כאבים הם חלק מהירושה? – מאמר חמישי בסדרה.

תרשו לי הפעם להתחיל מסיפור.

הגיעה אלי לטיפול אישה בת 69 עם כאבים עצומים בגב התחתון. לאחר הדרכה ותרגול, הכאב חלף. אחרי חודשיים היא מתקשרת אלי שוב, הפעם היא צולעת עם ברך נפוחה. צרוף מקרים קצת מוזר, אבל יכול לקרות.. שוב עשינו הדרכה ותרגול והכאבים חלפו. זמן קצר לאחר מכן אני שוב מקבל טלפון ממנה. בקול רועד היא מספרת לי על כאבים עצומים בכתף ושאינה יכולה להזיז את היד… עכשיו הנורות האדומות שלי התחילו להבהב ולצפצף.

עצרתי ושאלתי אותה, מה הסיפור? בקול בוכים היא סיפרה שאמא שלה ושתי אחיותיה הגדולות נפטרו כולם בגיל 70… (בשלב הזה היא כבר הייתה בגיל 69.5..). מלחיץ.

נניח לרגע לאותה גברת, ונדבר על התופעה שנקראת גנטיקה.

פעמים רבות אני שומע ממטופלים קביעות נחרצות: "אצל אמי התחילו כאבי גב בגיל 45 ואני כבר בן 42, אז נותרו לי שלוש שנים לחיות באושר…".

בואו נכיר רגע שני מושגים שאנו נוטים לבלבל בניהם – גנטיקה ותורשה.
ראשית: גנטיקה ותורשה זה לא אותו דבר. אמנם תורשה עוברת במשפחה דרך המערכת הגנטית, אך גנטיקה בכלל לא תלויה בתורשה.
בואו נסביר.

נקח למשל ילדים שנולדו עם תסמונת דאון. מדובר בבעיה גנטית מובהקת (בשפה המקצועית – טריזומיה של כרומוזום 21), אך אין לה קשר לבעיה תורשתית. ככל הידוע לנו כיום לאף אחד מההורים של ילדי תסמונת דאון אין 'נטיה' לבעיה הזו, מדובר בגנטיקה חדשה של הילד.

למה זה חשוב לנו?
מחקרים שונים מצאו קשר בין גנים מסוימים לבין ניוון מוגבר של עמוד השדרה. גם כאן אין הדבר אומר שהגנים האלה עברו בתורשה במשפחה. נוסף על כך, אותו ניוון בעמוד השדרה לא בהכרח יהיה קשור לכאבי גב בשום שלב בחיים.

המסקנה המתבקשת – גם אם לשני ההורים, הסבא וכל הדודים יש כאבי גב, וגם אם נמצא שיש קשר בין הכאבים שלהם לבין הגנים הקשורים לניוון מוגבר של עמוד השדרה (מה שכנראה לא יהיה נכון), זה עדיין לא אומר שלצאצאים שלהם יהיו כאבי גב.

עכשיו תחזיקו ראש.
עדיין, וכאן מגיע הצד השני של המטבע – בהחלט יתכן קשר מסוים בין הורים הסובלים מכאבי גב כרוניים לבין התפתחות כאבים דומים אצל הצאצאים. בחלק מהמקרים יתכן שגנים מסוימים אכן עברו בתורשה וגרמו לנטיה מוגברת לבעיות גב.

יתכן שישנו גם קשר פסיכולוגי לתורשה של כאבי גב. ילד הגדל בבית שבו אחד ההורים כל השנים מיטלטל בין חדרי מיון, חדרי ניתוח וזריקות מורפיום בגלל כאבי גב, בהחלט עלול לפתח כאבים דומים בעצמו.

אבל, והחשוב מכל – כפי שלמדנו במאמרים הקודמים, המרכיב הגנטי הינו מרכיב בלתי משתנה. אין מה לעשות אתו, ולכן אין שום טעם להתעסק בנושא. גם אם יש קשר בין הגנטיקה של האדם לבין הכאבים שלו, זה רק קשר. לא גורם.

גם אם ניקח שני אנשים באותו גיל עם אותו משקל גוף, העוסקים באותה עבודה ואותה פעילות ספורטיבית, ומצבם הפסיכוסוציאלי דומה, יתכן שהמרכיב הגנטי יהיה קשור לזה שלאחד מהם יהיו כאבי גב כרוניים, ולשני לא. אבל זה אומר שאין מה לעשות?

יש ויש.
אנחנו עדיין לא יודעים להחליף גנים (וגם לא בטוח שרוצים לדעת…), אבל אנחנו יודעים להשפיע על הגורמים האחרים שיכולים להשתנות.
בדיוק לפי אותו עקרון במאמרים הקודמים, ברגע שנשפר את המרכיבים המשתנים של הבעיה היא בע"ה תיעלם, למרות שהגנטיקה כמובן לא תשתנה כלל.

ולמי שדאג לגברת מהסיפור – כיום היא בת 72, בריאה כמו שור… נאחל לה אריכות ימים עד מאה ועשרים.

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