PNBC Research & Information
The Mystery of Spinal Pain
This page is designed to help you learn as much as possible about spinal pain. Because the source of back and/or neck pain is often obscure, confusion reigns. Every doctor or therapist has a different opinion about the source of your pain and what to do about it. In this environment your education about spinal disease is even more important.
Here is something you need to know: About 85% of the time, an exact source of back pain cannot be identified. Here is what the New England Journal of Medicine says:
Perhaps 85% of patients with isolated low back pain cannot be given a precise pathoanatomical diagnosis. The association between symptoms and imaging (e.g., MRI, Xray, CT) results is weak. Thus, nonspecific terms such as strain, sprain, or degenerative processes, are commonly used. Strain and sprain have never been anatomically or histologically characterized and patients given these diagnoses might accurately be said to have idiopathic (source is unknown) low back pain.
If this is true, why is it that every time you see your doctor or chiropractor or therapist, you get told where the pain is coming from…… "You have a degenerative disc", "Your back is out of alignment", "Your hamstrings are tight causing the pelvis to tilt causing your back to compensate", "You have arthritis", "You have the back of an 82 year-old", “You have fibromyalgia" (click for more information about fibromyalgia).
Here's why: Most people go to the doctor for answers. They want to know what is wrong and what can be done. They don't want to hear the doctor say "I don't know." Moreover, doctors don't like to say "I don't know." They like to give patients what they want. With this dynamic firmly in place it is not surprising that an answer emerges.
But that answer is most often a guess. An educated guess, perhaps, but a guess nonetheless about 85% of the time.
In the 1990s the US government, in response to rapidly increasing costs for spinal pain (estimated at more than $100 billion yearly in the US alone), convened the Agency for Healthcare Policy Research to study the subject. The group was composed of researchers from some of the most prestigious universities in the country. They produced a report that included the question:
What do the following terms have in common?
| Annular tear |
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| Internal disc disruption |
| Spondylosis |
| Degenerative joint disease |
| Fibromyalgia |
| Adult spondylolysis |
| Subluxation |
| Lumbar disc disease |
| Back sprain/strain |
| Myofasciitis |
| Facet syndrome |
| Osteoarthritis |
Their answer?
"These terms are commonly used to describe the cause of low back pain. However, scientific studies have not been able to show a connection between these diagnoses and back symptoms."
This doesn't mean that none of these conditions can cause back pain. It simply means that we have not been able to prove it. It means that you may have degenerative disc disease or arthritis or spondylolisthesis visible on a scan or x-ray but those abnormalities may have nothing to do with your pain.
Fortunately, there is still an approach that makes sense. After a good initial evaluation, the physician makes a sure you don't have something serious such as a tumor, infection, new fracture, pancreatitis or peptic ulcer disease (these can masquerade as back pain), rheumatoid arthritis (or one of its many variants), etc. This may require an imaging study but often it does not. Next, are you one of the 15% of patients with a definable source of pain (for example a limbar disc herniation causing leg pain)? If not, you fall into the 85% group-those patients with nonspecific back or neck pain.
These patients often have symptoms of pain or tingling into the arms or legs (What is referred pain? Go to question 4). But the exact pain generator is obscure.
It is hard to live with uncertainty. But that is where the current state-of-the-art is with spinal pain.
One piece of good news is that exercise seems to be effective regardless of the diagnosis (click here for reference). As patients get into better condition, they usually feel better and are able to do more. The evidence is pretty clear on this point: Rest and inactivity don't work on chronic spine pain. Instead, inactivity promotes diffuse atrophy, stiffness, and more pain in a downward spiral.
For those contemplating an exercise program a few key points need to be made. First, "effective" exercise for chronic spinal pain is not easy - it requires real effort and patience.
Some get worse before they get better. Nevertheless, even if the pain increases initially, patients, provided they are properly supervised, rarely cause any harm to the spine. A neck or low back that has been painful for a long time can be likened to a rusty gate. The first few swings are creaky and lurching. A few more swings and the movement gets easier. More swings eventually lead to a smoothly functioning gate. Spinal movement against resistance is like adding oil to the rusty gate.
Maybe the most important result from strengthening the neck or the low back relates to recovery time. Even a spine optimized for strength, flexibility, and endurance can experience pain. But recovery is much faster. For example, after a large snowfall you grudgingly pick up a shovel and head out to battle the latest 12 inches. You get sore. But you have been diligent about maintaining your spinal fitness so the next day you are back to normal. A weak, stiff spine cannot recover like a strong, flexible one.
Below are a few conditions you may have heard about but don't fully understand. Most respond well to the right kind of exercise. Don’t be alarmed if your PNBC physician has a different opinion than what is expressed below. Our opinions are based on our experience in treating over 75,000 patients and on our interpretation of the scientific evidence. However, we want all patients to be as informed as possible so they can be active participants in their own care. As stated above, there are great differences of opinion about matters pertaining to the spine. Digesting the information below will help you to ask better questions and wade through what can often be a confusing picture.
Spondylolysis/ Spondylolisthesis
http://www.spine-health.com/topics/cd/spondy/spondy01.html
spinal stenosis
http://www.spine-health.com/topics/cd/spinsten/stenosis/sten01.html
http://www.spine-health.com/topics/cd/scheuermanns/scheu02.html
http://www.spine-health.com/topics/cd/scoliosis/scoliosis01.html
Degenerative disc disease
http://www.spine-health.com/topics/cd/degen/feature/w_degen01.html
http://www.spine-health.com/topics/cd/d_difference/diff01.html
Sacroiliac joint dysfunction
http://www.spine-health.com/topics/cd/sjd/sjd01.html
Spinal abnormalities such as an extra lumbar vertebra or an extra sacral bone
http://www.spine-health.com/topics/anat/confusion/confusion04.html
http://www.spine-health.com/topics/cd/overview/lumbar/misc/misc06.html
The purpose of this section is to educate readers so they can make a more informed decision about their own care. Don't just be an observer. Be an active participant. Ask a lot of informed questions. There are many different treatments for spinal pain. Arm yourself with knowledge before you make your choice.
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