Thoughts and Links on Back Pain

I am going to try to start doing weekly posts that collect some quick thoughts and links from my regular reading. We'll see how this goes. Here are some quick links and thoughts for stuff I read last week.

1. NPR talks posture, culture and back pain

NPR recently ran an article called: Lost Posture: Why Some Indigenous Cultures May Not Have Back Pain. It appeared in my Twitter feed this headline:

"Esther Gokhale traveled around the world to find cultures with low rates of back pain."

I replied:

"I traveled Pubmed to find correlations between posture and back pain: found little or none."

Read here to find the fruits of my research.

I also traveled to Facebook to ask my knowledgeable friends whether it is indeed true that some cultures don't have back pain. My recollection from past reading (including a good presentation by James Steele) is that the evidence on this issue is mixed and poor, and confounded by the fact that many indigenous people consider back pain a normal part of life and not something to complain about.

Consistent with this idea is an interesting study provided by Rob Tyer, stating that:

This study provides evidence that negative beliefs about CLBP and its future consequences among Aboriginal people living in rural and remote areas of Western Australia are influenced by interactions with healthcare practitioners who communicate negative biomedical beliefs [e.g. that pain is caused by structural factors] about LBP to their patients.

In other words, it may be that worrying about posture is more a Western disease than an indigenous cure.

2. Back Pain and Evolution

Speaking of evolutionary perspectives on back pain, Dan Lieberman, author of The Story of the Human Body: Evolution, Health and Disease, came out with a new paper (with the thrilling title "Low Back Pain") asking whether LBP is basically the price of walking upright. Or maybe its more of an "evolutionary mismatch" between our modern environment and a natural envrironment. Good questions, but of course more research needed.

3. New study on spondylolisthesis

According to this new study on spondylolysis, with or without isthmic spondylolisthesis:

There is no strong or consistent association between SL/IS and LBP in epidemiological studies of the general adult population that would support a hypothesis of causation. It is possible that SL/IS coexist with LBP, and observed effects of surgery and other treatment modalities are primarily due to benign natural history and nonspecific treatment effects. We conclude that traditional surgical practice for the adult general population, in which SL/IS is assumed to be the cause of non-radicular LBP whenever the two coexist, should be reconsidered in light of epidemiological data accumulated in recent decades.

I wish my soccer teammate knew about this study before he went under the knife.

4. New study on spinal degeneration in people without pain

Here's a systematic literature review on the many studies showing that non-young people without back pain have lots of damage in their back:

The prevalence of disk degeneration in asymptomatic individuals increased from 37% of 20-year-old individuals to 96% of 80-year-old individuals. Disk bulge prevalence increased from 30% of those 20 years of age to 84% of those 80 years of age. Disk protrusion prevalence increased from 29% of those 20 years of age to 43% of those 80 years of age. The prevalence of annular fissure increased from 19% of those 20 years of age to 29% of those 80 years of age.

Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging-based degenerative features are likely part of normal aging and unassociated with pain.

5. A question about back pain

Here's a question in light of all this info. If you:

• disagree with Lieberman that our backs may not be fully evolved to deal with standing;
• or disagree with Gokhale that back pain results from an "evolutionary mismatch"
• or you believe that back pain has little or nothing to do with tissue damage:

Then what is it about backs that makes them hurt more than say ... fronts? Put another way, if back pain is primarily driven by top-down psychological factors, then why do we go so psycho about low backs?