Research and Useful Information

Pain is regularly attributed to a structural cause, such as a prolapsed disc or arthritis, but often these conditions occur in people who do not have any pain. We feel there is a much stronger correlation between lifestyle factors and the level of stress you are under causing pain. This pain is caused by adaptive changes in the central nervous system, to learn more about the adaptive changes have a look at :

‘How we feel pain – Part 2 Our adaptive nervous system and central sensitisation’ in the section of this website

Below are some studies that highlight that structural changes observed on MRI scans are normal and often not the cause pain:

Research into discs and MRI scans:

1) Matsumoto et al (2013) European Spine Journal (PMID: 22990606), 2013, 708–13.
‘Tandem age-related lumbar and cervical intervertebral disc changes in asymptomatic subjects.’

Conclusions: MRI showed degenerative changes [including protrusions, compressions and stenosis] in both the lumbar and cervical spine in 78.7% of the [asymptomatic] volunteers [mean age 48].

2) SJ Kim et al (2013)  Journal of the Korean Neurosurgical Society (PMID: 23440899)

‘Prevalence of disc degeneration in asymptomatic Korean subjects. Part 1: lumbar spine.’

Conclusions: Lumbar MRI of asymptomatic volunteers (age 14–82, mean age 46) showed 60% had bulges, 45% had protrusions, 31% had extrusions, 76% had annular fissures, 76% had nuclear degeneration.

3) Karppinen et al (2001) Spine (PMID: 11295915): 149–54.
‘Severity of symptoms and signs in relation to magnetic resonance imaging findings among sciatic patients.’

Conclusions: No correlation was found between symptoms and the degree of disc displacement, nerve root enhancement or nerve compression in 160 patients with unilateral sciatica.

4) Jensen et al (1994) New England Journal of Medicine: Vol 331; 69 – 73

‘Magnetic Resonance Imaging of the Lumbar Spine in People without Back Pain’

Conclusions: On MRI examination of the lumbar spine, many people without back pain have disk bulges or protrusions, but not extrusions.Given the high prevalence of these findings and of back pain,the discovery by MRI of bulges or protrusions in people with low back pain may frequently be coincidental

5) Boden et al (1990) The Journal of Bone and Joint Surgery, Vol 72, Issue 3 403-408

‘Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects’: A prospective investigation

Conclusions: About one-third of the subjects were found to have a substantial abnormality (57% in the over 60s)

6) Borenstein et al (2001) The Journal of Bone and Joint Surgery (American) 83:1306-1311

‘The Value of Magnetic Resonance Imaging of the Lumbar Spine to Predict Low-Back Pain in Asymptomatic Subjects’ A Seven-Year Follow-up Study

Conclusions: The findings on magnetic resonance scans were not predictive of the development or duration of low-back pain.Individuals with the longest duration of low-back pain did not have the greatest degree of anatomical abnormality on the original,1989 scans.

Research into OA and pain:

Kalichman et al (2008) Facet Joint Arthritis and low back pain in the community-based population. Spine 1;33(23):2560-5

‘To evaluate the association between facet joint Osteoarthritis (OA) and pain in the community’

Conclusions: In this study, they failed to find an association between Facet joint OA, identified by multi-detector CT scan, at any spinal level and lower back pain in a community-based study population.

Medically unexplained symptoms:

Brown, R.J. (2007) Introduction to the special issue on medically unexplained symptoms. Clinical Psychology review, 27, 769-780.

‘Review of medically unexplained symptoms in different medical specialities.’

Conclusions: “Every ‘medically explained’ symptom has an unexplained counterpart, and every medical speciality has its own unexplained syndromes”

Pain and emotions:

Lumley et al (2011) Pain and emotion: a biopsychosocial review of recent research. Journal of Clinical Psychology, 67 (9) 942-968.

‘Review of the effects of emotions on pain.’

Conclusions: ‘Psychological research demonstrates that greater pain is related to emotional stress and limited emotional awareness, expression, and processing’.