Back Pain and Diabetes

Identifying the cause of lower back pain can be perplexing, especially if you have diabetes.

Yes, back pain is common in people with diabetes. According to the University of Sydney, people with diabetes have a 35 percent higher risk of experiencing low back pain. Back pain has many potential causes, some of which overlap with the causes of type 2 diabetes, including obesity and lack of exercise. In some cases, such as neuropathy, type 1 or type 2 diabetes may be a direct cause of back pain. And in other cases, back pain and diabetes may have nothing to do with each other.

If you are suffering from lower back pain, you’re actually among the majority of Americans—75 to 85 percent, according to the American Association of Neurological Surgeons. In almost 90 percent of cases, the pain is temporary and improves without undergoing surgery. But if the pain continues for more than 12 weeks, it’s considered chronic and deserves professional evaluation.

If your pain appears to be chronic, it’s probably time to get medical help. And if you have diabetes, it’s worth knowing that your back pain may be related to your metabolic health. There are several conditions that link diabetes and back pain:

Obesity, lack of exercise, and/or depression
Diabetic neuropathy
Lumbar disc degeneration, or LDD
DISH, or Forestier disease
Osteoporosis

In this article, we’ll explore the relationships between diabetes, back pain, and these related conditions. 

Common Risk Factors: Obesity, Lack of Exercise, and Depression

There are several risk factors common to both type 2 diabetes and back pain. 

It’s well established that an excessive amount of body fat can help lead to type 2 diabetes. So can sedentary behavior. It’s also well established that obesity increases mechanical stress in the body, along with inflammation. A 2021 study explained that the increased load on the lumbar spine can lead to disc degeneration and herniation, as well as spinal stenosis — all of which express themselves as lower back pain.

Depression is another sneaky common factor. There are significant bidirectional associations between back pain and depression, meaning that each condition can help cause or worsen the other. There is also a 60 percent risk of depression associated with both type 1 and type 2 diabetes. The links between the two include poor adherence to therapy, loss of metabolic control, decreased standard of living, increased disability, lack of physical activity, and the burden of managing its complications.

For many people, mental health issues stemming from diabetes management fall under the heading of “diabetes distress.” This may take the form of losing interest or motivation in maintaining diabetes-related self-care, which includes not just taking insulin or medications, but also eating healthfully and exercising. If self-care is ignored due to depression or distress, it can lead to weight gain, worsening lack of motivation, and, in turn, back pain.

The good news is that good diabetes management — eating healthy food, exercising, and using medication wisely — might help your blood sugar and your back pain at the same time.

Diabetic Neuropathy

We commonly associate diabetic neuropathy with issues around the feet and legs, not necessarily the back. Neuropathy is a type of nerve damage; in people with diabetes, it is caused by chronically-elevated blood sugars.

But it is also possible to have neuropathic pain in the back or spine that’s caused by diabetes, says MercyHealth. The clinic notes risk factors that include advanced age and being overweight. 

Typically, neuropathy in the back or spine can manifest pain as cold, burning, deep pain; severe, shooting, or sharp pain; persistent tingling, weakness, and numbness; or pain that travels from the nerve path down to legs, hands, or arms.

Neuropathy is extremely common. A 2021 report explained that both type 1 and type 2 diabetes can lead to neuropathy in 90 percent of patients within 25 years of diagnosis. Muscle weakness, lack of coordination, and pain are symptoms that gradually spread from the lower side of the body to the back and neck. “Diabetes and low back pain are connected,” noted the researchers, “and pain is one of the leading symptoms of diabetic neuropathy.”

Lumbar Disc Degeneration

Lumbar disc degeneration (LDD) is when the spinal discs between your vertebrae wear down. The discs function as shock absorbers and when they wear away, the bones can rub together, causing back pain and potentially conditions like adult scoliosis, herniated disc, spinal stenosis, or spondylolisthesis. Once you hit age 40, disc degeneration is, to some degree, pretty common, although not everyone is symptomatic. But while it’s most common in people over 40, one factor in developing LDD is obesity. 

In 2018, a study reported that type 2 diabetes was a risk factor for LDD, holding that the length of type 2 diabetes had a “mild tendency” to develop more severe LDD than those who don’t have diabetes — and that the longer someone had diabetes, the more severe the disc degeneration would be. The study also reported that patients with higher blood sugar levels were more likely to experience severe disc degeneration.

DISH or Forestier Disease

Diffuse idiopathic skeletal hyperostosis (DISH) is also known as Forestier disease. It’s a hardening of tendons and ligaments that commonly impacts the spine. According to the Mayo Clinic, it may be associated with type 2 diabetes, “perhaps due to insulin or insulin-like growth factors that promote new bone growth.” An estimated 11 million Americans over the age of 50 may have DISH, the Arthritis Foundation reported

While DISH doesn’t cause inflammation or attack joint cartilage, the hardened tendons and ligaments can form bone spurs where they connect to bones. It’s commonly treated the same way as osteoarthritis or degenerative disc disease — with regular exercise and over-the-counter pain relievers, as well as stretching to improve stiffness and range of motion. If DISH is related to diabetes, it stands to reason that getting blood sugar and weight into a healthy range might help slow its progression.

Osteoporosis

Most women who have gone through menopause are familiar with the risk of osteoporosis. It’s a disorder that causes bones to weaken, increasing the risk of broken bones. But, according to Mayo Clinic, people with type 1 diabetes also have an increased risk for the condition since they tend to have lower bone mineral density. Researchers don’t yet fully understand why this is the case, but hypothesize that insulin may play a part since our bones are known to play a part in blood sugar level regulation. 

Early on, there are rarely any symptoms, but as osteoporosis progresses, you can experience loss of height, stooped posture, broken bones – and, yes, back pain if there are broken or collapsed bones in the spine. Osteoporosis risk occurs in later life. Authorities recommend physical activity and getting plenty of calcium and vitamin D through a healthy diet and, if necessary, supplements.

Getting a Diagnosis and Treatment

Because back pain can be caused by so many possible conditions, separately or in combination, including diabetes, it’s important to be examined by your healthcare provider. According to MedCentral, once a doctor has already established that you have diabetes, they should do a physical exam to establish if the back pain is neuropathic. Patients may be asked to complete a pain-symptom body style chart to mark lines of pain.

There may be other tests your doctor may recommend, from blood work to imaging. If DISH is a possibility, it’s usually diagnosed by X-ray, along with blood tests for inflammation. Lumbar disc disease can be diagnosed initially with questions asked by your healthcare provider about your pain, followed by imaging scans and a physical exam. 

It may be that your back pain is something that a lifestyle change can address. An exam with your doctor may determine that good diabetes management that focuses on eating healthfully and exercising could help address your back pain.

If your back pain is diagnosed as a symptom of neuropathy, there are several ways to manage it, starting with improving your mood with rest and good mental health. Yes, regular good sleep and a good mood will help reduce your perception of pain, as well as better manage your diabetes — and, if necessary, your doctor may prescribe medication relief.  There are many options for treating neuropathic pain, including prescription drugs, exercise, and topical treatments, though it may take much experimentation to find what works for you.

Finally, if you have type 1 diabetes, it’s a good idea to discuss with your doctor your potential for developing osteoporosis and the best ways to head it off. If you’re older, ask your doctor if it’s appropriate for your bone mineral density, or BMD, to be scanned for osteoporosis and, if you get a diagnosis that you have it, what the best treatments are. They may include low-impact physical activity like walking, swimming, and yoga.

Back pain is a complex issue to diagnose, and having diabetes can complicate that. Perhaps it’s related to diabetes, perhaps something else is the cause — or perhaps multiple issues are contributing to your pain. Your best course of action is to see your doctor for an exam to determine, if not an immediate diagnosis, a good treatment plan.

 

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Painful Diabetic Neuropathy: SCS as a New Treatment Option. MedCentral. November 9, 2021.

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Osteoporosis. Mayo Clinic. September 7, 2023.

Osteoporosis and Diabetes. Diabetes.co.uk. October 29, 2023.

DISH: A Culprit in Back Pain. Arthritis Foundation. April 21, 2021.

Degenerative Disk Disease. Cleveland Clinic. May 27, 2021.

Shahid S et al. Association of Diabetes With Lower Back Pain: A Narrative Review. Cureus. June 2021.

Yang H et al. Bidirectional Comorbid Associations between Back Pain and Major Depression in US Adults. International Journal of Environmental Research and Public Health. March 2023.

Bone and Joint Problems Associated with Diabetes. Mayo Clinic. April 9, 2022.

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Study Links Diabetes and Back Pain. Orthopedic Design & Technology. April 8, 2019.

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