Athlete versus pain, an inevitable battle?

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Training session after training session, top athletes must push themselves to the limits to test their bodies. Although pain is a clear emergency signal, athletes in pain may push themselves even further. This makes them vulnerable to injuries and severe pain conditions including acute and chronic lower back pain. Although there are several treatment options to alleviate the symptoms, the treatment of acute and chronic pain is not straightforward. A multidisciplinary approach is required, and more treatment options are needed that focus on treating the underlying cause.

The cost of training

Because of the physical intensity and training load, elite athletes are especially vulnerable to developing severe pain conditions such as lower back pain (LBP). Physical exercise is important in both the prevention and treatment of LBP, but too much activity, including extreme sports, frequent lifting, bending, and twisting movements, has been associated with a higher risk for LBP. Back pain has a high prevalence in the general population and is the number 1 cause of disability worldwide according to the World Health Organization (WHO). In 2020, 619 million people suffered from LBP, affecting their quality of life and mental well-being. For athletes, this results in high drop-out rates and decreased performance.

The International Olympic Committee (IOC) released a consensus statement in 2017 on pain management in elite athletes. According to this consensus, pain management should be a multidisciplinary approach where biological, psychosocial, and contextual contributing factors are identified to adapt the treatment accordingly. Current approaches include physical therapy, pain education, psychological guidance, and surgery in cases of structural damage or non-responsiveness to other treatment modalities. Pharmacological agents are included but should not be solely relied on due to their possible side effects or risk of dependency.

The stamina of pain

Pain normally serves as an alarm signal warning you of potential damage within your body. Unfortunately, this signal has stamina and the ability to last and can turn into a chronic condition; LBP is no exception. According to the International Classification of Diseases (eleventh revision (ICD-11)), chronic pain affects approximately 20% of people worldwide and is a multifactorial syndrome with biological, psychological, and social contributing factors. It can arise even despite successful treatment of the causal factor. The body will shift its focus from healing to accepting and compensating. When you have LBP, your body might compensate by adjusting your posture, consequently leading to other complaints as well. “Therefore, it is very important to find the origin of chronic pain and not just treat the consequences of it,” says René Quintus, founder of Qmedic, a company studying dynamic neuromodulation for the treatment of chronic pain and more specifically LBP. “Chronic pain is the alarm signal of your body telling you not to overload. However, the painful area is not necessarily equal to the origin of the pain.

Technology versus pain

Currently,  technological solutions are being developed for the treatment of chronic LBP. In general, these technologies prevent pain signals from reaching the brain using various mechanisms. Medtronics Belgium develops neurostimulators, also known as spinal cord stimulators, which block the signals via small controlled electrical pulses. The stimulators are placed surgically and can, in successful cases, relieve the patients of more than 50% of their pain. The company also develops implantable analgesic pumps that prevent signals from reaching the brain through administration of analgesics directly to the pain receptors near the spine. This allows the administration of lower dosages compared to oral medication. Next to neurostimulators, Abbot develops radiofrequency ablation technology, which uses thermal energy to create small lesions within the nerves, stopping the pain signals from reaching the brain.

Qmedic’s dynamic neuromodulation technique uses electrical pulses to identify and treat the origin of the complaint. Compared to neurostimulation, modulation also measures the reaction of the brain to the pulses. “We stimulate all the nerves coming out of the spinal cord using specialized pulses and look at the quality of the brain’s reaction to that pulse,” explains Quintus. After a decade of research, we started to understand the correlation between the quality of the reaction and the root cause of chronic pain. A low-quality reaction is correlated to an overstimulation of the nerve, which is the case in chronic conditions. After detecting the root cause, we stimulate specific nerves to reactivate the low-quality neurological circuit while continuously measuring the reaction of the brain so we can choose the most optimal pulse. This process is bi-directional, each consecutive pulse varies from the previous pulse based on the measured neurological response.” This technique works as a magnifying glass, redirecting the focus of the brain to the cause of chronic pain so the body can start healing again instead of accepting and compensating. The technique also has the potential to reduce recovery times in athletes. After an intense training session, the muscles need time to recover, leading to athletes losing precious time to start training again. Based on a cohort study, it seemed that using Qmedics neuromodulation can help speed up this process, shifting the attention of the body to the recovering body part.

Although various options are already available, further research is needed to develop treatment modalities targeting the causes of chronic pain. Especially for athletes, more consistent research is needed on the benefits and risks of different treatments and their combinations according to the IOC consensus. A systematic review from 2020 agrees by underlining the urgent need for high quality randomized controlled trials after reporting unclear results of what the most effective treatments for LBP in athletes are.

It’s time to back up athletes battling with pain, so they can be freed up to start competing in competitions like the Olympics instead!