The Continuing Story on Back Pain and Genetics

Back pain and genetics, a continuing story...

Part I

The recent study on back pain and genetics:

Lumbar Disc Disease is Very Popular and Should Not Be Considered the Same as Back Pain

There is a recent exciting but currently unhelpful study on back pain and genetics.  The study was done by British researchers who pooled available data from several studies (a meta-analysis), that was recently published in Annals of Rheumatologic Disease.   It suggests that there is a gene that is associated with lumbar disc disease.  It may lead to future studies that are helpful.  What they did is look at DNA for 4600 individual for whom they also had imaging (x-rays, CAT scan or MRI).  They found there was a strong association for a few specific changes in one particular gene called "PARK2" and visible changes on the imaging.  This suggests that some change (likely considered a defect) in this gene is associated with changes on the imaging that suggested lumbar disc disease.  Lumbar disc disease is present in a large amount of the population, from 25% to 75%, depending on the study.  It's important to know that Lumbar disc disease is not the same thing as back pain.  You can have back pain without having any lumbar disc disease.  You can also have lumbar disc disease and have no back pain or other symptoms.  Lumbar disc disease is however, associated with the more severe types of back pain.  Lumbar disc disease is generally associated with sciatica, symptoms that travel from your lower back into one or both of your legs.  

The Question of Gene Therapy is Often Addressed While Discussing Possible Remedies to Lumber Disc Disease

As this information is better studied, there are questions that people will try to answer.

First question is; can we directly address back pain by doing something to give people the normal form of the protein or gene?  Most likely not. It is unclear exactly what the gene does in the body, and giving the body more of that protein does not mean that the body would incorporate the protein into the body in a useful way.  There is no way of knowing it would be safe.  An even more unclear group of techniques is gene therapy.   Gene therapy is a highly experimental field of medicine where a defect in a gene is addressed by actually introducing the normal form of the gene into the patient.   It has had a few successes, but most attempts have yielded more promise than results. 

What does PARK2 actually do?  Unfortunately for people who were hoping for a simple answer, probably a lot.  PARK2 is associated with a protein called ubiquitin.  Ubiquitin is called that because it's found in almost in all tissues in the body.  The proteins are involved in breaking down proteins in the body.  Proteins, at varying rates, are constantly made, then taken apart, then remade, and it's thought that PARK2 may be involved in regulating how this happens.  PARK2 is very unlikely to be a protein only involved in making your back healthy, it's also found in many tissues throughout the body.  Changing PARK 2 expression throughout the body could very likely have unseen results.  In the words of Buckaroo Banzai, famous world adventurer and neurosurgeon, "Don't tug on that.  You never know what it may be attached to."

One promising avenue for research is that will hopefully lead to studies that break back pain patients down into different groups.  As a clinician who has used a variety of different techniques, it is clear that not everyone responds well to the same approach.  Some patients benefit tremendously from chiropractic manipulation, others respond well to traction, other respond well to deep tissue or myofascial release while others respond well to exercise.  Some respond best to a combination of these approaches.  Very often, we don't know what will work best unless we've tried one or more of these techniques.  Knowing that there is a gene that is linked to different types of changes in the back may mean that there is a better way to treat a patient who has a certain form of the gene.  There may eventually be a blood test that suggests the best way to treat someone's back pain.

It may give us a better insight as to how disc degeneration occurs, and possibly suggest medications that directly affect this pathway.  If someone shows early signs of disc degeneration, there may be a new or even an existing medicine that affects the pathway and prevents it from getting worse.  

Currently surgery is used as a last resort for back pain patients. The reason being is that, even with modern minimally invasive surgery, there is still some risk, and not everyone is helped.  Some are even worse off after surgery.   It may be that certain forms of the gene are correlated with better or worse success, and would better allow surgeons to identify patients who they are most likely to help with surgery.  

Before I was a chiropractor, I worked in a biochemistry lab for eight years, looking at molecular biology of extracellular matrix proteins.  I have insight into how a gene may affect the entirety of an organism.   I'll be enlarging on genetics and back pain in future blog posts.  In the meanwhile, I will continue to apply evidence based techniques of chiropractic and physical therapy in my Rockville practice.  

For more information and health tips, visit the Rosa Chiropractic Rockville website and like us on Facebook.

 Dr. Charlie Ginsburg has a strong research background, having spent eight years in the field of connective tissue biochemistry. His practice focuses on the treatment of acute and chronic musculoskeletal injuries to the extremities and the spine. He uses physical therapy, rehab and chiropractic techniques, and incorporates ergonomics and therapeutic exercise into patients' treatment. He believes in inter-professional collaboration, and has strong relationships with members of the medical community and diverse alternative practitioners. Dr. Ginsburg has special interests in evidence-based medicine and martial arts injuries. He has a Bachelor of Arts from Vassar College, spent six years in the PhD program at Boston University School of Medicine (ABD), and has a Doctorate of Chiropractic from the National College of Chiropractic.  He is licensed in Maryland as a Chiropractor with Physical Therapy Privileges.

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