Back pain pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S [2]

Overview

Back pain can be broadly classified into inflammatory, mechanical, degenerative, oncologic and infectious. Lumbar disc disease have been linked to genetic involvment. The risk of developing lumbar disc disease increases if found in other close relatives. Genes involved in the pathogenesis of back pain include, HLA-B27, SOX5, CCDC26/GSDMC, and DCC.

Pathophysiology

The exact pathogenesis of back pain depends on the underlying cause.
Back pain can be broadly classified into inflammatory, mechanical, degenerative, oncologic and infectious.^[1]^[2]^[3]^[4]

Type of back pain	Pathophysiology
Inflammatory	Inflammation of joints (sacroiliitis), inflammation of enthesis (spondyloarthritis)
Mechanical	Trauma, muscle sprain, extra weight on muscles (pregnancy, heavy lifting),
Oncologic	Lytic lesions in spine, nerve compression due to mass effect, pathologic fracture due to weakened bone
Degenerative	Cartilage degradation and bone remodeling decreases elasticity and causes pain , fractures can also occur due to osteoporosis,
Infectious	Infection involving spine, disc, joints, abscess formation.

Genetics

Genes involved in the pathogenesis of ankylosing spondylitis (AS) include Human Leukocyte Antigen–B27(HLA-B27).^[5]
Lumbar disc disease have been linked to genetic involvment. The risk of developing lumbar disc disease increases if found in other close relatives.^[6]
Genes involved in the pathogenesis of back pain include:^[7]
- SOX5
- CCDC26/GSDMC
- DCC

Associated Conditions

Conditions associated with back pain include:^[8]^[9]^[10]^[11]^[12]
- Heavy lifting
- Ligaments and muscle strain
- Back injuries/fractures
- Arthritis
- Osteoporosis
- Metastatic cancer
- Abnormal posturing
- Degenerative disc disease
- Depression
- Pregnancy
- Fibromyalgia
- Sciatica
- Spinal disc herniation
- Spinal stenosis

References

↑ Patrick N, Emanski E, Knaub MA (2014). "Acute and chronic low back pain". Med Clin North Am. 98 (4): 777–89, xii. doi:10.1016/j.mcna.2014.03.005. PMID 24994051.
↑ Goode AP, Carey TS, Jordan JM (2013). "Low back pain and lumbar spine osteoarthritis: how are they related?". Curr Rheumatol Rep. 15 (2): 305. doi:10.1007/s11926-012-0305-z. PMC 3606549. PMID 23307577.
↑ Ross MD, Bayer E (2005). "Cancer as a cause of low back pain in a patient seen in a direct access physical therapy setting". J Orthop Sports Phys Ther. 35 (10): 651–8. doi:10.2519/jospt.2005.35.10.651. PMID 16294986.
↑ Chien JJ, Bajwa ZH (2008). "What is mechanical back pain and how best to treat it?". Curr Pain Headache Rep. 12 (6): 406–11. doi:10.1007/s11916-008-0069-3. PMID 18973732.
↑ Fiorillo MT, Greco G, Maragno M, Potolicchio I, Monizio A, Dupuis ML, Sorrentino R (August 1998). "The naturally occurring polymorphism Asp116-->His116, differentiating the ankylosing spondylitis-associated HLA-B*2705 from the non-associated HLA-B*2709 subtype, influences peptide-specific CD8 T cell recognition". Eur. J. Immunol. 28 (8): 2508–16. PMID 9710228.
↑ Feng Y, Egan B, Wang J (2016). "Genetic Factors in Intervertebral Disc Degeneration". Genes Dis. 3 (3): 178–185. doi:10.1016/j.gendis.2016.04.005. PMC 5016799. PMID 27617275.
↑ Suri P, Palmer MR, Tsepilov YA, Freidin MB, Boer CG, Yau MS; et al. (2018). "Genome-wide meta-analysis of 158,000 individuals of European ancestry identifies three loci associated with chronic back pain". PLoS Genet. 14 (9): e1007601. doi:10.1371/journal.pgen.1007601. PMC 6159857. PMID 30261039.
↑ Jandrić S, Antić B (2006). "[Low back pain and degenerative disc disease]". Med Pregl. 59 (9–10): 456–61. doi:10.2298/mpns0610456j. PMID 17345822.
↑ Nowotny J, Nowotny-Czupryna O, Brzęk A, Kowalczyk A, Czupryna K (2011). "Body posture and syndromes of back pain". Ortop Traumatol Rehabil. 13 (1): 59–71. doi:10.5604/15093492.933788. PMID 21393649.
↑ Oliveira DS, Vélia Ferreira Mendonça L, Sofia Monteiro Sampaio R, Manuel Pereira Dias de Castro-Lopes J, Ribeiro de Azevedo LF (2019). "The Impact of Anxiety and Depression on the Outcomes of Chronic Low Back Pain Multidisciplinary Pain Management-A Multicenter Prospective Cohort Study in Pain Clinics with One-Year Follow-up". Pain Med. 20 (4): 736–746. doi:10.1093/pm/pny128. PMID 30010966.
↑ Katonis P, Kampouroglou A, Aggelopoulos A, Kakavelakis K, Lykoudis S, Makrigiannakis A; et al. (2011). "Pregnancy-related low back pain". Hippokratia. 15 (3): 205–10. PMC 3306025. PMID 22435016.
↑ Idris Z, Ghazali FH, Abdullah JM (2014). "Fibromyalgia and arachnoiditis presented as an acute spinal disorder". Surg Neurol Int. 5: 151. doi:10.4103/2152-7806.143364. PMC 4228496. PMID 25396073.

[pmid24994051-1] Patrick N, Emanski E, Knaub MA (2014). "Acute and chronic low back pain". Med Clin North Am. 98 (4): 777–89, xii. doi:10.1016/j.mcna.2014.03.005. PMID 24994051.

[pmid23307577-2] Goode AP, Carey TS, Jordan JM (2013). "Low back pain and lumbar spine osteoarthritis: how are they related?". Curr Rheumatol Rep. 15 (2): 305. doi:10.1007/s11926-012-0305-z. PMC 3606549. PMID 23307577.

[pmid16294986-3] Ross MD, Bayer E (2005). "Cancer as a cause of low back pain in a patient seen in a direct access physical therapy setting". J Orthop Sports Phys Ther. 35 (10): 651–8. doi:10.2519/jospt.2005.35.10.651. PMID 16294986.

[pmid18973732-4] Chien JJ, Bajwa ZH (2008). "What is mechanical back pain and how best to treat it?". Curr Pain Headache Rep. 12 (6): 406–11. doi:10.1007/s11916-008-0069-3. PMID 18973732.

[pmid9710228-5] Fiorillo MT, Greco G, Maragno M, Potolicchio I, Monizio A, Dupuis ML, Sorrentino R (August 1998). "The naturally occurring polymorphism Asp116-->His116, differentiating the ankylosing spondylitis-associated HLA-B*2705 from the non-associated HLA-B*2709 subtype, influences peptide-specific CD8 T cell recognition". Eur. J. Immunol. 28 (8): 2508–16. PMID 9710228.

[pmid27617275-6] Feng Y, Egan B, Wang J (2016). "Genetic Factors in Intervertebral Disc Degeneration". Genes Dis. 3 (3): 178–185. doi:10.1016/j.gendis.2016.04.005. PMC 5016799. PMID 27617275.

[pmid30261039-7] Suri P, Palmer MR, Tsepilov YA, Freidin MB, Boer CG, Yau MS; et al. (2018). "Genome-wide meta-analysis of 158,000 individuals of European ancestry identifies three loci associated with chronic back pain". PLoS Genet. 14 (9): e1007601. doi:10.1371/journal.pgen.1007601. PMC 6159857. PMID 30261039.

[pmid17345822-8] Jandrić S, Antić B (2006). "[Low back pain and degenerative disc disease]". Med Pregl. 59 (9–10): 456–61. doi:10.2298/mpns0610456j. PMID 17345822.

[pmid21393649-9] Nowotny J, Nowotny-Czupryna O, Brzęk A, Kowalczyk A, Czupryna K (2011). "Body posture and syndromes of back pain". Ortop Traumatol Rehabil. 13 (1): 59–71. doi:10.5604/15093492.933788. PMID 21393649.

[pmid30010966-10] Oliveira DS, Vélia Ferreira Mendonça L, Sofia Monteiro Sampaio R, Manuel Pereira Dias de Castro-Lopes J, Ribeiro de Azevedo LF (2019). "The Impact of Anxiety and Depression on the Outcomes of Chronic Low Back Pain Multidisciplinary Pain Management-A Multicenter Prospective Cohort Study in Pain Clinics with One-Year Follow-up". Pain Med. 20 (4): 736–746. doi:10.1093/pm/pny128. PMID 30010966.

[pmid22435016-11] Katonis P, Kampouroglou A, Aggelopoulos A, Kakavelakis K, Lykoudis S, Makrigiannakis A; et al. (2011). "Pregnancy-related low back pain". Hippokratia. 15 (3): 205–10. PMC 3306025. PMID 22435016.

[pmid25396073-12] Idris Z, Ghazali FH, Abdullah JM (2014). "Fibromyalgia and arachnoiditis presented as an acute spinal disorder". Surg Neurol Int. 5: 151. doi:10.4103/2152-7806.143364. PMC 4228496. PMID 25396073.

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