A Healthier You - Why Does My Back Hurt? Part 1

By: Kyo Mitchell

Editor’s Note: Dr. Kyo Mitchell served as faculty at Bastyr University in Seattle and Wongu University in Las Vegas for over a decade. Dr. Mitchell practices in Summerlin and can be reached at 702/481-6216 or by email: rkyomitchell@gmail.com.     

The predominant reason people seek out medical help is due to pain. From my years of experience, more people seek relief from back pain than any other form of pain.

Despite the fact that many patients have been to multiple practitioners and undergone multiple forms of therapy, many still suffer from back pain. Why is this?

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To understand the problem and solution, one needs to first understand what gives rise to the pain. The causes of back pain are many. Most back pain however, is due to either pressure on the nerve or local inflammation.

One of the major reasons is due to a stenosis, or a narrowing of the space the nerve ordinarily occupies. This narrowing may compress and irritate the nerve, causing it to fire and create the sensation of pain.

A descriptive example of one form of compression may help to give a picture of what is occurring. The spine is designed so that there are vertebrae stacked on top of one another.

In between each of these vertebrae is a vertebral disc. The vertebral discs serve as “shock absorbers” preventing damage to the vertebral bones. 

They also serve as “spacers” providing room for nerves to exit the spinal cord as the nerves leave the spinal cord and innervate their respective areas of the body. 

The problem is gravity. Over time, the vertebral discs wear down and get thinner (which is why people get shorter with age).

As the discs get thinner, the space between the vertebrae decreases. When this space gets too small, a nerve may be compressed by the vertebrae above and below it, as it exits the spinal cord.  

As an analogy, think of placing your finger on a table and then putting a fifty pound weight directly on your finger - and keep the weight there for an extended period of time. How would the nerves in your finger respond? This is how the nerves in your back respond to a stenosis.

Overtime, this excessive pressure on the nerve can damage it and this nerve can then do something very strange and unpleasant. Damage to the nerve can cause it to become sensitized. 

Nerves which conduct pain usually only fire when there is a certain amount of damage to the tissues of the body. Only when damage is being done to your body should you feel pain. 

However, when a nerve becomes sensitized, a stimulus in the past that might have been felt as pressure, movement or not felt at all, now elicits the sensation of pain - either continuous or sharp spasms.

Inflammation can also contribute to a person’s back pain. The inflammatory response is part of the necessary repair cycle of tissues that occurs when the body is damaged. 

One of the effects of the inflammatory process is that it makes the nerves in an area of tissue damage more sensitive to pain. However, inflammation (and the pain associated with it) should be temporary. Many times, this is not the case.

Next month: Strategies, potentials and limitations of treating pain.