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Back pain doesn’t follow the signs

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

This just in: a huge new study of the relationship between back pain and common signs of spinal arthritis, finding mostly that … there wasn’t much of one. The correlation was there, it was just rather puny. MRI findings, on average, “do not have clinically important associations with low back pain.”

The study was a bit unusual, a big “longitudinal” one: just observing the same group of people for a long time. We don’t see a lot of those in back pain research, or of this size/duration: about 3300 people over six years. But it gives us insight into the order of things, producing what I think is probably the most important single result here: pain didn’t develop in people who started out with signs of spinal degeneration. It’s not just that they aren’t strongly correlated, it’s that pain doesn’t follow the signs. More formally stated by the authors:

“We found most MRI findings were not associated with future LBP-severity regardless of the presence or absence of baseline pain.”

And the signs don’t follow the pain either.

Another way to sum this study up: most spinal arthritis isn’t painful, which sounds a bit radical. But none of this is actually news. It’s just great new data that really drives the old point home that most back pain is not caused by spines that are cruddy with arthritis.

Great addition to the salamander's bibliography.