Low Back Pain: An Unusual Cause?

 

There are many causes of low back pain (LBP). Most of us can think of the time we bent over to lift a child, the heavy tongue of a trailer, a 5-gallon pail of water, or maybe simply sneezed too hard and threw out our back. These causes are common and most often associated with LBP. But, one unusual cause of LBP (not so unusual once you know about it) involves Vitamin D deficiency. Yes, you heard me – a VITAMIN DEFICIENCY!

One study reported on a 360 patient (90% women, 10% men) group being treated at spinal and internal medicine clinics over a 6-year time frame for LBP of 6 months or greater with no obvious cause. Doctors tested these patients for blood levels of vitamin D (25-hydroxy vitamin D), as well as calcium and alkaline phosphatase (an enzyme found in bone). Then, they administered Vitamin D supplements and the same tests were repeated. Their results are VERY INTERESTING! The findings showed 83% of the group studied (299 patients) had abnormally low levels of vitamin D before supplementation and after treatment of ONLY vitamin D, clinical improvement was seen in ALL the groups that had low vitamin D levels and in 95% of all 360 patients! THAT’S AMAZING! 

They concluded “Vitamin D deficiency is a major contributor to chronic low back pain,” and recommend screening for vitamin D deficiency and treatment with supplements which they say, “…should be mandatory...,” especially in areas that are “endemic” for vitamin D deficiency. They also conclude that bone softening diseases like osteomalacia may occur as a result of vitamin D deficiency, while many other studies have linked vitamin D deficiency with osteoporosis. Another question then arises, what geographic regions are most susceptible to low sunlight and hence, vitamin D deficiency? 

One study showed that during the 8 months centered around summer in the US (March-October), for all locations from the southern tip of Texas to just south of Portland, OR, no difference was found in the vitamin D levels. But, in the winter months (November-February), a significant difference was seen where as latitude increased northward, the amount of vitamin D decreased “dramatically.” However, in lower latitudes (< 25 degrees), no difference was found between summer vs. winter months. What about sun block? Does using it reduce vitamin D absorption from the sun? The answer is, YES. On “The Peoples Pharmacy” website, it was reported that the typical dose of vitamin D of 400 IU “…is probably inadequate to overcome a deficiency.” They recommend 10-15 minutes of time in the sun without sunscreen a few times a week or a higher dose of vitamin D3 (“…closer to 2000 IU of vitamin D”). 

There are many other benefits – not just in terms of LBP – from taking vitamin D that have good scientific support. In fact, a PubMed search for “benefits of vitamin D” resulted in 554 studies, some of which included conditions such as, HIV, heart conditions (many), chronic illness in the elderly, osteoporosis, cancers (colorectal, prostate, breast and others), kidney disease, autoimmune diseases (celiac disease, MS, rheumatoid arthritis, many others), types I & II diabetes, and more! You get the picture, I’m sure.

           

Why Is Lower Back Pain So Common?

Low Back Pain: Why Is It So Common?

This question has plagued all of us, including researchers for a long time. Could it be because we’re all inherently lazy and don’t exercise enough? Or maybe it’s because we have a job that’s too demanding on our back? To properly address this question, here are some interesting facts:

• The prevalence of low back pain (LBP) is common, as 70-85% of ALL PEOPLE have back pain that requires treatment of some sort at some time in life.
• On a yearly basis, the annual prevalence of back pain averages 30% and once you have back pain, the likelihood of recurrence is high.
• Back pain is the most common cause of activity limitation in people less than 45 years of age.
• Back pain is the 2nd most frequent reason for physician visits, the 5th ranking reason for hospital admissions, and is the 3rd most common cause for surgical procedures.
• About 2% of the US workforce receives compensation for back injuries annually.
• Similar statistics exist for other countries, including the UK and Sweden.

So, what are the common links as to why back pain is so common? One reason has to do with the biomechanics of the biped – that is, the two legged animal. When compared to the 4-legged species, the vertically loaded spine carries more weight in the low back, shows disk and joint deterioration and/or arthritis much sooner, and we overload the back more frequently because, well, we can! We have 2 free arms to lift and carry items that often weigh way too much for our back to be able to safely handle. We also lift and carry using poor technique. Another reason is anatomical as the blood supply to our disks is poor at best, and becomes virtually non-existent after age 30. That makes healing of disk tears or cracks nearly impossible. Risk factors for increased back injury include heavy manual lifting requirements, poor or low control of the work environment, and prior incidence of low back pain.

Other risk factors include psychosocial issues such as fear of injury, beliefs that pain means one should not work, beliefs that treatment or time will not help resolve a back episode, the inability to control the condition, high anxiety and/or depression levels, and more. Because there are so many reasons back problems exist, since the early 1990’s, it has been strongly encouraged that we as health care providers utilize a “biopsychosocial model” of managing those suffering with low back pain, which requires not only treatment but proper patient education putting to rest unnecessary fears about back pain.