The Pain Mystery
It’s an incredible thing; Americans spend up to 600 billion (billion with a B) dollars to treat pain. Almost 30% percent of people with pain have low back pain and about 25% of them have chronic low back pain.
Low back pain is common and not well understood. Sound familiar? Low back pain may have connections to FM and ME/CFS
You’d think with that many people in pain we’d be pretty far along in understanding low back pain, but it’s just the opposite. The scans don’t line up, the exams don’t lend a clue. It’s a big mystery and it’s a mystery that could have implications for fibromyalgia, chronic fatigue syndrome and other pain disorders.
These mysterious chronic pain sufferers may be the fibro patients of the back.
“Currently we know very little about why some patients suffer chronic low back pain,” said Debra Babcock, M.D., Ph.D., a program director at NINDS.
The same question applies to chronic low back pain that applies to ME/CFS, FM, IBS, post-cancer fatigue, etc.. Why while person makes it through an infection, injury, stressful event, cancer treatment, etc. and moves on with their lives while remain stuck in in pain and fatigue.
The Study
These researchers did something very similar to what the Dubbo researchers did with chronic fatigue syndrome years ago; they took a bunch of people with a new case of, in this case tested them early and then tested them later to try and figure out why one group got sick while the others didn’t.
In this case, researchers took people with a recently onset of low back pain scanned their brains with a diffusion tensor imaging machine, followed them for a year and and scanned their brains again.
Results
Different Brains Early on
“The hypothesis (is that)..the propensity to pain chronification is an a priori disposition awaiting an inciting event” Authors
The astonishing thing about their findings was not that the brains of the people who developed chronic low back pain were different after a year, but that they were different from day one.
Their brains appeared to be set up to, when the right trigger hit, to start producing chronic pain, perhaps for the rest of their lives. The startling suggestion is that people who are largely symptom free may nevertheless be undergoing changes that cause their systems to become chronically unbalanced at some point.
This study suggests overactive connections between some parts of the brain predispose people to pain..Similar connections were found to be upregulated in a GWS study.
This kind of internal system set up may not be unusual in chronic illness. The stage appears to be set for autoimmune disorders years before many people become ill. People with ME/CFS often appear to go through a string of infections which they recover from before a last one finally tips the balance. People who later come down with Alzheimer’s appear to have abnormalities that long precede the actual disease.
This study found that the white matter which forms the connections between different parts of the brain was altered from the beginning. An analysis concluded that white matter changes occurring prior to or early in the pain process could predict 80% of those who came down with long term back pain. The high degree of predictability astonished the researchers.
Specifically, the connections between the nucleus accumbens in the back of the brain and the medial prefrontal cortex in the front of the brain were different. If you’re still thinking this is all about low back pain consider that Baraniuk’s recent Gulf War Vets found increased activity in the similar but a bit different tract that ultimately extends to the nucleus accumbens as well. Batraniuk concluded that one part of the PFC connection was ‘intimately associated with the severity of fatigue’. It may be that different parts of this major nervous system circuit determine how much pain and fatigue we feel.
Aging Brains
Interestingly, given Dr. Newton’s findings of similar problems with blood pressure regulation in people with ME/CFS and fatigued elderly people this study found evidence of accelerated aging had taken place in the brains of people with chronic low back pain.
One possible clue is that the connectivity in the prefrontal regions of the people who came down with chronic pain was similar to that found in people who were no less than 30-50 years older.
Predictive
“We were surprised how robust the results were and amazed at how well the brain scans predicted persistence of low back pain. Prediction is the name of the game for treating chronic pain.” Dr. Apkarian
The fact that genetics appears to explain from 75-90% of the differences in white matter in the brain suggests a brain that was hardwired, at some point to produce ongoing pain once the necessary trigger occurred. The high heritability of white matter is intriguing given the high degree of heritability found in ME/CFS and FM relative to other disorders.
Are chronic pain and fatigue sufferers set to to fail before they became ill? This study suggests they might be.
White matter abnormalities have been found in other ‘neurodegenerative’ diseases, and the disorders they listed was highly informative; they included chronic regional pain syndrome, fibromyalgia, temporal mandibular disorders, cluster headache and IBS. (Given Baraniuk’s recent results they could have included GWS in there.)
These findings clearly suggest chronic back pain may fit in the same kind of disease spectrum as fibromyalgia, chronic fatigue syndrome, GWS and other disorders. It’s not that the same patterns of connectivity shows up, but that unusual patterns of connectivity consistently show up in these different disorders. They are all, at least in part, brain or ‘neurodegenerative disorders’.
“…brain white matter abnormalities reported in diverse chronic pain conditions should be considered as evidence for structural predisposition for developing these specific chronic pain conditions.”
Ultimately this study suggests DTI could be used a sort of predictive screen that could highlight people at risk, not just for low back pain but for all sorts of chronic pain conditions.
Rewiring the Brain?
If some parts of the brain are interacting too intensely for the brains own good it may be possible to turn them down using transcranial magnetic stimulation or other therapies. A recent rTMS FM study found therapy was able to significantly enhance FM patients ability to perform daily activities, improve their sleep quality and ‘perceived chronic pain’. More rTMS trials are underway in FM and the technology is improving rapidly.
I had a 7 year period of low back inflammation, initiated by emotional stress. It was preceded by a 7 year period of asthma, which itself began w/ sinusitis, turning into bronchitis. A year and a half ago I learned about pyroluria. It includes all of these symptoms, as well as lists of others. It’s been 10 years since the onset of ME/CFS. Removing gluten and dairy, and adding supplements for pyroluria, and MTHFR, has set me on the path of healing. B12/Mfolate corrections are leading me into the land of wellness. I used many mind-body techniques through all those years, with some positive results. Yet it turned out to be a biochemical deficiency all along.
I have chronic low back pain since my teens.
“Scoliosis” was “the answer”.
Apart from that I was as healthy as anyone can be.
In my late teens I developed headaches in the back of my head. I wasn’t able anymore to lay on a pillow because the area of my head were I rest on, couldn’t tollerate any kind of pressure on it. Not even from a pillow. That’s still the case.
That same period I started having very painful IBS episodes.
In my early 30s I became very ill OVERNIGHT (octobre 2001).
After a year I got a diagnosis: CFS (ME isn’t used over here).
A year after that I was so ill I had to stop working.
Alzheimer’s runs in my family (mother’s side: great-grandmother, grandmother, aunt, and at the moment we all think it’s started for my mum too).
Auto-immune disease is where one of my sisters comes in: vitiligo since she was 18.
Don’t know if all these things are connected.
I only know that when I have gut-pain, my low back pain is even worse.
That’s the only connection I have found.
Defect genetic wiring of our brain (in some of us) … it wouldn’t surprise me at all …
There are quite a few possibilities including Chiari malformation and as Gijs points out bacteria, and her we have changed connections in the brain. I think the soup of possibilities is getting thicker and thicker (if that analogy makes sense :).
Funnily enough I’ve just been reading up on something called ‘laughter yoga’ (which involves a lot of laughing
Funnily enough I’ve just been reading up on something called ‘laughter yoga’ which involves a lot of laughing and next to no yoga.
There are lots of claimed health benefits as per this Huff Post article :
http://www.huffingtonpost.com/2012/05/06/laughter-yoga-benefits_n_1478960.html
The thing is that the nucleus accumbens is involved in anticipating and processing pain and pleasure with reward and motivation also tied up in it (remember the CDC finding that ME/CFS patients didn’t respond to a monetary reward?). Laughter (even forced laughter) increases blood flow and activation of the nucleus accumbens and laughter induced “eustress” may be able to counter distress.
http://findlab.stanford.edu/Publications/Humor_neuron.pdf
Science is increasingly supporting the old notion that ‘laughter is the best medicine’.
Studies have found various physiological effects including increased NK activity and human growth hormone production, reduced cortisol, reduced levels of pro-inflammatory cytokines, increased heart rate variability, improved blood sugar regulation, improved mood and reduced pain.
http://www.worldlaughtertour.com/pdfs/Lee%20Berk-%20Alt-Ther%20Vol%207-2.pdf
http://www.ncbi.nlm.nih.gov/pubmed/22894892
http://www.currentpsychiatry.com/home/article/no-laughing-matter-laughter-is-good-psychiatric-medicine/c450d9ae6b44750f80d5dc9200c2db9a.html
I deliberately set myself down yesterday to a triple dose of Its a Wonderful Life, While you Were Sleeping and Finding Nemo.
All pretty saccharine stuff – but it did feel good!
Happy holidays!
Even forced laughter :)..I love this stuff. I think it’s really good for anyone with a disorder that involves the stress response. Happiness helps!
Thanks!
Lower back pain can be caused by bacteria:
Albert, Lambert, Rollason et. al. Does nuclear tissue infected with bacteria following disc herniations lead to Modic changes in the adjacent vertebrae?, European Spine Journal, mei 2013. DOI:10.1007/s00586-013-2674-z
Albert, Sorenson, Christenen et. al. Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy, European Spine Journal, mei 2013 DOI:10.1007/s00586-013-2675-y
Very interesting finding!
Thanks Gijs 🙂
This is fascinating to me. I had 4 very extensive spine operations since I was 15 yrs old. Each time I recovered well with no back pain at all. I became a mom of 5, a teacher, a long distance runner. At age 38 I had lost the feeling in one leg, with sciatic type pain and loss of bowel/bladder control. Had my 5 th major back surgery expecting that I would have the typical post surgical pain, 6 weeks of P.T., and then I would be good as new. My surgery was planned 4 months out. In the meantime I took my kids ice skating as I had been a figure skater as a teen. A hockey kid buzzed by me knocking me up into the air and I landed on my tailbone which broke, and then my head. My husband says I had an open, fixed gaze, but unresponsive on the ice for 3-4 min before coming around. The tailbone was still sore when I had my 12 hour spine surgery by a well known Neurosurgeon. When I awoke after surgery and tried to move a little, the pain was like nothing I had ever experienced! I wouldn’t let anyone touch me for days. This pain never went away. Ever. Shortly after this I began having symptoms that 7 years later would be diagnosed as ME/CFS. During that 7 years I was trying all kinds of therapy for my back pain-but the therapy would leave me unable to do anything for days afterward. The fatigue got so bad that I could no longer go to any physical therapy.
During these past 25 years, my 4 daughters have been diagnosed with juvenile Rheumatoid Arthritis, severe Crohn’s Disease, Hydretinitis Supulveta, IBS, and all 4 had to undergo IVF to get pregnant.
Does anyone else find this interesting?