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063 LOW BACK PAIN HERITABILITY AND THE ROLE OF DISC DEGENERATION
Back pain problems are a leading cause of work loss and long-term disability. Commonly, the disc is a suspected culprit. Twin studies suggest that disc degeneration and back pain have a substantial genetic component. Our objective was to examine whether genetic influences on back pain are mediated through genetic influences on disc degeneration.
We conducted a classic twin study exploring pathways through which genes and environment influence back pain. Subjects included 147 monozygotic and 153 dizygotic male twin pairs from the population-based Finnish Twin Cohort. All subjects underwent lumbar MRI and completed an extensive interview, including back pain history and exposure to possible environmental risk factors. Disc height narrowing was the degenerative finding most associated with pain history, and was used to index disc degeneration in the bivariate quantitative genetic models. Significant correlations indicated the presence of underlying factors common to both degeneration and pain.
The heritability estimates for the various definitions of back pain problems ranged from 30% to 46%, with more severe problems tending to have higher heritability estimates. The heritability estimates remained the same or only minimally changed (less than 4% of variance) after adjusting for measured covariates (eg, occupational demands). Statistically significant genetic correlations were found for disc height narrowing and lifetime back pain histories, such as the duration of the worst back pain episode (rg = 0.46), hospitalisation for back problems (rg = 0.49), and difficulties doing daily work (rg = 0.33). There also were statistically significant, but weaker environmental correlations for disc height narrowing and back symptoms over the prior 12 months. A genetic influence on selection of occupational physical loading conditions was also apparent.
The moderate heritability estimates found for various definitions of back pain reporting were relatively unaffected by controlling for covariates. A substantial minority, up to one-quarter, of the genetic influences on pain was due to the …