WHY DO WE GET SUCH HORRIBLE PAIN?
MOST OF US EXPERIENCE SOME SORT OF BACKACHE NOW AND AGAIN. THE PAIN IS USUALLY A BRIEF NUISANCE, BUT FOR SOME, THE BACK PAIN CAN BE THE BANE OF THEIR LIVES, WITH CHRONIC, INTRUSIVE PAIN RUINING THEIR QUALITY OF LIFE.
WHY DO SOME OF US SUFFER MORE THAN OTHERS?
The Pain is in the Brain
First of all, if something causes pain and the pain continues for a while, the brain structurally adapts to accomo-date the chronic pain, with the grey matter of the brain tissue in the thalamus (an area of the brain associated with interpreting pain) shrinking in proportion to the duration of the chronic pain (ref Apkarian, 2004). The pain itself has caused us to adapt to the pain in a negative way due to the brain changes. The changes influence our sleep, our mood and the ability to make decisions. The good news is that the brain changes associated with chronic pain appear to be reversible when the pain is removed. But until then, chronic pain sufferers really do suffer more than others.
Inherited Pain Syndromes
There are also inherited genetic mutations which can cause pain syndromes, such as a syndrome called “Extreme Pain Disorder” and ‘Erythermalgia’.
Sometimes, pain can re-wire itself into a continuous feedback loop, so that even when the cause of the pain has been removed, the pain symptom continues anyway. This may explain why some people have persistent pain despite seemingly successful surgery for a definable problem causing back-related pain. This persistence of pain without a pain source appears to be related to a genetic variant of the COMT enzyme, which is involved with pain sensit-ivity and response to pain killers. The influence of the COMT enzyme can literally dictate whether an operation is likely to help the back pain (Day, 2010).
Finally, a pain perception experiment involving 202 volunteers demonstrated a spectrum of pain sensitivity to cutaneous and deep noxious stimuli. There was a strong association between COMT expression and pain sensitivity in this study, and broad variation in pain sensitivity among the normal volunteers tested was seen (Diatchenko, 2005).
There’s no doubt that certain lifestyles encourage bad backs, such as smoking, being overweight and not being physically active. Also, if we stop smok-ing, get a normal body mass index by losing weight and motivate ourselves into being physic-ally active, we can make our backs feel a lot better (despite the initial horrible pain when we first start moving!).
To blame back pain on worn discs is very contro-versial. Many believe that worn discs are the same as having grey hair and simply represent maturity.
A worn disc, however, can predispose to the disc bulging and pressing against spinal nerves, which in turn can cause problems like sciatica. So, having worn discs can increase our risk of getting a defin-able back problem like a disc prolapse/slipped disc.
Back pain itself, as a symptom, doesn’t seem to run in families according to research but, on the other hand, having worn discs appears to be hereditary to some extent. There are genes such as COL11A1 which are associated with worn discs when the gene is underactive (Min, 2009). Similarly, people with a variant of the SKT gene are more prone to having disc bulges which require surgery for pain management (Karasugi, 2009).
Nature and Nurture
So, while it is true that some people inherit a vulnerability to the shock-absorbing discs becoming worn prematurely, the actual problem of back pain is not inherited. We come back to the Nature and Nurture story, where nature may make us more prone to developing back problems, but if we look after our posture, keep active and avoid damaging habits such as smoking and eating too much for the amount that we move, then we should not develop back-related pain. If we develop pain, however, the amount of pain we feel appears to be inherited. We may be lucky and experience little in the way of pain, or we may be very unlucky and actually have an inherited pain syndrome, where even very small pain stimuli are perceived as severe intrusive pain. If we develop chronic pain, it appears that the chronic pain changes the brain so that other functions are affected as well, including sleep problems and the ability to make decisions. There doesn’t seem to be any way that we can influence this aspect of how we process pain, unfortunately, but at least we can take comfort in realising that if we tend to have a very low pain threshold, this is a recognised and inherited situation and has nothing to do with “being a wuss”! What we inherit is truly beyond our control, but how we maintain ourselves to get the best out of our backs (and our lives) is our own responsibility.