Interpreting back pain: disease or telltale symptom?
In recent decades, pain management has escalated from health issue to health emergency, both for its high incidence and its socio-economic impact on the population of Western countries. Back pain in particular is one of the main causes of demand for diagnostic-therapeutic intervention, with severe social and financial repercussions.
This condition was traditionally attributed to anatomical causes involving structures like the intervertebral discs, articular facets or highly-innervated ligaments located in the area where pain is perceived. According to this simplified approach, overweight-related functional overloads, incorrect posture and a sedentary life or excessive physical exertion were responsible for painful symptoms. Our understanding of back pain was brought a step forward by the identification of neuro-motor alterations in core muscles as a possible cause of pain, in the absence of anatomical alterations. The truth is, though, that the extensive research in this area has so far been inconclusive, failing to identify both the definitive causes of back pain and the most effective therapeutic strategy.
However, the perspective widens dramatically if we consider back pain in terms of co-morbidity rather than as a condition in itself. This means that when we identify and take into account concomitant pathologies that affect physiological functions at various levels (metabolic, anatomical and psychic), we become capable of addressing back pain from a holistic perspective which goes beyond the mere study of the body area affected by pain. More often than not, patients with back pain syndrome also suffer from apparently unrelated conditions like widespread pain and stiffness, anxiety, digestive, sleep or mood disorders or chronic fatigue.
This might explain why research in this field seems to demonstrate greater results associated with practices such as yoga and acupuncture than with various physiotherapeutic approaches.
By looking beyond the limited scope of a symptom-oriented medical approach, we discover that back pain is often associated with other conditions that have a gastroenterological (e.g. irritable colon syndrome), gynaecological (e.g. endometriosis), rheumatological (e.g. fibromyalgia) or psychiatric (e.g. anxiety or depression) origin, rather than an orthopaedic one.
In this context, gastro-intestinal disorders are of particular interest to us because of their high incidence, impact and possible consequences in terms of safer food choices – both on individuals and society. The decisive role of the human microbiota (the community of symbiotic bacteria living within our organism) in determining a person’s state of health or disease has been scientifically acknowledged and demonstrated. Nowadays, diagnostic tools are already available for the analysis of intestinal microbial populations. In many cases, results can, especially if integrated with a personalised clinical evaluation, facilitate a cause-oriented therapeutic path that may not only treat back pain effectively, but also improve or cure other conditions of which the patient might or might not be aware, like hypercholesterolaemia, hypertension or digestive disorders.
Written by MD Sergio Veneziani, Specialist in surgery, orthopaedics and traumatology