For some people, back pain is a daily occurrence that drastically affects their quality of life. For others, it may be an intermittent nagging problem that pops up occasionally, often without rhyme or reason.
If you are like me, you may have thought that back pain was always a mechanical or structural type of problem — something is broken down in the back that hurts.
We talk about it as a mechanical problem: “I was moving a piano yesterday, and I threw out my back.” (Or, more realistically for people that I know: “I was sitting on the couch… reached to grab a blanket and threw out my back.”)
But that isn’t all that there is to the story. It turns out that the majority of people by middle age have disc degeneration. But most don’t have pain from it. Piano movers can move that piano all day long and be perfectly fine; someone else might step off of a curb wrong – and be in pain for months. And yes, your genes are involved.
The spinal column is made up of 33 vertebrae, separated by spongy discs.
In between the vertebra are the discs that are made up of connective tissue. The outer part of the disc is called the anulus fibrosus, which is a tough yet flexible material. The inner part of the disc is called the nucleus puposus, which is more a gel-like material.
The anulus fibrosus is made up of layers of cartilage that is made from type I and type II collagen. The nucleus puposus consists of loose fibers suspended in a gel. This acts like a shock absorber for the spine. The extracellular matrix that makes up the gel is composed of a couple of types of collagen and specific glycoproteins.
There are several different elements at play in back pain:
We are all different in our genetic variants in the genes coding for inflammatory cytokines, collagen formation, and autophagy (the cleanup and recycling of cellular waste). Back pain can come from a combination of those sources – inflammation, altered collagen in the extracellular matrix, and oversensitive pain receptors. These causes work together – inflammatory cytokines can cause the breakdown of the extracellular matrix of the disc. Excessive autophagy can cause cell death. [ref]
A herniated or slipped disc refers to when part of the nucleus puposus protrudes through the anulus fibrosus. The terminology is a bit misleading here because nothing is really ‘slipped’, more of a bulging in one direction.
Lumbar disc degeneration is caused both by genetics and by environmental or physical factors. Researchers actually estimate that genetic factors are more important than environmental factors.
A lot of people have disc degeneration and don’t know it — they have no pain or symptoms! A study of the MRI’s of 98 people without lower back pain and 27 people with lower back pain showed some interesting results. Of the people without lower back pain, 36% had normal discs. That leaves 74% of people with disc degeneration and no pain! Half of those were bulging discs and about a quarter were protrusions.[ref]
Interestingly, there is a link to bacterial infection and disc degeneration. Researchers had suspected for more than a decade that a portion of diseased discs was due to chronic infection from Propionibacterium acnes. (This is one of the bacteria that causes acne on the skin.) There have been quite a few studies showing this, but there was always a question of whether the bacteria could have been contamination from the skin instead of colonizing the disc material. A recent study put this question to rest. It looked at samples of 162 discs from people undergoing surgery for disc herniation. The samples showed that 44% of the discs had bacteria in them, with most of those having the Propionibacterium acnes in them. The samples showed high levels of the bacteria and biofilms having formed in the disc material. [ref]
Some of the same genetic risk variants for acne also increase the risk for disc degeneration (below).
Pain, numbness, and tingling that shoots down your hip and leg can be caused by a herniated lumbar disc pressing on the sciatic nerve. This can be extremely painful and aggravating. Genetics studies using twins estimate that the genetic component of sciatica could be as high as 40%.[ref]
Below are some of the genetic variants associated with disc disease (bulging, herniated, degeneration, and sciatica). Studies in twins show that the ‘heritability’ or genetic component of disc degeneration is between about 34-76%, depending on the location of the degeneration. This is surprisingly high for something that most people think of as a problem associated with injury or due to repetitive use. [ref]
Disc degeneration can be induced, at least in part, by inflammatory cytokines. This basically means that the body’s inflammatory response is overactive and causing a breakdown of the extracellular matrix within the disc. [ref]
The IL1A gene codes for the interleukin 1-alpha cytokine. This gene plays a central role in regulating, or turning up or down, acute inflammatory response.
Check your genetic data for rs1800587 -889C/T (23andMe v4, v5; AncestryDNA):
Interleukin-6 is a cytokine or inflammatory molecule produced by the body as part of an inflammatory reaction.
Check your genetic data for rs1800797 (23andMe v4, v5; AncestryDNA):
Check your genetic data for rs1800795 (23andMe v4, v5; AncestryDNA):
The CILP gene codes for the cartilage intermediate protein. This protein interacts with TGF-B1 in inducing the extracellular matrix proteins.
Check your genetic data for rs2073711 (23andMe v4, v5; AncestryDNA):
This gene codes for type I collagen that is incorporated into the spinal discs.
Check your genetic data for rs1800012 (23andMe v4, v5):
Check your genetic data for rs2276454 (23andMe v4 only; AncestryDNA):
COL11A1 and COL11A2 genes:
These gene codes for a type of collagen (type XI) that is incorporated in the extracellular matrix disc.
Check your genetic data for rs1676486 (23andMe v4 only; AncestryDNA):
Check your genetic data for rs2076311 (23andMe v4, v5; AncestryDNA):
This is an autophagy gene, illustrating that autophagy (the breaking down and clearing out of cellular waste) is important in healthy discs.
Check your genetic data for rs4645978 (23andMe v4 only; AncestryDNA):
This gene codes for a protein called parkin which is thought to play a role in autophagy (mitophagy) and degrading unwanted proteins.
Check your genetic data for rs926849 (23andMe v4, v5; AncestryDNA):
I’m going to assume that if you have back pain, you’ve probably tried various pain relievers (NSAID’s, aspirin) and either a heating pad or ice pack already… Hopefully, you have already looked into stretches and gentle exercise options as well. Instead, this section will focus on some more targeted therapies. This is all for informational purposes only – talk with a doctor if you have questions.
If you have disc disease and your genetic susceptibility lies in the inflammatory genes (IL1A, IL6), there are a couple of things you could try to turn down that inflammatory response.
Photobiomodulation, also known as low-level laser light therapy, reduces IL1B and IL6 levels at some wavelengths. [ref] Note that this is dependent on the wavelength used, with some wavelengths upregulating IL6.[ref][ref] Photobiomodulation seems like a powerful therapy option, but one that needs to be done correctly.[ref][ref]
Curcumin, a natural anti-inflammatory compound, may decrease IL1A and IL6. [ref][ref] You can get curcumin as a supplement or in the spice, turmeric. Google ‘golden milk’ for recipes for a turmeric drink.
Black seed oil, also known as black cumin seed oil and Nigella sativa, contains high levels of thymoquinone. Thymoquinone has been shown in studies to reduce IL-1 and IL-6. [ref][ref] You can buy black seed oil either in capsules or as liquid oil. For pain management in rheumatoid arthritis, it has been shown to be effective either orally or topically.[ref]
If your genetic susceptibility lies with the autophagy genes (PARK2, CASP9), here are a couple of autophagy-related things to investigate:
Resveratrol inhibits mTOR and increases autophagy. [ref] Red wine and grapes are food sources of resveratrol, or you can get it as a supplement.
CBD oil, cannabidiol, induces autophagy in intestinal epithelial cells.[ref]
Luteolin, a flavonoid found in abundance in broccoli, parsley, and celery, was found to activate autophagy after a traumatic brain injury (TBI).[ref]
To be honest, I have no idea what will help with the collagen related genetic variants. Check back later – I’ll keep digging into this topic.
General Back Pain Relief:
Capsacian, the ‘hot’ spice found in chili peppers, has some good research to back up its use for pain. Basically, it de-sensitizes the pain receptors.[ref] A study on a capsaicin 8% topical patch found that pain was reduced by at least 30% in the majority of people with recent back pain onset. [ref] [ref]