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.
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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