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The Somatic Connection  |   January 2015
Are Some of Us Doomed to Have Chronic Low Back Pain?
Article Information
The Somatic Connection   |   January 2015
Are Some of Us Doomed to Have Chronic Low Back Pain?
The Journal of the American Osteopathic Association, January 2015, Vol. 115, 54-55. doi:10.7556/jaoa.2015.012
The Journal of the American Osteopathic Association, January 2015, Vol. 115, 54-55. doi:10.7556/jaoa.2015.012
Junqueira DRG, Ferreira ML, Refshauge K, et al. Heritabilty and lifestyle factors in chronic low back pain: results of the Australian Twin Low Back Pain Study (the AUTBACK study). Eur J Pain. 2014;18(10):1410-1418. 
Australian researchers at the Faculty of Health Sciences at the University of Sydney examined genetic and lifestyle factors related to chronic low back pain (LBP) in a cohort of monozygotic and dizygotic twins. The large Australian Twin Low Back Pain (AUTBACK) study database was used to recruit 243 pair responders, of whom 105 pairs provided complete and valid data related to their LBP in an online survey. A subgroup of 38 pairs, in which only 1 of the twins had LBP, provided data on lifestyle activities possibly related to LBP. 
The authors' definition of chronic LBP was based on the twin's self-report of having had back pain for 3 months and having had a whole month without LBP longer than 3 months before completing the survey. The overall prevalence of LBP was 55.4%, with a calculated heritability factor of 32.0%, which was considered by the authors to be important in the understanding of what causes LBP. Also, among the 105 pairs of twins, when 1 of the twins was affected with LBP, monozygotic twins were 5 times more likely than dizygotic twins to have LBP. Regarding lifestyle activities, a sedentary lifestyle or time spent in activities such as vigorous lifting and gardening was associated with LBP, but moderate activities such as swimming, cycling, and jogging were not associated with LBP. 
From my osteopathic perspective, I seriously question that genetics are this large of an etiologic factor in LBP. Most importantly, there are structural factors that genetic researchers do not address, mainly that the twins come down the same birth canal or at least are subjected to the same uterine environment if born via cesarean delivery. The biomechanics of neonatal bodies are indeed affected by the birth process,1 which could predispose a person to LBP later in life. 
The authors' speculation on genetic mechanisms contributing to LBP is interesting. They cite research suggesting that genetics control expression of the inflammatory cytokines tumor necrosis factor-a, interleukin 1, and interleukin 6 that relate to disk degeneration and nerve growth factors affecting axonal function. Osteopathic research has shown relationships between these cytokines and LBP as well. Licciardone et al2,3 found that TNF-a was reduced by osteopathic manipulative treatment (OMT),2,3 whereas in vitro OMT modeling in a study by Standley and Meltzer4 showed impact on interleukin 1 and interleukin 6. 
If the OMT impact on cytokine levels is confirmed by future research, I believe researchers will have to reevaluate the idea that genetics have such great control over our lives. (doi:10.7556/jaoa.2015.012) 
Hollis H. King, DO, PhD 
University of California, San Diego School of Medicine, California 
References
Frymann VM. Relation of disturbances of craniosacral mechanism to symptomatology of the newborn: study of 1250 infants. J Am Osteopath Assoc. 1966; 65(10): 1059-1075. [PubMed]
Licciardone JC, Kearns CM, Hodge LM, Bergamini MV. Associations of cytokine concentrations with key osteopathic lesions and clinical outcomes in patients with nonspecific chronic low back pain: results from the OSTEOPATHIC Trial. J Am Osteopath Assoc. 2012; 112(9): 596-605. [PubMed]
Licciardone JC, Kearns CM, Hodge LM, Minotti DE. Osteopathic manual treatment in patients with diabetes mellitus and comorbid chronic low back pain: subgroup results from the OSTEOPATHIC Trial. J Am Osteopath Assoc. 2013; 113(6): 486-478.
Standley PR, Meltzer KR. Modeled repetitive motion strain and indirect osteopathic manipulative techniques in regulation of human fibroblast proliferation and interleukin secretion. J Am Osteopath Assoc. 2007; 107(12): 527-536. [PubMed]