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Wise Guide Article October 2016

As a pain management doctor for the last 13 years, seeing thousands of patients with lower back pain, I noticed some curious patterns. On one hand, I saw lawyers and accountants, as well as others who did mostly sedentary work, with severe lower back pain and findings of severe degenerative disc disease on their MRIs, and on the other hand I noticed farmers and construction workers, those who did heavy physical work their whole lives, with minimal degenerative disc disease. I wondered how that could be! If degenerative disc disease was just caused by so called “wear and tear” that came from heavy lifting over and over for decades, then one would expect there to be a clear correlation between degenerative disc disease and those who had done heavy work, and we would expect that those that did mostly sedentary work to have less degenerative disc disease. But this was not the case. I then supposed that perhaps those that did the heavy physical work had built up better core muscles and thus protected their spines from wear and tear, and perhaps those who did more sedentary work were less fit, and when they did some minor lifting on the weekends, they injured themselves more. This explanation may hold some validity, but it was still not fully satisfactory to me and I knew there had to be more to the story.

Lower back pain is the second leading cause of disability in the United States, causing an estimated 149 million work days per year lost due to low back pain and correlating 100-200 billion dollars annually lost.1 Cardiovascular disease is the third leading cause of disability, arthritis being the first2, but could there be a correlation between chronic lower back pain and cardiovascular disease? Dr. Kauppila, from Helsinki University Central Hospital in Finland, did a systematic review of all the literature covering this topic and published her findings3 which help to shed light on this subject.

We know that in developed countries, 10% of the population already has advanced atheromatous plaques in the abdominal aorta by the age 20! This disease process rapidly accelerates between the ages 44 and 64. The main blood supply to spinal segments in the lower back comes from blood vessels originating directly from the abdominal aorta (L1-4) or from branches off of the abdominal aorta (L5). Thus, it would make sense that advancing atherosclerosis would affect blood flow to the spinal cord and lumbar discs.

In the literature review, it was found that smoking and high serum cholesterol levels were found to have the most consistent associations with disc degeneration and lower back pain. One study showed that people with blocked arteries to the lumbar spine were 8.5 times more likely to have back pain. Thus, as we step back and look at the overall weight of the evidence, it becomes clear that vascular disease and lower back pain are related. This also helped explain to me why we see the variations in the degree of degenerative disc disease, not just on the basis of how hard somebody worked with their back, but also on how healthful their lifestyle was. This gives us more motivation to follow a heart healthy diet, eating plenty of fruits and vegetables as well as unprocessed whole foods. Now, we can add back pain to the long list of reasons why we should live a healthy lifestyle, avoiding cholesterol laden foods and not smoking.

  1. Freburger, J.K. et al. “The Rising Prevalcence of Chronic Low Back Pain.” Archives Internal Medicine 2009 Feb 9: 169(3): 251-258.

  2. From the Centers for Disease Control and Prevention. Prevalence of disabilities and associated health conditions among adults--United States, 1999. JAMA. 2001;285(12):1571–1572.

  3. L.I. Kauppila. “Atherosclerosis and Disc Degeneration/Low-Back Pain- A Systematic Review.” Eur J Vasc Endovasc Surg. 2009 June:37(6) 661-70.

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