PureInsight | February 27, 2003
[Pureinsight.org] When a person suffers from debilitating lower back pain, a torn vertebral disc is often pinpointed as the cause, and physicians frequently turn to invasive surgery to correct the condition. But a new study indicates that these tears can be found in lots of people, even those who have no trouble twisting, turning and bending. The results suggest that the duration and severity of the pain may have as much to do with the patient's state of mind as with the presence of a damaged disc.
"For better or for worse, the identification of a certain kind of torn disc has been one of the main tools used to diagnose the cause of lower back pain, and now it looks like it's a false start in many patients," said Eugene Carragee, MD, an associate professor at Stanford University and the lead author of the study.
This study may revolutionize the way physicians diagnose and treat back aliments. Medical care for the lower back is an increasing concern in the United States and other countries. Carragee estimates that up to five percent of the working population in the United States is disabled by lower back pain on any given day. Medical treatments and disability expenses related to this condition cost up to $150 billion each year in this country alone.
Until now, tears in the vertebral discs that cushion the spine have been thought to be the culprit for most of these lower back pain complaints. Tears in the flat saucer-shaped discs can appear as bright areas, or "high intensity zones" on a magnetic resonance imaging (MRI) scan. The presence of a tear is confirmed by a discography, in which a physician injects a dye into the suspect disc. Until now, physicians have thought that the identification of a high intensity zone coupled with discomfort during a discography confirmed that the damaged disc was the source of the patient's back problems, and planned their treatment accordingly.
But when the researchers completed a rigorous comparison of the MRI and discography results of 96 patients with known risk factors for disc degeneration, they found something surprising. People whose discs had high intensity zones were only slightly more likely to experience back pain during normal activity than those without obvious disc problems. Additionally, high intensity zones were found in 25 percent of people who -- despite their known degenerative disc disease -- had no corresponding symptoms of lower back pain.
The research team concluded that the presence of the high intensity zones, and thus torn discs, doesn't automatically mean that the patient is experiencing pain during everyday activities, or that they will feel pain during a discography. This suggests that not every disc tear is painful, and not all low back pain results from a damaged disc.
A better predictor of pain, they found, is an abnormal result on psychometric testing administered to all the study patients before the examinations. They found that people with poor coping skills or who have ongoing workers compensation claims or personal litigation related to a back injury are more likely to perceive discography as painful and to have symptoms of lower back pain during their daily activities.
Carragee believes it is vital to the patient's recovery to get to the true root of the problem, which may have both physical and emotional dimensions. It is especially important to avoid unnecessary, invasive and expensive treatments, such as back fusions, that reinforce the perception that the patient has a grave disease of the spine, he said.
In contrast, Carragee has found that many patients respond well to reassurance and an active physical fitness program, which can improve both their back pain and sense of well being.
From this, we can see that whether a person feels he is in pain or not is not only related to his physical body. It is related to the way that he approaches life and handles situations in life. Mind and matter are one. Living simply and being happy with what one has are good ways for one to maintain one's health.
The Chinese version is available at: http://www.zhengjian.org/zj/articles/2003/1/24/20159.html