Many of the patients I encounter in my clinic have had ongoing back problems for many years, and in many cases, spinal degeneration and the resulting pain have profoundly affected their quality of life. A large number of these patients have been told something along the lines of ‘your arthritis is the cause of your pain’.
Most of the time these patients have also had some form of scan (such as an x-ray or an MRI) which confirms the arthritis, isolates where it is and shows the extent to which it is happening.
This is another occasion where a simplistic statement like ‘arthritis causes back pain’ is far too reductionist and does not explain the full story.
Before going into the science behind my argument, I would like to reiterate that I am not suggesting people are inventing their pain or that it isn’t real. I’m simply making the case that, statistically speaking, over 90% of the time there are more factors at play than simply arthritis.
The type of arthritis I am referring to in this article is more accurately known as osteoarthritis. This is the age-related bone change found in your skeleton (the skeletal equivalent of grey hair and wrinkles!). Osteoarthritis is actually an umbrella term and has many smaller subgroups such as bony spurs (known as osteophytes), intervertebral disc degeneration, facet joint sclerosis and bone cysts, to name a few.
The percentage of people who have these kind of osteoarthritic changes in their spines is significant and that percentage increases with age. A study from 2015 by Binjikji et al found that around 37% of 20 year olds and 96% of 80 year olds had intervertebral disc degeneration in their spines. This shows that this form of spinal degeneration is incredibly common and something that almost everyone will have at some point in their life.
More interestingly, the study also found that spinal degeneration can be found in high levels in patients WITHOUT back pain. Therefore showing that it is possible to have osteoarthritis in your spine without having back pain, which challenges the traditional narrative that osteoarthritis directly causes pain or is the single underlying cause behind your pain.
This study isn’t alone in these findings. A study in 2022 by Chadha et al also found that there is a high prevalence of intervertebral disc degeneration in asymptomatic individuals. The author of the paper recommended that MRI findings must always be compared to the patients symptoms in order to check whether they are relevant or have simply been found by coincidence.
In fact, to further this point, a study by Chiu et al in 2024 concluded that disc degeneration alone is NOT enough to trigger low back pain.
This further reiterates what the majority of the research on low back pain tells us. Over 90% of the time back pain is caused by multiple different factors, covering everything from the condition of the tissue, to inflammation, to the patients activity level, their sleep habits and even their mental health.
What I am not saying is that osteoarthritic changes, like disc degeneration, are irrelevant. Another study from 2015, also by Brinjikji et al, found that disc degeneration is more common in people with low back pain. So it seems that arthritic spinal changes definitely play a role in a patient’s back pain, but it would be fair to say that osteoarthritis falls short of completely explaining why a patient has experienced back pain.
The message that I convey to my patients regarding their spinal degeneration is a simple one; we can’t change your osteoarthritis – it’s there and it is probably playing a role in the pain you feel – but there is a good chance that we can still reduce your overall pain levels and improve your quality of life.
To read Rob Bailey’s latest column in the Diss Express please click here.
