A new study gives great insight into inflammation and back pain, and its startling findings may help you manage chronic back pain. Chronic inflammation in the whole body is an oft-ignored problem which can make back pain worse. Understanding when to focus on treating this issue, and how best to do it sans drugs, may make the difference between your ability to manage back pain and the pain managing you.
The Latin root of the word inflammation (meaning swelling) is fire, which makes sense, as something that’s inflamed is red and hot. There are two main types of inflammation, and not understanding the difference hurts many patients. One will heal you, while the other will slowly kill you. Let’s have a brief look at these two types of inflammation.
Acute inflammation is the swelling that happens immediately after an injury. This is your body attempting to heal the problem. It’s a process that has gotten a bum rap because of a serious but rare phenomenon called “compartment syndrome.” In rare cases, severe trauma will cause normal swelling to become a problem because of the pressure created by an enclosed space (the surrounding “compartment” is made up of the fascia). This is a medical emergency that can be solved with surgery. However, in trying to reduce the chances of the rare event occurring, doctors have recommended that we do everything we can to blunt this inflammatory healing fire (RICE, i.e. rest, ice, compression, elevation plus taking NSAID medication). It’s the equivalent of saying that if there’s a tiny chance you could die in a car crash, you should never drive! Acute inflammation is good; it’s how we heal. Blunting its effects rather than letting the body heal the problem is a dumb idea, except in the rare event of a compartment syndrome.
Chronic inflammation is a killer. This is the low level inflammation that happens more often as we age, don’t exercise, eat too much sugar, carbs, and inflammatory foods, and gain weight. This type of inflammation isn’t helping us, and it can take over the body, leading to middle aged aches and pains.
Think of chronic inflammation as a low level fire in a forest that represents your body. If the forest is damp and healthy, not much happens. If the forest is dry with an abundance of dead trees, it may go up in flames at any moment.
If you experience low levels of chronic inflammation in your body and you get a back injury, the injury stays localized, and acute inflammation will help heal the issue. However, if you experience high levels of chronic inflammation in your body and the same injury occurs, like our forest, a small fire may set the whole body aflame.
This phenomenon was captured nicely in recent study that looked at how long the symptoms of a herniated disc lasted if the patient had low versus high levels of chronic inflammation in the whole body. Patients with higher levels of chronic inflammation had pain that lasted longer (their body provided the kindling for the acute fire trying to heal the back which then spiraled out of control), while those with less chronic inflammation had shorter symptoms (their body was like the damp and healthy forest so the fire remained small and burnt out).
A marker in the blood for chronic inflammation is IL-6. Consider it a smoke detector for our out-of-control forest fire. The above study used IL-6 levels, as did a more recent study on different types of back pain and chronic inflammation. In this study, published in the journal Arthritis Research, patients with degenerative disc disease (DDD), spinal stenosis (SS), and a herniated disc (HD) had their levels measured.
Let’s briefly define what each of these patients was experiencing. DDD means that the disc between the spinal bones (vertebrae) had collapsed. SS occurs when the arthritis in the spine puts pressure on the spinal cord or nerves in the spinal canal. And HD means that the disc material has ruptured and is placing pressure on a nerve.
In patients with DDD and SS, IL-6 levels were high, indicative of much chronic inflammation. By comparison, when averaged together, patients with a herniated disc had lower levels of IL-6. This data provides us some insight into how best to help these patients based on their differences.
For example, we know from the earlier study that patients with higher levels of chronic inflammation had longer recoveries from a herniated disc. We also know that patients with DDD and SS had higher levels than those with HD. These are typically chronic and life-long conditions. Additionally, we know based on other studies that not all patients with DDD or SS on MRI scans have symptoms. A picture is emerging that explains much of what doctors see every day. Allow me to explain.
Doctors love to order MRI scans because the concept is simple – a problem detected on the scan must explain why someone hurts. Patients love them for the same reason. However, research studies continue to show that they aren’t very accurate, especially in the spine. For example, some patients with severe problems on the image have little pain, and others with little problems on the image have severe pain. The studies above seem to suggest why. Structural issues seen on the imaging can be made worse by whole body chronic inflammation. A camp fire in a damp and healthy forest does little damage, but that same fire in a hot and dry forest with an abundance of dead trees can cause a conflagration. Hence a structural problem like a degenerated disc in someone with low levels of chronic inflammation may not be an issue, but the same problem in someone with high levels can lead to chronic pain.
The study findings also go the other way as well. It could be that higher levels of whole body, chronic inflammation provide the right environment for the disc to degenerate and caused DDD or arthritis in the back to get worse, causing SS.
Get your chronic inflammation under control! If you’ve been noticing more random aches and pains as you get older, here’s your plan:
The upshot? The realization that controlling aches and pains caused by chronic inflammation can also reduce the likelihood of ending up with chronic back pain is now being supported by more research. Use your New Year’s resolutions to change your body from a looming forest fire to a calm, soothing, and healthy forest that keeps the camp fires in check!
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About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…