Low back pain 4- Brain

We have further evidence that there are central neurological changes in individuals with chronic low back pain.  In this study, researchers found that in people with chronic low back pain, there was a decrease in gray matter in both the thalamus and prefrontal cortex.  The authors go on and state, 

"We hypothesize that atrophy of the brain circuitry involved in pain perception may dictate the properties of the pain state, such that as atrophy of elements of the circuitry progresses, the pain condition becomes more irreversible and less responsive to therapy."

In other words, the longer you have pain, the more that pain will establish itself as a regular part of your life by "rewiring" your brain.  At the very least, research like this suggests that in order to ameliorate low back pain, we must not only correct your peripheral structures (muscles, joints), but also address the brain.

Other experts agree with this idea.

"There is increasing evidence that chronic pain problems are characterised by alterations in brain structure and function. Chronic back pain is no exception. There is a growing sentiment, with accompanying theory, that these brain changes contribute to chronic back pain..." Man Ther. 2010 Jul 23. [Epub ahead of print]

Where does this leave us?  It suggests that everything we know about maintaining the health of your brain applies (to varying degrees) to chronic low back pain.  Brain research has exploded in the past 2 decades and we now recognize a variety of mechanisms to compromise the brain; inadequate nutrition, oxidative stress, stress hormones, lack of sleep, environmental triggers, gluten (to those who are sensitive), lack of exercise and so much more!  

There is truth to the thought that low back exercises will aid in brain function.  However, if those exercises are performed and the brain is then swamped with a Happy Meal (and the saturated fat, blood sugar surge, oxidative components, noxious chemicals, trans fats etc.) as you drive home from your physical therapy session, you are working against yourself.   Your are trying to re-wire the brain with the exercises, and then proceeding to assault it with your diet.  Food and low back pain are related.

In the next post, we will address other metabolic perspectives on low back pain.