Weekly Blog

Mar 27

If you read the summary and imagine a lab where mice walk around in back braces, that's not quite it—but, unsurprisingly, the headline was an attention grabber. It read: "Scientists discover a hormone that might stop lower back pain at the source." The concept opened a door to another dimension of back pain management that we rarely discuss. For those having trouble finding relief, this could be a very interesting new avenue. Let's start by setting the stage.

The first and possibly most important concept is that pain, while a universal experience commonly depicted as our threat detection system, is almost always temporary. When we remove the threat, things typically return to the baseline. However, sometimes when aches linger long enough, a more lasting imprint develops, and the warning bells continue to alert. This is both a source of great frustration for the person experiencing it and a complex puzzle for any professionals consulted to unwind it. Lower back pain, the world's most disabling condition, is known to be particularly tricky in this way. While many people find relief through combinations of physical activity, efforts to improve sleep quality, and systematic reductions in stressors that rev up the nervous system (like smoking or emotional distress), a small group still struggles to find a formula that works for them. For these people, changes in nutrition may offer a growing source of hope.

While, as recently as 2017, the guidelines for non-invasive treatment for low back pain have not included nutritional recommendations, a growing list of studies, as pointed out here in a review published last year, suggests they should. Exactly why healthy eating improves pain, however, is less clear. Some research points to a definite connection between pro-inflammatory diets and pain sensitivity; it seems foods that drive inflammation go hand-in-hand with pain sensitivity. Yet, it was alcohol intake that was identified as the strongest predictor in another study. Some experts argue that, as shown here, this idea puts the proverbial "cart before the horse" because pain (like depression) could be as much the cause of poor eating as the effect of it. Realistically, it is almost certainly bidirectional and therefore self-reinforcing: poor dietary choices sensitize our nervous system, which, when threatened or chronically irritated, drives us toward comfort foods as shown here. So, the link is clear, but the mechanism is murky, which leads us to the current study and the potential roles of calcium and vitamin D.

A research team affiliated with Johns Hopkins University administered parathyroid hormone to mice with various spinal conditions known to induce pain, ranging from degenerative changes to instability. In something that sounds a bit like science fiction, they found that the bony tissues began to show signs of healing. But that wasn't all. Like a watchdog that has decided there is no visible threat, the nerve-endings in the area began to pull back, allowing for pain desensitization and thus the freedom and desire to move more. Considering other related findings, calcium and vitamin D may play central roles in the biochemistry of back pain. Here's the logic:

Since (1) reducing inflammation through dietary improvements has been shown to improve chronic pain, (2) calcium sensing receptors are closely linked with inflammation, (3) parathyroid hormone (which worked this time) is tightly linked with calcium and vitamin D regulation and (4) vitamin D supplementation has shown promising results for back pain sufferers who are deficient, it is clear these nutrients matter. However, since it is still very early days and risks may prove to outweigh rewards, the most practical application we can all benefit from now is understanding that foods naturally high in calcium and enough sunshine to stimulate vitamin D production (but not too much) may have very real impacts on aches and pains, especially when coupled with movements that promote flexibility and strength. Luckily enough, gardening season, which features all 3, is here or very close...try the leafy greens.

Have a great weekend,

Mike E.