Back pain and inflammation

Back pain. We’ve all experienced it and we all know how completely debilitating it can be. A pulled muscle is one thing, but experiencing chronic pain for months on end can affect so many areas of your life, including your social life, mood and sleep. This is how it feels when dealing with inflammatory back pain. Inflammatory back pain is thought to affect up to 7% of people in the UK (1), though rates of overall back pain are much higher - no doubt influenced by our pro-inflammatory lifestyles. In this article, I’ll be exploring back pain, with a specific focus on inflammation-associated back pain, and taking a look at its management from a holistic viewpoint.

First off, what type of back pain are you dealing with?

Back pain can generally be divided into two camps - mechanical and inflammatory. Mechanical back pain refers to pain caused by physical strain or injury, resulting in disruption within components of the back (such as the spine, muscle, intervertebral discs, and nerves). In contrast, inflammatory back pain is caused by inflammation, most commonly in the vertebrae but also seen in the joints of the spine and entheses – the sites of tendon and ligament attachment to bone (2).

Why does it matter?

Treatment options are very much dependant on the type of back pain you are dealing with. For mechanical back pain, it’s best to treat it the same way you would treat any other strain or sprain; rest, ice, and nature’s best medicine - time. However, inflammatory back pain will not greatly improve using these techniques. Instead, inflammatory back pain requires management of the root cause(s) of inflammation (3).

How can I tell if I have inflammatory back pain vs mechanical?

Mechanical back pain can often be traced back to a cause - overdoing it at the gym, lifting something heavy without correct posture or simply sleeping on a bad mattress. Inflammatory back pain, on the other hand, can appear out of nowhere. If the pain has been present for at least 3 months, wakes you in the night, radiates down the legs/buttocks, and improves with exercise and anti-inflammatory treatment, it’s most likely caused by inflammation (2,3). It’s also more often seen in people of a younger age (often before 35) and can accompany other inflammatory conditions such as inflammatory bowel disease (IBD) and psoriasis. This is reflected in increased levels of inflammatory cytokines, such as leukocytes and C-reaction protein, in those dealing with inflammatory back pain (1).

How is inflammatory back pain treated?

We know traditional treatment for strains won’t help, so what will? Medical treatments such as NSAIDS have been shown to reduce pain (4), however not everyone can or wants to take medication long term. Luckily, there are plenty of things you can do to reduce levels of systemic inflammation and in turn, reduce inflammation-associated pain. Managing body weight has been shown to be an effective method of reducing pain, as fat cells are inflammatory in nature (carrying excess weight also puts additional pressure on joints which increases the risk of pain and injury) (5).

What else can I do?

Diet is one of the main lifestyle drivers of inflammation. Therefore, focus on a Mediterranean-style diet, limiting inflammatory diet components (alcohol, caffeine, highly refined carbohydrates and processed foods) while increasing intake of anti-inflammatory ones (fruits, vegetables, oily fish, wholegrains) to support this. In fact, higher adherence to a Mediterranean diet has been demonstrated to support pain reduction and reduce circulating inflammatory cytokines (6). One thing to note here, eating an anti-inflammatory diet is likely to support improvements in pain regardless of whether it’s mechanical or inflammatory, as you’ll be giving your body the nutrients it needs to heal effectively.

Finally, it’s important to consider other lifestyle factors that influence levels of inflammation in the body. Stop smoking, manage stress levels, improve sleep quality and engage in restorative movement to keep inflammation at bay and effectively manage your back pain.

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