Muscle Composition as a Potential Biomarker for Chronic Back Pain

Chronic back pain remains a prevalent and challenging condition affecting over 80 million individuals across Europe. When back pain persists beyond three months, it is classified as chronic, significantly impairing quality of life and placing a heavy financial strain on healthcare systems. Recent research conducted by scientists at the Technical University of Munich (TUM) has explored the connection between muscle quality and chronic back pain through advanced whole-body magnetic resonance imaging (MRI) paired with artificial intelligence (AI) analysis.

Analyzing MRI data from approximately 30,000 participants in the German National Cohort (NAKO), researchers discovered that individuals with a higher proportion of adipose tissue (fat) within back muscles and reduced muscle mass were more likely to suffer from chronic back pain. These findings, published in The Lancet Regional Health - Europe, suggest that evaluating muscle composition could provide valuable insights into assessing the risk for developing chronic back pain.

The study emphasizes that back pain, particularly in its long-term form, is influenced by multiple factors, including lifestyle elements like physical activity, diet, and daily habits. The use of MRI technology allows for precise quantification of body compartments, aided by AI-enabled models that facilitate detailed muscle segmentation. Dr. Sebastian Ziegelmayer, a researcher and physician at TUM University Hospital, highlighted that the muscles in the back are highly affected by lifestyle choices and hypothesized that their composition could undergo changes in those with chronic pain.

The research analyzed whole-body MRI scans from 27,518 participants aged 19 to 74, of whom 21.8% reported experiencing chronic back pain. Using AI-supported methods, the back muscles were segmented into fatty and non-fatty parts for detailed analysis. After adjusting for confounding factors such as age, gender, physical activity levels, and other health conditions, the data revealed a significant association: increased intermuscular adipose tissue correlated with a higher likelihood of chronic back pain, whereas greater muscle mass was linked to a lower likelihood.

The study further found that engaging in physical activity consistent with World Health Organization recommendations—about 150 minutes of moderate exercise per week—was associated with the lowest incidence of back pain. Surprisingly, both insufficient and excessive exercise levels appeared to elevate the risk, indicating that moderation is key.

While these findings shed light on the importance of muscle health for back pain prevention and management, the authors acknowledge limitations, such as the observational nature of the study, which precludes establishing causality. They suggest that further research is needed to understand the underlying mechanisms and causal relationships.

The researchers propose that muscle composition assessments could become an integral part of routine diagnostics, especially when combined with other factors like lifestyle, psychological status, and biomechanical considerations. Such an approach could lead to personalized strategies for preventing and treating chronic back pain, ultimately reducing its social and economic impact.

Source: https://medicalxpress.com/news/2025-06-muscle-composition-biomarker-chronic-pain.html