Is Back Pain Genetic?

There’s been a lot of talk in the press (BBC, The Telegraph, Yahoo, Medical News Today, etc.) this week about finding the gene that causes back pain. So now back pain can be added to a host of other inherited conditions such as obesity, depression, cancer and diabetes. Before I give my opinion, I’d like to specify exactly what recent research has found. The study was carried out at King’s College London and was published this month in the Annals of Rheumatic Diseases. They found an association between the PARK2 gene and lumbar disc degeneration (LDD). The PARK2 gene switches off in people with LDD. LDD is the progressive dehydration of lumbar discs leading to disc space narrowing and osteophyte (bony spurs) growth. It is thought to be a common cause of low back pain (LBP).

It’s interesting to note however, that only 5 % of the population is affected by LDD but over 80% of people will have an episode of LBP at some time in their lives. Also, lots of people diagnosed by MRI scan with LDD have not experienced low back pain…strange? The obvious conclusion is that most LBP is not caused by LDD. Now, let’s look more closely at the relationship between the PARK2 gene and LDD. Does having the PARK2 gene automatically lead to disc degeneration? No! The PARK2 gene has to be switched off for that to happen. What switches it off? That there is the million dollar question, and it hasn’t been answered to satisfaction. The researchers have alluded to environmental factors such as lifestyle and diet. This is starting to sound familiar…could this be the old ‘nature vs nurture’ debate again?

Epigenetics explains how genes can be switched on and off. It’s the study of mechanisms by which the environment controls gene activity. “These mechanisms can enable the effects of parents’ experiences to be passed down to subsequent generations eg. paternal grandsons of Swedish men who were exposed during preadolescence to famine in the 19th century were less likely to die of cardiovascular disease, if food was plentiful, then diabetes mortality in the grandchildren increased” (Wikipedia).

Being told that we have a gene for x, y or z disease can lead to a helpless condition where we believe we have no control over what happens to us and so we gloomily go down a predestined path. “I can’t do anything about it, it’s in my genes.” Incidentally, self-fulfilling prophecies can come into play here. On the other hand, epigenetics puts us firmly in the driver’s seat. We can control our environment by controlling what we do, how we think, what we eat, drink, etc. It empowers us to write our own scripts. Gattaca is a beautiful example of this…I know it’s only a film but wasn’t it good!

Coming back to LBP, nothing has changed. Acute back pain is often caused by physical factors such as poor lifting technique, twisting, and prolonged sitting. Whereas with chronic back pain, there is the added contribution of mental, emotional and social factors. The good news is that whether it is acute or chronic, there are lots of things that can be done to prevent, treat and manage low back pain.

Mindfulness Changes Pain

I read an interesting passage in ‘Mindfulness’, Ellen Langer’s insightful book on social psychology.

“Patients are often certain that pain is inevitable in a hospital. Caught in such a mindset, they assume that, without the help of medication, pain cannot be controlled. In our experiment, we tried to learn whether people could control their experience of pain by putting it in a different, more optimistic context.

Patients who were about to undergo major surgery were taught to imagine themselves in one of two situations: playing football or preparing for a dinner party. In the midst of a rough skirmish on the football field, bruises are hardly noticed. Similarly, cutting oneself while rushing to prepare dinner for ten people who will be arriving any minute might also be something one would hardly notice. In contrast, a paper cut suffered whilst reading a dull magazine article quickly becomes the focus of attention. Through examples of this sort, participants in the study were taught that, rather than being inevitable, much pain we experience appears to be context-dependent.

Hospital staff, unaware of our hypothesis, monitored the use of medication and the length of stay for the participating patients in the experimental group and in the control groups. Those patients who were taught to reinterpret the hospital experience in nonthreatening ways took fewer pain relievers and sedatives and tended to leave the hospital sooner than the untrained patients. The same hospital experience seen through psychologically different eyes is not the same experience, and the difference could be measured in lower doses of medication and quicker recoveries. This reappraisal technique effectively loosened the hospital mindset and, by showing that pain was not a certainty, gave the participants more control over their convalescence.”

This experiment clearly demonstrates that changing our mindset can change our experience of pain!

Shaun

“I saw Gauthier after being involved in a major motorcycle accident and had big problems with my shoulder and thumb afterwards. I had restricted movement in my shoulder and weakness with my thumb and grip strength. Gauthier gave me a course of acupuncture and ultrasound which worked wonders. I was a bit sceptical about the benefits of acupuncture, and whether it would actually work, but I can honestly say the improvements are remarkable. After only one session of acupuncture I had increased movement in my shoulder, and after several more sessions I had full range of motion in my shoulder back, and had retained the strength in my hand. Gauthier has a pleasant nature to him and puts you at ease during sessions, and is very easy to talk to. I would highly recommend Gauthier!”

Acupuncture NICE For Headaches

The National Institute for Health and Clinical Excellence (NICE) has released its first clinical guideline on how to diagnose and manage headaches. It differentiates 4 types of headache: tension-type headaches, migraines, cluster headaches and medication overuse headaches. NICE recommends acupuncture as a treatment option for tension-type headaches and it says we should “consider a course of up to 10 sessions of acupuncture over 5–8 weeks for the prophylactic treatment of chronic tension-type headache”.