Astronauts Risk Herniated Discs and Back Pain From Space Flight

PainRelief.com Interview with:
Dr. Radostin Penchev
Johns Hopkins Medicine

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Although fewer than 600 people have travelled to space, human space travel is expected to exponentially surge with several companies now offering space excursions as well as with the establishment of the U.S. Space Force in 2019. In parallel with this effort, NASA plans to have a sustained presence on the Moon by 2028.

It turns out that more than 50% of astronauts experience back pain (termed space adaptation back pain) during their mission and are over 4 times more likely to suffer from herniated discs than the normal population. As such, physicians should anticipate a surge in space-related back pathology. More importantly, understanding the cause of back pain in astronauts may also improve the care for other austere environment populations including deep sea divers, fighter pilots and high-altitude explorers.

In this comprehensive review of the literature, we examined the epidemiology, potential causes, and treatments for spinal pain in astronauts.

PainRelief.com: What should readers take away from your report?

Response: Data from space travelers reveal that exposure to microgravity results in elongation of the spine up to 3 inches, decreases active and passive spinal motion and alters the normal curvature of the spine which results in decreased stability. A sustained presence in space for several months results in spinal muscle atrophy and alterations in the biochemical structure of intervertebral discs, which further compromises spinal stability. Other factors that can contribute to space adaptation back pain include pro-inflammatory cytokines released due to musculoskeletal microtrauma from intense vibrational forces during take-off and spinal ligament elongation. These phenomena can be further exacerbated by a relative caloric and nutritional deficit experienced by virtually all astronauts in space, which can further compromise spinal stability.

Current measures to mitigate these pathological changes in spinal health during space travel include special elastic suits that counteract the spinal column elongation observed in space coupled with intense resistance exercises. Yet, these suits are uncomfortable, and the exercise regimen is not only strenuous and tedious, but can also detract from the limited time astronauts have to complete their duty assignments.

PainRelief.com: What recommendations do you have for future research as a result of this work?

Response: Future studies performed in larger cohort populations should center on optimizing nutritional intake and correcting the caloric deficit experienced in space, as well as using non-traditional modalities such as neuromuscular electrical stimulation and manual therapies as preventative measures for back pain. In addition, designing flight equipment that is more comfortable and better able to absorb the vibrational forces experienced during landing and take off can further reduce the risk of back pain and spinal injuries experienced by space travelers including disc herniation.

Any disclosures?

This study was supported by the departments of anesthesiology and physical medicine and rehabilitation at the Johns Hopkins University School of Medicine, the Uniformed Services University of the Health Sciences, and by the U.S. Department of Defense.

Citation:

Radostin Penchev, Richard A. Scheuring, Adam T. Soto, Derek M. Miletich, Eric Kerstman, Steven P. Cohen; Back Pain in Outer Space. Anesthesiology 2021; 135:384–395 doi: https://doi.org/10.1097/ALN.0000000000003812

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