Many people are familiar with the term "bulging disc" in regards to lower back pain. It can feel like an intense, sharp, stabbing sensation that can often travel down your leg through your hips and bum, sometimes as far as your feet.
This is a common diagnosis when you start to develop back pain. You get a scan which shows changes in the disc, and the pain matches the effected nerve area. It can be a scary diagnosis.
But you may be surprised to know that a lot of people who don't have pain have also been found to have changes in their discs. I find this study to be really encouraging, because it shows that people who have significant changes to their disc structure can still live a painfree life. It suggests that the disc changes may have already been there for some time before any painful symptoms even began, and gives hope that even if the structure doesn't change, that the pain can change.
Lets have a look at this interesting literature review, particularly in regards to the findings around disc degeneration, disc bulges and disc protrusions.
This is a literature review of 33 separate studies that investigated the imaging of spinal degeneration in painfree people ranging from their 20's to their 80's. It was published in the American Journal of Neuroradiology in 2014.
In total, the review takes into account MRI and CT scan imaging on 3110 individuals with no painful symptoms.
As you would likely predict, the number of findings increased with the participants age group, showing age-related degeneration occurs even in people who aren't experiencing pain.
Lets have a look at the imaging results for the disc degeneration, bulge and protrusion categories:
Disc degeneration - changes to the disc and surrounding vertebrae that result in loss of cushioning and support, may include signs of osteoarthritis at the joint.
Disc degeneration in painfree participants was identified in:
Disc bulge - changes that alter the shape of the disc and can make portions of it "bulge" out of place, which can apply pressure to nearby nerves.
Disc bulge in painfree participants was identified in:
Disc protrusion - changes to the annular membranes around the disc allows the disc nucleus to protrude and apply pressure to the nerves.
Disc protrusion in painfree participants was identified in:
What does this mean for your bulging disc?
It means that theres a good chance that your structural changes were already present before your back became painful. The area may be irritated or flared up right now, but these findings are a good indication that even if your scans don't change, your back pain still can settle down.
It means that a scan showing disc changes doesn't have to be a life sentence of pain.
Does this mean bulging discs DON'T cause pain, then?
Don't get me wrong, bulging discs can be painful, and for some people it can be severe. This study just helps to show us that theres more to back pain that what shows up on MRI or CT scans. Structural changes are just one layer in the complex onion that is back pain.
We can help!
There are lots of ways we can change your experience of back pain through massage and myotherapy techniques like dry needling, taping and support, strengthening the surrounding muscles with exercises that are appropriate for you, and supporting your understanding of how your back functions.
Book a time to come see us to talk about your back pain and creating a treatment plan to reduce it.
Last week, I shared a bit about four interesting studies that look at pain. But I couldn’t stop at just four! So today, we’ll look at another four of the latest studies around how pain works, and what we can do about it.
Mindful people experience less pain
Some people just don’t seem to experience pain as much as others. One study has suggested that part of the reason why is mindfulness.
What is mindfulness? It’s being in the present moment, rather than the past or future. When you are mindful, you are an observer of your experience rather than reacting with emotions and judgements.
76 volunteers with varying levels of innate mindfulness took part. Their brains were scanned as they were exposed to painful heat of around 49 degrees Celcius (aka a typical Aussie summer day, right?)
The scans reveal that people who were more mindful did not activate an area of the brain called the posterior cingulate cortex as much as those who were less mindful. Those who reported high pain levels had a greater activation of the cortex.
The researchers concluded that mindful people are less caught up in the experience of pain.
You can’t change your in-born level of mindfulness, but there is other research that suggests that mindfulness practices can help with pain. This might explain why!
Being hungry shuts off perception of pain
Pain is a valuable experience for the human body. Without it, we would damage our bodies without realising the consequences! But chronic pain can lead to lethargy and exhaustion. So what if nature gave us a way to suppress chronic pain temporarily?
Turns out, nature might have done just that. Researchers have pinpointed a group of 300 brain cells that prioritise hunger over chronic pain. They found that hungry mice would respond to acute pain, but were less fussed about longer-term inflammatory pain compared to well-fed mice.
Further experiments revealed that the neurotransmitter NPY can block the inflammatory pain response when needed. This is a new area for more research, but it could reveal ways to inhibit chronic pain without shutting off acute pain.
'Tuning' the brain can alleviate pain
Previous research has found that alpha waves are associated with relief of pain from a placebo effect, and can influence how different parts of the brain process pain. So researchers looked into whether ‘tuning’ the brain to alpha waves can reduce pain.
The experiment involved flashing light or playing noise that were in the alpha range. Both of these interventions significantly reduced intensity of pain. The researchers are now looking into how effective these are for different pain conditions.
It’s early days. But soon, you could be watching YouTube videos or listening to meditations in the alpha range that are able to reduce your pain!
Does an exploding brain network cause chronic pain?
Hyperactive brain networks could be why people with fibromyalgia experience hypersensitivity. Their brain networks are primed to react with rapid and system-wide responses to minor in response to minor changes. This is known as explosive synchronisation.
The researchers looked at the electrical activity of women with fibromyalgia. There was a strong correlation between the hypersensitivity of the brain and the intensity of pain reported by the women.
This suggests that a chronic pain brain is electrically unstable and sensitive. So the next time someone asks you about your fibromyalgia, tell them it’s your exploding brain network!
In case you haven’t figured out, supporting people with chronic pain is my passion. If you’re looking to work with a health professional who will work with you on your journey to recovery, book a myotherapy appointment today.
It’s no secret that I’m a bit of a research geek. Scientists everywhere are exploring the experience of pain and how we can alleviate it. So I thought I’d share some of the most recent findings about pain.
Some of these you might be able to apply in your daily life. Some you might like to share with your healthcare providers. And some are just interesting to know!
Men and women remember pain differently
Scientists have theorised for years that chronic pain is related to memories of earlier pain. One team has found that men remembered a previous painful experience quite clearly. This made them hypersensitive when they were returned to the location of that experience. On the other hand, women were less stressed about their experience.
The same researchers did the same experiment on mice, and ‘blocked’ the memories of male mice. When they ran the experiment with the blocked mice, they did not show signs of being stressed by the previous pain.
The brain cells that make pain unpleasant
If you step on a sharp object, your nerve cells in the brain tell you two things – there’s a piercing sensation in your foot, and that it’s not a nice feeling. But a team of scientists have discovered the brain cells that tell you all about that not-so-nice feeling – these brain cells are responsible for the negative emotions of pain.
In an experiment with mice, they were able to identify a group of neurons in the basolateral area of the amygdala (often called the fear centre of the brain). When the mice experienced pain, these neurons would fire.
But when this bundle of neurons was turned off, the mice didn’t experience the discomfort of pain. They were still able to feel and respond to sensations, but pain was no longer unpleasant for them.
Pain as a self-fulfilling prophecy
Have you ever flinched at something that you expect to hurt? The latest research suggests that you probably will feel pain, even if it doesn’t cause pain. Say what?
If you expect pain, your brain will respond to that pain. Researchers scanned the brain of people who were exposed to low heat and high, painful heat. The participants were shown cues to suggest whether the heat was going to be low or high. When the heat was applied, they rated their pain.
But what they didn’t realise was that the cues didn’t always correlate to the heat they received. When they expected high heat, brain regions around threat and fear were activated while they waited. When the heat was applied, there was more activity in the pain regions of the brain – even if it was a low heat.
This may be part of why chronic pain lasts long after the damage to tissue has healed.
Genes associated with chronic back pain discovered
Chronic back pain is actually the number one cause of years lived with disability world-wide. So scientists are looking at all of the factors that might contribute to it. Recently, researchers have uncovered three gene variations that are associated with chronic back pain.
The study looked at the genes of 158,000 people, including 29,000 that had chronic back pain. Then they looked for the genes that popped up for those with chronic back pain.
One gene variant, SOX5, is involved with development of the body in the womb. If it’s turned off, it causes defects in cartilage and bone formation. A second gene that was already associated with disc herniation was linked to chronic back pain. The third was a gene that plays a role in the development of the spinal cord.
This might not cure your chronic back pain, but it does help researchers to pinpoint the structures and processes involved. In the meantime, make sure you get yourself booked for a myotherapy session!
There were so many interesting research papers that I have pt 2 coming up next week! If you don’t want to miss out, make sure you’re following my Facebook page. There, I share tips, info and insights into chronic pain management and myotherapy.
Mel is a Myotherapist based in Ferntree Gully.