'd say, with some extra "simplified" techniques and learnings. It's easy to dismiss this type of therapy (even more so before there were studies on it), but the mindset changes which it advocates are very wholesome and are likely to increase quality of life even if it would fail to lessen the pain, so there's very little to lose!
Sounds quite similar! Alan Gordon (who treated the patients in the study) has a free program online[1] which goes through the ideas behind PRT (though it doesn't call it PRT in there, I think that term is much more recent).
[1]: https://www.tmswiki.org/forum/painrecovery/
[1]: https://www.tmswiki.org/forum/painrecovery/
Have there been any studies comparing the brains of people who derive pleasure from pain vs people who don’t? I wonder if this could be related? Some people seem to have “trained” their brains not to recognize pain signals as unpleasant. Or (because I imagine they still feel pain) maybe they can even decide when and which pain signals are pleasant vs unpleasant? I wonder if people who enjoy BDSM are any more or less likely to suffer from chronic pain than the rest of the population.
If you found the article interesting you might want to look into Explaining Pain (EP). Teaching patients about pain is a common approach in treatment and there is some clinical evidence that better understanding can make pain easier to manage or even reduce the experience of pain (e.g. https://pubmed.ncbi.nlm.nih.gov/14690673/).
I think society should have preventive instructions because indeed there are subtle shifts we can't yet notice until too late. Regular full body exercise may improve things (improve proper mechanical use, diffusion of efforts, preserving sensitive articulations like discs).
I think regular full body exercise has been preached to me my entire life.
Because it works. A strong core and regular movement does wonders for preventing a lot of back pain. Obviously an overuse (someone lifting all day) or acute injury is different, but for the common office worker, exercise gets amazing results.
I agree with this. One of the best things I've done last year was signing up to a powerlifting gym and working through all the basic movements (from a long warmup to compound movements) with a professional trainer. It did wonders for my lower back.
Likewise. I used to have chronic back pain sitting. Consistent deadlifting seems to have fixed that.
Ah deadlifting. Undeniably one of the best movements there is... Until you irreversibly damage your spine.
I wish this trope would go away. Can you hurt yourself picking things up, especially if you pick them up incorrectly? Yes. Can you hurt yourself trying to pick something up beyond your limits? Yes. But neither of those requires DLs to happen, and shouldn't stop people from learning how to properly pick something up from the ground. People also don't need crazy weights to make the deadlift useful[1].
Too often people avoid DLs because 'they don't want to hurt their back', w/o realizing they are setting themselves to get hurt later. Years of DLs mean I instinctively pick up everything with good form. Meanwhile my friend hurt his back by awkwardly picking up his toothbrush that fell on the floor...
[1] I heard a measure once that for non-workout people, a good rule of thumb is to be able to easily and correctly KB squat and DL ~#45-#50 - the average weight of a toddler.
Too often people avoid DLs because 'they don't want to hurt their back', w/o realizing they are setting themselves to get hurt later. Years of DLs mean I instinctively pick up everything with good form. Meanwhile my friend hurt his back by awkwardly picking up his toothbrush that fell on the floor...
[1] I heard a measure once that for non-workout people, a good rule of thumb is to be able to easily and correctly KB squat and DL ~#45-#50 - the average weight of a toddler.
My motivation for seeking help from a different physical therapist was so I could pick up my infant without gritting my teeth from the pain in my lower back. Practicing lifts, which I'd never done before, using my core muscles made a huge difference; I felt hopeful again, and was much more functional.
Spine problems from weights are no joke here for sure - been there, done that. That's why I emphasised on the professional trainer in the original post. Technique and staying within your limits are really important to avoid any injuries.
Any good resources (videos, books) about this ? I'm in ~rehab so I'm used to take it slow, and be very careful about the mechanics and cardiac limits, but I sure want to know more.
It's mentioned in mine but not really integrated deeply. It could be spread with a tiny bit of marketing (TV, street ads, more outdoor devices etc). Unlike qigong/taichi in asia.
Someone mentioned it below, but the books by Dr. Sarno might help. My buddy had chronic back pain and was able to clear it out completely with his methods.
About 10 years ago, I started having really bad low back pain and could barely get out of bed some mornings. Different doctors told me different things. I tried chiropractic, acupuncture, stretching - nothing was helping. Then I came across one of Sarno's books. I was very skeptical, but I found that within 20 pages, he had described my situation to a tee. I followed the advice in the book and was back to running and yoga within a week, and was lifting weights again a couple weeks later.
Sarno's books and theories are a bit outdated at this point, but we now have people like Howard Schubiner and Nicole Sachs, and things like Curable.
[1] https://pubmed.ncbi.nlm.nih.gov/34586357/ [2] https://podcasts.apple.com/us/podcast/the-cure-for-chronic-p... [3] https://www.curablehealth.com
Sarno's books and theories are a bit outdated at this point, but we now have people like Howard Schubiner and Nicole Sachs, and things like Curable.
[1] https://pubmed.ncbi.nlm.nih.gov/34586357/ [2] https://podcasts.apple.com/us/podcast/the-cure-for-chronic-p... [3] https://www.curablehealth.com
Also very related to the study I linked in another response, though under the guise of pain reprocessing therapy (PRT). An interesting read if you want to know more about the latest scientifical progress on this type of therapy!
I have chronic back pain. So far, several doctors agree that the symptoms are there, but none of them have been able to identify the cause. Pain and the mobility issues that come with it sometimes disappear briefly, for an hour or so. I know it sounds crazy, but sometimes I can make the pain go away by focusing on it. None of it seems to make sense.
Medicine systematically underestimates the ambiguity and complexity of the relationship between our minds and our bodies.
Tangentially and more generally, it seems to completely ignore that the hard problem of consciousness is unsolved and the mainstream idea of causality pointing from material world to consciousness—X is wrong with your body, hence neurons fire, hence you feel pain—is essentially an unprovable conjecture.
When it somehow works, it is very good at creating an impression that we know what we are doing, but it strikes me at being more or less in shambles at some fundamental level.
Tangentially and more generally, it seems to completely ignore that the hard problem of consciousness is unsolved and the mainstream idea of causality pointing from material world to consciousness—X is wrong with your body, hence neurons fire, hence you feel pain—is essentially an unprovable conjecture.
When it somehow works, it is very good at creating an impression that we know what we are doing, but it strikes me at being more or less in shambles at some fundamental level.
This is not surprising. Pretty much anything that we experience subjectively can be affected by willful projection of our mental intention. Placebo effect is another name for this phenomenon. Meditative states and specific focus in those meditative states can cause cessation of pain, states of euphoria, tingling, out-of-body sensations, etc.
I have intermittent (usually bi-annually) severe back pain stemming from what has been determined by MRI as a congenital/hereditary narrowing of the spine that causes muscle spasms and long-lasting pain.
I'm currently in one of my bi-annual cycles and this one is particularly nasty. 800mg ibuprofen + 1500mg of acetaminophen + 10mg cyclobenzaprine every four hours was doing absolutely nothing for the symptoms. I ended up trying every other remedy under the sun including epsom salt baths, Tiger Balm, etc., for relief. What worked? CBD balm.
I don't believe in anything that can be attributed to the placebo effect and that's what I consider remedies like CBD balm. But, it worked and I am going to run w/it. I wish it were easier than me having to fork over $30 for snake oil to trick my body into a positive response but here we are.
I'm currently in one of my bi-annual cycles and this one is particularly nasty. 800mg ibuprofen + 1500mg of acetaminophen + 10mg cyclobenzaprine every four hours was doing absolutely nothing for the symptoms. I ended up trying every other remedy under the sun including epsom salt baths, Tiger Balm, etc., for relief. What worked? CBD balm.
I don't believe in anything that can be attributed to the placebo effect and that's what I consider remedies like CBD balm. But, it worked and I am going to run w/it. I wish it were easier than me having to fork over $30 for snake oil to trick my body into a positive response but here we are.
Maybe it's like a messaging system. When you read the message, the notification goes away.
Pain usually doesn't work this way. It's relatively stateless, as in as long as there is a problem in a part of your body you'll feel pain associated with it, and it's not like the pain goes away once you ack it.
That chronic pain can have a central, neuropsychiatric origin is likely to have been considered at least briefly by anyone who's learned that (or who has been prescribed them) antidepressants, of all things, are frequently prescribed for chronic pain that appears without a clear cause.
I'm sure that the medicine of neurodegenerative diseases will receive more attention than almost any other field of medicine in the coming decades. Alzheimers, ALS and similar grave diseases are already major research priorities, but if chronic lower back pain and other chronic pain is definitely shown to frequently be the result of brain atrophy then better understanding (and hopefully treatments) may matter for a large part of the working population as well.
I'm sure that the medicine of neurodegenerative diseases will receive more attention than almost any other field of medicine in the coming decades. Alzheimers, ALS and similar grave diseases are already major research priorities, but if chronic lower back pain and other chronic pain is definitely shown to frequently be the result of brain atrophy then better understanding (and hopefully treatments) may matter for a large part of the working population as well.
Assuming that this is a real effect, it seems that the causality could be in either direction: perhaps atrophy in the brain contributes to pain, or perhaps constant pain causes the pain-related regions of the brain to atrophy.
Read about Dr. Sarno
Based on personal experience, my sense is that much back pain is caused by bacteria. Obviously some people have a specific injury that causes their back pain, but I think doctors have an easier time finding the problem, when there was a specific injury. But when the pain slowly appears with aging, and has no specific cause, I suspect bacteria plays a role.
As an analogy, most cases of pneumonia are caused by streptococcus pneumococcus, and most of us have this bacteria in our lungs by the time we are 5 years old, and yet the bacteria lives in our lungs for most of our lives, and it does no damage, so long as our immune system is healthy. But then one day, when we are 85 years old, the streptococcus pneumococcus becomes active and hurts us. This is after 80 years of peaceful coexistence.
At one point I was looking up incidence of disease on the CDC website, and I was surprised to see that they said 1 out of 3 Americans test positive for exposure to neisseria meningitis, which can cause spinal meningitis. Only about 55 Americans a year die from this, so this is a bacteria which apparently reaches 100 million Americans but causes death in less than 0.000000001% cases. But maybe it can cause back pain? Maybe as we get older, and our immune system is less active, neisseria meningitis could cause inflammation in the spine?
I once had an illness that doctors thought was Lyme disease. Among other things, it gave me agonizing back pain, so bad that I would have to lie on the couch all day, unable to move. But antibiotics fully resolved the situation. So the fact that bacteria can cause back pain is well known to me, and the fact that antibiotics can solve back pain, in some cases, is also well known to me.
As an analogy, most cases of pneumonia are caused by streptococcus pneumococcus, and most of us have this bacteria in our lungs by the time we are 5 years old, and yet the bacteria lives in our lungs for most of our lives, and it does no damage, so long as our immune system is healthy. But then one day, when we are 85 years old, the streptococcus pneumococcus becomes active and hurts us. This is after 80 years of peaceful coexistence.
At one point I was looking up incidence of disease on the CDC website, and I was surprised to see that they said 1 out of 3 Americans test positive for exposure to neisseria meningitis, which can cause spinal meningitis. Only about 55 Americans a year die from this, so this is a bacteria which apparently reaches 100 million Americans but causes death in less than 0.000000001% cases. But maybe it can cause back pain? Maybe as we get older, and our immune system is less active, neisseria meningitis could cause inflammation in the spine?
I once had an illness that doctors thought was Lyme disease. Among other things, it gave me agonizing back pain, so bad that I would have to lie on the couch all day, unable to move. But antibiotics fully resolved the situation. So the fact that bacteria can cause back pain is well known to me, and the fact that antibiotics can solve back pain, in some cases, is also well known to me.
I had a deer-tick bite a while back, though the two tests for tick-borne illness came back negative. Coincidentally my back pain (which I'd had already) became more acute. I don't know if it was causative, and it seems more likely that it was stress and other factors, but I keep this story around just in case.
I’m curious why this was downvotes?
Start deadlifting in your 20s and 30s and you'll do just fine
Any resources on this? I’m interested. I’ve tried stretching, cycling, hot baths & a stand-up desk. I messed mine up diving off a boat 8 years ago.
Strong Lifts. The app is free. 3x a week
Personally, it's squats that make any back pain starting go away like clockwork.