(Reuters Health) - People with diabetes are more likely to report back and neck pain, but it's still unclear if diabetes is the cause of their pain, a research review concludes.
Diabetes was associated with a 35 percent higher likelihood of reporting back pain, in an analysis of five studies with a total of 131,431 people, and with a 24 percent greater risk of neck pain, according to two studies with 6,560 people.
But the only study in the analysis to follow people over time found no connection between diabetes and the risk of back, neck or spinal pain, the study team notes in PLoS ONE. That suggests other factors might also account for increased reports of back pain among diabetes patients.
"We know that obesity and physical inactivity are risk factors for both conditions so it is likely that they underlie that link," said senior study author Manuela Ferreira of the University of Sydney in Australia.
"Keeping normal blood sugar levels, managing body weight and most importantly keeping physically active are key in managing and preventing this combination of chronic diseases," Ferreira said by email.
One in two people will experience low back pain or neck pain at some point in their lives, the study authors note. Some previous research suggests that diabetes makes this type of chronic pain more likely to develop, but results have been mixed and strength of the connection isn't clear, they write.
Researchers looked at patients with both types of diabetes, each of which is a chronic disease that affects the way the body manages blood sugar.
The most common form, type 2 diabetes, is linked to obesity and aging and happens when the body can't properly use or make enough of the hormone insulin to convert blood sugar into energy. The less common form, type 1 diabetes, develops in childhood or young adulthood and occurs when the pancreas produces no insulin at all.
Altogether, researchers examined data from 11 different studies in six countries that looked at back pain, neck pain, spinal pain or some combination of these issues.
Only one study tracked people with diabetes who didn't have skeletal pain to see if they developed this problem over time. After two to four years of follow-up, this study failed to find a connection for back pain, neck pain or spinal pain.
The studies included in the analysis were not designed to prove whether or how diabetes might cause back, neck or spinal pain. The smaller studies also varied in their definitions of pain and the context in which diabetes patients reported their pain.
Even so, it's likely that obesity contributes to both diabetes and musculoskeletal pain issues, said Dr. Ahmed Hassoon, a researcher at the Johns Hopkins Bloomberg School of Public Health in Baltimore who wasn't involved in the study.
"If we add more weight beyond the capacity of the spine and its supporting disks and muscles, then we will destabilize it and will have all sorts of issues, and if we don't move enough, our support muscles will not be strong enough to support the spine," Hassoon said by email.
People with diabetes may be overweight or obese, and have diabetes complications that impair how blood vessels and nerves function. These problems can, in turn, compromise spinal health and contribute to back pain, Hassoon said.
"Long-term uncontrolled diabetes has negative impact on our blood vessels, nerves, muscles, and bone," Hassoon said. "Which, in turn, can generate all kinds of musculoskeletal symptoms, like chronic pain."
SOURCE: https://bit.ly/2XUxoLX PLoS ONE, online February 21, 2019.