Backache – novel options to help you manage pain


Key points:

  • Pain warns you that inflammation is at work in your spine
  • The damage caused by inflammation may be worse than the pain.

It is estimated that nine out of ten adults experience back pain at some stage of life, and five out of ten working adults suffer from back pain every year. Lower back pain is responsible for 40% of the sick leave taken in the United States and is considered the single leading cause of disability globally.

Back and neck pain are often due to inflammation and muscle spasm, caused by injuries to the joints, discs and ligaments of the spine. Degeneration of the discs between the vertebral bones of the back from ageing, injury, wear and tear, is a leading cause of chronic and debilitating pain. Besides back ache, disc damage also causes referred pain via the nerve roots. ‘Sciatica’ is a term used for a set of symptoms caused by the compression or irritation of one of the spinal nerve roots in the lower back. Symptoms include lower back or buttock pain, as well as a dull, nagging ache that radiates to various parts of the legs and feet as part of a referred pain syndrome. Numbness and pins-and-needles may also be present. If the disc damage occurs in the neck, similar symptoms may arise in the shoulders, arms and hands.

The role of inflammation

If you crush a grape by standing on it, the outer casing will rupture and the innards will spill out. The same thing happens to the rubbery discs that join the vertebral bones of the spine. Once squashed or ‘prolapsed’, it applies a direct pressure to the nerve roots housed in the body cave that contains the spinal cord. To explain pain through this mechanism makes perfect sense.

However, research has demonstrated that the pain produced by a prolapsed disc is significantly more complex than just mechanical forces. In experiments conducted, scientists have found that simply by introducing herniated disc material to a healthy nerve without any pressure involved, inflammation of the actual nerve tissue rapidly ensues. This causes more swelling of the nerve, leading to even more pressure.

The biochemistry of backache

Research has shown that a powerful pain-producing inflammatory trigger called ‘Tumour Necrosis Factor alpha’ (TNF-alpha) plays a dominant role in causing back ache. Once a disk prolapses, its internal structure becomes disrupted. In accordance with the rules of healing, any injury leads to the immediate release of a cascade of biochemical reactions, collectively called inflammation. Not only does this process cause acute inflammation within the disc itself, but the chemical drivers of inflammation released by this process also rapidly spreads to surrounding healthy tissues and activates a secondary inflammatory process there as well.

Besides the nerves, the muscles, blood vessels and vertebral bones of the spine also become affected. As a consequence of this train of events, various other biochemical agents are released, including an enzyme called Cathepsin G (Cat G), not only a trigger for pain, but for substantial tissue destruction too.

Why inflammation eventually destroys the spine

The integrity and health of connective tissue such as cartilage, intervertebral discs, ligaments and bones plays an integral part in a highly dynamic process that requires resisting mechanical strain and recovering from the friction that is caused by constant movement. Cathepsin G (Cat G) is a protein cleaving (photolytic) enzyme responsible for the breakdown of proteins though a process called proteolysis. Whilst the process of proteolysis serves many beneficial purposes during the healing process, such as the removal of damaged tissue, the unregulated cleavage of protein-based structures also causes significant structural damage to healthy tissue.

Once activated by inflammation, CatG cleaves numerous structural proteins such as collagen, elastin and laminin, the building blocks of cartilage, intervertebral discs, ligaments and bones. In doing so, CatG plays a dominant role in both the repair and destruction of connective tissue at sites of injury or inflammation. Unfortunately, the rate of damage caused by the inflammatory process outweighs the rate of repair. The end result over years is a spine that looks damaged, distorted and somewhat weather-beaten on X-ray, even to the untrained eye.

Treatment options

Since the vast majority of disc-related back ache is inflammatory in origin, it should ideally be treated medically. Surgery should only be an option when a large disc causes compression of the nerve roots, particularly when it leads to muscle weakness and urinary or bowel incontinence.

Anti-inflammatory drugs (NSAIDs) and steroids work because they broadly block key inflammatory enzymes at a high level in the inflammatory cascade. Although highly effective for helping to reduce inflammation and secondary pain, this also explains their high side effect profile, which extends to many organs, especially the stomach and the kidneys. All anti-inflammatory drugs (NSAIDs) are also strongly implicated in the development of heart disease and stroke, with some being worse than others. For example, in 2004, the drug Rofecoxib caused between 88 000 and 140 000 cases of serious heart disease and was subsequently withdrawn from the market.

Novel approaches to manage inflammatory pain

Since the unwanted side-effects of the regular usage of anti-inflammatory drugs, especially over the long term, may outweigh the benefit, scientists have started looking for effective alternative sources, but with a lower side effect profile.  Extracts from Indian Frankincense, contained within RheumaLin, have been used in traditional Chinese, Ayurvedic and Middle Eastern medicine as an anti-inflammatory and pain relieving agent for centuries. Accumulating evidence in scientific literature from both animal and human studies supports the use of frankincense resin for a variety of inflammatory disorders including osteoarthritis.

The effects of frankincense resin are biochemically attributed to a group of chemical compounds called boswellic acids.  Research has demonstrated that these acids are powerful inhibitors of CatG. During automated, molecular docking experiments, boswellic acids tightly bound to the active centre of CatG and, as a result, strongly suppressed the proteolytic activity of CatG. This indicates their potential to help alleviate inflammatory pain and preserve joint health by helping to prevent the enzymatic degradation of cartilage and surrounding soft tissues. View our full health product range

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