Degenerative disc disease is exactly what it says – the discs that act as shock absorbers between the vertebrae begin to degenerate or breakdown. As this happens, significant pain occurs.
A vertebral disc has two parts:
- The annulus fibrosus. The annulus fibrosus is the firm outer layer that also contains nerves.
- The nucleus pulposus. The nucleus pulposus is the jellylike core that is rich in proteins.
When the disc is damaged, it is unable to regenerate as it has a low blood supply. However, because of the anatomy of the disc, significant pain is felt if the disc tears.
Often, those who suffer from a herniated or ruptured disc also have degenerative disc disease (but not always!).
A herniated disc – also called a bulged, slipped, or ruptured disc – occurs when a portion of the nucleus of the disc extends out of the annulus. When this happens, the disc often presses on spinal nerves, which produces pain – sometimes severe.
Though herniated discs can occur in any part of the spine, they are most common in the lumbar spine (the lower spine).
You’ve probably heard an elderly family member say, “I have a pinched nerve.” Maybe you’ve experienced this before. Radiculopathy is the medical term for a pinched nerve.
There are various places in the body that pinched nerves can occur:
- Lumbar radiculopathy. Symptoms occur in the low back. This specific type of radiculopathy is most commonly referred to as sciatica as the sciatic nerve is involved.
- Cervical radiculopathy. Symptoms occur in the neck due to a compressed nerve root in the cervical spine. The hands and arms are typically affected by this radiculopathy.
- Thoracic radiculopathy. Symptoms occur in the thoracic region. This type of radiculopathy is the least common.
With all three radiculopathies, back pain is common. The location of the pain will be dependent on the location of the nerve compression.
Radiculopathies can be caused by “changes in the tissues surrounding the nerve roots. These tissues include bones of the spinal vertebrae, tendons and intervertebral discs. When these tissues shift or change in size, they may narrow the spaces where the nerve roots travel inside the spine or exit the spine; these openings are called foramina. The narrowing of foramina is known as foraminal stenosis, which is very similar to spinal stenosis that affects the spinal cord.”
They may also be caused by herniated discs and bone spurs.
Spondylolisthesis is a condition that affects the vertebrae of the lower back. When this occurs, the lower vertebrae begin to slip forward, directly onto the bone below it.
Mild cases of spondylolisthesis may cause no pain, but often those suffering from it experience severe pain and cannot perform activities of daily living. In fact, the symptoms are all “pain” symptoms:
- Consistent lower back pain
- Stiffness in the back and legs
- Thigh pain
- Tight hamstrings and buttock muscles
Spondylolisthesis can occur at any age as it may run in families. Children may suffer from it because it can occur as a congenital disability or from rapid growth. It can also occur due to sports injuries, most often from football, gymnastics, weightlifting, and track and field.
When we discuss "trauma" as it relates to back pain, it can relate to various causes.
Srini Pillay, MD, of Harvard Health, notes, "not all people respond in the same way to this often-disabling condition. In fact, even if two people have the same level of pain, their responses to that pain can be very different. These differing responses are due in part to different people's psychological attitudes and outlooks."
It doesn't necessarily mean that back pain is "in your head," but it can be related to psychological trauma that you've experienced. Also, no – you're not imagining that back pain – it's there.
- If you have psychiatric conditions, your brain functioning is already abnormal as it likely isn't processing dopamine effectively. This means that perhaps you're not only processing your emotional control, but also pain – and it can become consuming.
- Dr. Pillay notes, "The pain itself can rewire your brain. When pain first occurs, it impacts your pain-sensitivity brain circuits. But when pain lasts, the related brain activity switches away from the 'pain' circuits to circuits that process emotions. That's why emotions like anxiety often take center stage in chronic back pain."
Then, we have those with post-traumatic stress disorder (PTSD); those with PTSD are at a much higher risk of developing depression, heart disease, and physical pain, amongst various other health maladies.
According to VeryWell Mind, a study of firefighters with PTSD found that 50% had low back pain compared to their counterparts without PTSD. Why does PTSD frequently occur with pain? Often, PTSD occurs as a result of a traumatic, painful event – thus, the body is in pain. Examples include a natural disaster, a physical assault, and war combat. Occasionally, PTSD occurs as a result of an event that is not physical. Depression can also cause pain for various reasons.
Then we have physical trauma. This occurs as a result of something that happens to the body, such as a car accident, a sports injury, an assault. Physical trauma is not an everyday occurrence, such as tripping over your child's toy (though if you fall hard enough, that may cause trauma too!). These are injuries that are severe enough to injure your back or other body parts.
In all of the above cases, acute pain improves within a few weeks. However, acute pain that becomes chronic that is related to a traumatic event is typically related to central sensitization.
The Institute for Chronic Pain defines central sensitization as "chronic pain in which the nervous system becomes stuck in a state of heightened reactivity. In central sensitization, the sensations of pain can become more intense and things that are not normally painful, like touch or massage, can also become painful. Central sensitization maintains pain even after the initial injury or illness heals."