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.

An Integrated Approach To Low Back Pain Improves Results

An article in Medical News Today reviews a study in The Journal of Alternative and Complementary Medicine on the treatment of low back pain. A combined program of complementary and conventional therapies was found to be more helpful than the usual care provided by the primary care physician. The benefits of the program were a decrease in pain and an improvement in function. The complementary therapies provided included physiotherapy, acupuncture, massage, mind-body techniques, chiropractic and nutritional advice. Healing in Motion in St Albans aims to treat musculoskeletal disorders using a holistic, integrated approach.

Low Back Pain: When To See Your Doctor?

The BBC News-Health webpage currently links to the BBC Health site. The title of the link is “Back-pain danger signs, Symptoms to take straight to your doctor”. I followed it, read through the information and found it incomplete. In my opinion, a few things could be added to the list, but before adding anything…it’s important to bear in mind that the vast majority of low back pain is trivial and usually disappears after a couple of days or weeks. In a very small minority of cases the low back pain is a sign of something more serious. You should make an appointment to see your doctor if your back pain is associated with:

• Significant trauma (such as RTA or a fall)
• Osteoporosis
• Prolonged use of corticosteroids
• History of cancer
• Unexplained weight loss
• Fevers
• History or high risk of decreased immune response (AIDS or HIV, recreational drug use, steroid or immunosuppressant use)
• Unremitting pain (even when lying down)
• Neurological symptoms (urinary incontinence or retention, fecal incontinence, loss of sensation in the genital region, weakness or loss of sensation in the lower limbs)

Please note that the signs and symptoms listed above don’t automatically mean that something sinister is at hand but simply that further questioning and examination is required. Lastly, remember that the overwhelming majority of low back pain is insignificant…apart from the inconveniencing pain obviously!