We can consider degenerative changes like grey hair and wrinkles on the inside. They are a normal part of ageing and a better term is probably age-related tissue changes. We see that they are commonly found in spine imaging, and often in pain-free individuals as well as those with back pain.
So how do we explain why some people with degenerative tissue changes hurt, and others don’t?
‘Feeling low, coping poorly or being under stress, may be background mental states that also prime the central hypersensitivity circuitry. Hence spontaneous onset of physical symptoms due to the unmasking of normally muted nociceptive activity or circuitry. Further, psychological factors may be important in triggering pain states or making them more likely. They are also likely to amplify pain above ‘usual’ levels should the individual sustain some form of strain or injury. That there may not have been an obvious physical incident can be irrelevant if we consider that as most of us age we harbour more and more physical ‘abnormalities and imperfections’ that are silently signalling their status to the CNS. I think this is one of the major reasons why degenerative changes can be present for a great many years without any symptom manifestation.’
Many factors modulate pain. Do we need to change the structure to get out of pain? No.
‘Weak and deconditioned tissues in a vulnerable organism are likely to keep the sensitivity dimmer switch on a high setting, get them fitter and the switch can turn it all down. Big point here, it’s not necessarily the tissues getting fitter that do the trick – it’s the context in which the tissues get fitter that is the key. How the individual patient interprets it all can massively help or massively mess it all up!’