Treating chronic back pain holistically – the influence of the gut, psyche and stress (part 3)

Abdomen and intestines in connection with back pain

The abdomen and intestines can favour back pain in various ways, and many things are interrelated.

Reduced nutrient absorption

Reduced nutrient absorption, e.g. caused by a disturbed intestinal mucosa, affects muscles, fascia, bones and joints, which can cause pain, including in the back.

Imbalance of the intestinal flora

An imbalance in gut flora can trigger chronic inflammation that can affect the whole body, including the spine and surrounding muscles and fascia. Results from studies indicate that back pain may be linked to an altered composition of the gut microbiota. The gut microbiome is a key modulator of visceral pain, but also of other chronic pain (e.g. neuropathic pain of chronic sciatic nerve impingement) according to recent findings.

The brain-gut axis

The brain-gut axis is the bidirectional connection between the gut, nervous system and brain, mediated via nerve pathways such as the vagus nerve, the enteric nervous system, the immune system and the gut microbiome. If this interaction is out of balance – for example due to stress, an unhealthy diet or disrupted intestinal flora – this can trigger systemic inflammation, increased sensitivity to pain and muscular tension. Such processes can not only favour or exacerbate digestive problems, but also back pain.

Visceral pain transmission

The complex nerve network of the intestine is closely connected to the central nervous system, so that intestinal problems can be perceived as back pain. This is referred to as visceral pain transmission (visceral means affecting the intestines). This is because the nerves that supply the abdominal organs are located in the spinal cord on the same nerve pathways as those in the back region. The brain is therefore sometimes unable to precisely assign the origin of the pain and misinterprets visceral pain as back pain.

A round belly

Frequent, severe bloating or a permanently “round belly” can also trigger or exacerbate back pain. This is because the forward shift in posture puts more strain on muscles, intervertebral discs and joints, which leads to tension.

Abdominal fat – especially visceral fat, which is located deep in the abdomen around the internal organs – favours back pain in two ways: mechanically, as described, and through inflammatory processes. Visceral fat releases messenger substances that promote inflammation, make pain receptors more sensitive, slow down healing processes and lower the pain threshold. You could say that abdominal fat acts like a small, chronically active “inflammation factory” that affects the entire organism. It is important to note that even slim people can have unnoticed visceral fat deposits.

If you suffer from chronic back pain, it therefore makes sense to have your intestinal health checked and to provide targeted support – for example by changing your diet or, if necessary, through an individually tailored intestinal rehabilitation programme.

Some possible products to get the bowel moving again:

• Clinoptilolite
• Turmeric
• Neovital
• Probiotics / prebiotics
• Bitter drops
• Omega-3 fatty acids
• Vitamin D3

Tips for a gut-friendly diet:

• Anti-inflammatory diet with plenty of omega-3 fatty acids, antioxidants and fibre
• Fermented foods
• Less animal-based food from good animal husbandry
• Allow yourself periods of fasting (e.g. 16/8 fasting)
• Omit industrial sugar and wheat flour as far as possible
• Avoid highly processed foods and convenience products
• Clarify intolerances, omit incompatible foods
• Possibly omit gluten and / or cow’s milk products (try it out)

Pay attention to liver function and detoxification

It may seem unusual at first glance, but the liver can also indirectly contribute to back pain. It is a central organ for detoxification and plays an important role in hormone regulation. Excess or depleted hormones such as oestrogens, cortisol, insulin or thyroid hormones are broken down in the liver. However, if it is overloaded – for example due to stress, medication, alcohol, an unbalanced diet or hormonal changes during the menopause – this breakdown can be impaired. This results in hormonal imbalances, which can manifest themselves in muscle tension, cycle problems, sleep disorders or mood swings, among other things.

Impaired liver function also has an indirect effect on the musculoskeletal system: Via fascial connections and nerve reflexes, it can also cause back pain in the thoracic or lumbar spine as well as radiating pain in the right shoulder.

The liver also plays a key role in blood sugar metabolism. If insulin resistance or a fatty liver develops, inflammatory processes can occur that promote pain and muscle tension.

It is therefore worth keeping an eye on liver health in the event of chronic or unexplained back pain. A liver-friendly, alkaline-rich diet, sufficient fluid intake, moderate exercise and a conscious approach to stress have a supportive effect. It also makes sense to reduce potential stress on the liver – for example by choosing foods, personal care products and cleaning agents that are low in harmful substances. A high-quality water filter can also be helpful, as drinking water can contain residues of medication, hormones, bacteria or other harmful substances.

Possible dietary supplements to support the liver and detoxification:

• Clinoptilolite
• Bitter drops
• Milk thistle
• Turmeric
• Choline
• Antioxidants such as vitamin C, vitamin E, selenium, zinc, glutathione

Stress – what it does to your back

The stress response is actually a sensible emergency programme for the body: stress hormones such as cortisol are released, the nervous system switches to “fight or flight” and muscles tense up. This helps in the short term. However, if stress becomes chronic, the cortisol level remains high and the nervous system is permanently on alert.

Consequences for the back:

• Constant muscular tension can lead to chronic back pain
• Tissue regenerates more slowly, silent inflammation increases
• Digestion and nutrient absorption deteriorate, but at the same time the body needs more micronutrients under stress, and this deficiency in turn also affects back health

Stress management

Stress in everyday life cannot be completely avoided – and is not fundamentally harmful. It becomes problematic when we can no longer regulate it. It is not the quantity of tasks that is decisive, but our attitude and strategies. With good stress management, permanent stress becomes a situation that you can actively control.

Simple steps:

• Recognise triggers: e.g. conflicts, expectations, pressure to be perfect – and develop suitable solutions.
• Accept and regulate: Stress is part of life. Language helps: instead of “I can’t do it” → “I don’t know how yet.”
• Plan breaks: Micro-breaks in everyday life – e.g. if you have a sedentary job, regularly stand up briefly, move purposefully, stretch, close your eyes, breathe deeply.
• Use exercise: Just a few minutes of walking after eating has been proven to reduce stress hormones.
• Practise breathing: e.g. 4-7-8 method – calms the heartbeat and muscles.
• Set priorities: realistic daily goals instead of excessive demands.
• Set boundaries: e.g. only check emails at set times.
• Stop your thoughts: consciously say “stop” when you are ruminating and focus on your breath.

Used regularly, these measures lower cortisol levels, calm the nervous system and relax tense back muscles.

Lack of sleep

During the deep sleep phase, muscles and fascia regenerate, minor inflammations are reduced and the hormone balance is stabilised. If this restorative sleep is missing over a longer period of time, the back cannot recover sufficiently – pain increases.

A negative cycle often develops: pain disturbs sleep, lack of sleep increases stress, and stress in turn increases back pain. Even a few bad nights significantly reduce pain tolerance – pain is felt more strongly.

What helps:

• Relaxation: Breathing exercises, meditation or gentle movements calm the nervous system.
• Sleep hygiene: regular bedtimes, bedtime rituals, ending screen time one hour before bedtime, a quiet, inviting, well-ventilated sleeping area.

The right bed

The choice of the right bed system is very individual, so professional advice is recommended. The interaction between the slatted frame and mattress is crucial: they should adapt to the body – not the other way round. Ideally, they should allow movement, support the areas of the body that need it and allow others to sink in so that the spine is supported in its natural shape.

A comfortable bed climate is just as important: breathable materials as well as blankets and toppers that equalise temperature and moisture.

To help you relax and get to sleep, there are also good aids in the form of special dietary supplements that can be taken in the evening.

Some examples:

• CBD relaxes muscles and the nervous system, inhibits pain and promotes sleep
• Magnesium has a relaxing effect on muscles and the nervous system
• Products containing sleeping berry root extract (Ashwaghanda), milk protein hydrolysate (Lactium®) and L-tryptophan naturally promote sleep

Rest breaks and relaxation

Short, conscious breaks and moments of relaxation in everyday life are also important. The body uses these phases to release tension, regenerate muscles and calm the nervous system. Relaxation positions, breathing exercises and relaxation techniques can be integrated into your daily routine. The more stressed you are and the fuller your to-do list is, the more important it is to take breaks – even if it’s often not easy. This is precisely when they help to create a healthy balance between activity and relaxation – the basis for a pain-free back.

The psyche and back pain

Back pain can be the body’s way of telling us about emotional stress (psychosomatics). We often carry more on our shoulders than we think – worries or unresolved conflicts act like an invisible rucksack that the back has to carry. Anyone who permanently takes on too much or adapts, “bends”, will feel this physically sooner or later.

Body and psyche interact closely, connected by the nervous system:

• Mental stress leads to muscle tension and unfavourable movement patterns that strain the back and increase sensitivity to pain. If you carry too much weight, you feel it in your spine – in the truest sense of the word.
• Conversely, persistent pain can put a strain on the psyche and reinforce the feeling that you don’t have enough “backbone” or that you constantly have to carry more than is good for you.

This creates a negative cycle: the more psychological burdens you try to carry, the more you feel the physical consequences – pain, tension and increased sensitivity. Early burdens, e.g. experiences of stress or anxiety in childhood, characterise the nervous system. They often teach us to carry a lot early on, to adapt and to take on burdens, which favours chronic tension patterns and an increased risk of back pain in adulthood.

If you think you are stuck in such a negative cycle, there are various ways to work on it, sometimes professional help is appropriate.

Some possibilities:

• Cognitive behavioural therapy
• Relaxation techniques (e.g. progressive muscle relaxation)
• Biofeedback
• Trauma therapy
• Inner child work
• IFS therapy (Internal Family Systems therapy)
• Stress management methods (e.g. breathing exercises and techniques)
• Pastoral care
• Multimodal pain therapy (combines various approaches, including medical, psychological and physiotherapeutic measures)

Oestrogen and back pain

In women, especially during the menopause, there is a close connection between the sex hormone oestrogen and back pain. Oestrogen has an anti-inflammatory and pain-relieving effect. If oestrogen levels fall, the joints and spine are less protected, which can lead to pain.

A lack of oestrogen also increases the risk of bone loss (osteoporosis), which is often accompanied by pain in the musculoskeletal system, particularly in the back. In addition, muscle strength can decrease during the menopause, which favours postural problems and can increase back pain.

Oestrogen also influences the blood flow to the muscles – a deficiency can therefore increase muscle complaints. Hormonal changes can also cause inner restlessness and tension, which have a negative effect on the back.

In cases of severe oestrogen deficiency, treatment with bioidentical hormones can be useful to balance hormone levels and alleviate symptoms. At the same time, diet, exercise, psyche, gut and liver should be taken into account in order to provide comprehensive support for back health.

Support the back as holistically as possible

As you can see, chronic back pain is practically never just localised – it is a reflection of our lives. That’s why it makes sense to support the back as causally and holistically as possible. You have now learnt about a wide range of possible causes and strategies to develop an individual strategy with nutrition / dietary supplements, exercise, stress management and mental care to actively and effectively counteract back pain. Of course, you should always talk to your doctor or therapist about what is recommended in your case.

In any case, I wish you good back health!

This is part 3 of the series “Treating chronic back pain holistically”
Part 1 – Nutrition and supplements for a strong back
Part 2 – The back is made for movement

Studies

The role of the human microbiome in the pathogenesis of pain
https://pubmed.ncbi.nlm.nih.gov/36362056/

The gut microbiome plays a central role in human physiology and influences numerous bodily functions via the gut-brain axis. Disorders of the gut-brain axis are associated with gastrointestinal syndromes and also with the development of various types of pain. Changes in the microbiome (dysbiosis) can lead to incorrect reactions of the immune system and thus favour inflammatory and chronic pain (e.g. in endometriosis, migraines, functional bowel diseases). This occurs through the regulation of immune cells, microglia and astrocytes as well as through the control of cytokine expression.

Altered composition of the gut microbiota is associated with back pain in overweight and obese individuals

https://pubmed.ncbi.nlm.nih.gov/32982987

Conclusions: Our results suggest that back pain is associated with altered gut microbiota composition, possibly through increased inflammation. Further studies describing the underlying mechanisms may reveal strategies to reduce the incidence of Adlercreutzia for the treatment of back pain.

Gut microbiota influences neuropathic pain by modulating pro-inflammatory and anti-inflammatory T cells

https://pubmed.ncbi.nlm.nih.gov/32889847

The gut microbiota, a consortium of diverse microorganisms in the gastrointestinal tract, has been shown to be a key player in neuroinflammatory responses, underpinning the functional importance of the “gut-brain axis”. Chronic constriction injury of the sciatic nerve (CCI) is a commonly used animal model of neuropathic pain in which T cell-mediated immune responses play an important role. In this article, we aimed to investigate whether the gut microbiota influences neuropathic CCI pain, and if so, whether T cell immune responses are involved.

A link between chronic, widespread pain and the gut microbiome

https://pubmed.ncbi.nlm.nih.gov/33331911