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January 2015

The Role of Inflammation in Back Pain

Most episodes of back pain involve the presence of inflammation. Inflammation is the body's first defense against infection and first response to injury. Inflammation represents an immunological process to help clean up and repair and injured area.  Normally the process is self-limiting and stops. In some situations, the inflammatory process does not shut down and becomes chronic, leading to further tissue compromise.  Inflammation can occur in a localized area of the spine secondary to physical compromise of the tissue, chemical irritation of the tissue and/or secondary to a local infectious process. It most commonly arises from normal wear and tear on aging structures.  

One of the most common areas to become inflamed in the back is the spinal facet joint. There is a pair of facet joints behind the intervertebral disc at each level of the spine.  A persistent inflammatory process can lead to the development of adhesions or scar tissue which can causes reduced tissue movement and spinal segment stiffness. In some cases spinal manipulation and exercise therapy is required to improve spinal segment movement and stability. Age-related degeneration of the intervertebral disc is characterized by a loss of disc height (thinning of the disc) which leads to greater wieghtbearing stress being placed upon spinal facet joints. This renders the joint more prone to become inflamed. Ligaments and muscles of the spine can also become inflamed.  
Some tissues of the spine such as the intervertebral disc have chemicals that are normally contained, but when exposed to neighboring spinal tissues they promote inflammation and pain.  Spine inflammation can develop secondary to a local insult or process.  It can also be influenced by a systemic or a generalized inflammatory process affecting the entire body via the bloodstream.  Pro-inflammatory chemicals circulating in the blood may reach the involved area of the spine. 

There are many different types of therapeutic approaches which can be used in an attempt to reduce inflammation and pain.  This often includes the use of dietary modification, nutritional supplementation and/or the use of oral anti-inflammatory medication. In more sever cases a local anti-inflammatory injection may be used. A combined approach may be the most effective. The reduction of inflammation often leads to reduced pain intensity and distribution. The suspected presence of inflammation is the basis for the prescription of steroidal and non-steroidal anti-inflammatory drugs to treat or manage back pain. Some pharmaceutical pain killers do not reduce inflammation but simply block pain. Check with you doctor to see which approach is best for you.  

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