While attributing the pain to these radiographic findings is an easy answer, it is not really the full story. By the age of 35, virtually everyone has some degenerative changes in their spine. Further, in several studies of people who underwent MRIs, over 35 percent were told they had a problem with the disk in their spine even though they had no complaints of pain.
So if many people have radiographic evidence of arthritis or disk disease and experience no pain, how can we be certain that the presence of arthritis is the source of the pain in someone who is symptomatic? The plain truth is that we can't.
Oh, My Aching Back!
So often when we go to the doctor with a backache, we are told we have back pain due to strain, sprain or arthritis. This diagnosis is based upon a physical exam or an x-ray that revealed arthritis in the spinal bones or degeneration of the disks between the bones.
One of the best ways to treat the arthritic portion of pain is to give inflammation medicines such as non-steroidal anti-inflammatory (NSAID) drugs, and see if relief follows. These medicines treat many forms of inflammation. If they offer relief and the patient is satisfied with taking medicine, then nothing more may be required. While NSAIDS provide at least a short term answer for many, they have side effects and actually do nothing to fix the problem.
In the spine the bones themselves may become rough, or have an irregular surface. In addition, the facet joints — the portion of the spine where the bones rest upon each other — can develop rough surfaces. The disks — jelly-like donuts that act like cushions between the bones — can lose their fullness and therefore decrease the amount of cushioning between the bones as well.
In more prolonged or severe cases an MRI may have been performed. This study commonly reveals degeneration (drying up of jelly), bulging (too much jelly) or even herniation (jelly outside) of the spinal disks.
As a result, it can be helpful to look at causes other then inflammation when thinking of arthritic pain. This is especially true when NSAIDS do not work at all. One option is to think of arthritis as a door hinge that binds, or has become rough (maybe a bit rusted). In this case whenever the door is used, pain can occur from direct grinding of the bones upon themselves, rather then due to inflammation.
Other pain causing mechanical problems may occur as well. For example, if the doorstop, or bumper, is dried out (like a disk), it will not cushion the hinge well, Alternatively, abnormal function with movement can occur if the hinge is not lined up right (as with facet syndrome) or if the pin that holds the hinge together is weak (such as when ligaments are stretched and do not hold bone to bone properly).
Many other possibilities exist as well. The muscles can go into spasm as they try to protect the painful area from further injury, or the nerve that supplies the arthritic region can develop a short circuit, sending pain signals to it. Other abnormal signals, from either nervous or hormonal origin, can cause an escalating feedback loop that intensifies the pain, or they can make it feel like the pain has spread to other body parts. These are only a few examples of the numerous sources of pain that are often labeled "arthritis."
Can anything Be Done To Prevent It From Getting Worse, Or To make It Better?
By treating all of the structures that surround or affect disk disease, both pain relief and prevention of further deterioration can result. One simple technique is to improve range of motion by stretching muscles that are tight or inhibited, or by strengthening both muscles and ligaments that surround the disk (see Prolotherapy).
If a nerve is irritated, then the muscles that are supplied by it will go into spasm. If these muscles are involved in your pain, then stretching will only provide short-term relief (the nerve must be treated first).
If there is vascular disease, or infection, then medications that improve blood flow or remove infection can provide dramatic relief. When mechanical problems exist, correcting them through mobilization, orthotics or even postural exercise can also be extremely useful.
While it can become quite a task to determine which approach to take, or in what order to apply them, with an experienced, skilled physician these and other options for arthritic back pain may be just what is needed.
