Serious health complications, such as foot ulcers and retinopathy (damaged blood vessels in the back of the eye), are commonly associated with diabetes. However, signs of diabetes disease progression have also been linked to chronic back pain,1 suggesting that uncontrolled diabetes is likely to play a role in the development of chronic back pain. Additional factors related to diabetes, such as clinical obesity, may also be linked to chronic back pain and related spinal disorders.
Diabetes Is a Risk Factor for Lower Back Pain
Individuals with diabetes are 19% to 35% more likely to have lower back pain and 24% to 34% more likely to have neck pain than the general population.2,3 The noticeably higher risks of spinal pain may be the result of diabetes-related imbalances in blood sugar, insulin, and free radicals, which place unhealthy stress on spinal discs.
- Hyperglycemia (high levels of sugar in the blood)
- Hyperinsulinemia (high levels of insulin in the blood)
- Oxidative stress (high levels of free radicals)
Free radicals refer to unstable atoms that damage cells and contribute to the aging of the body. Antioxidants, such as vitamin E, help to stabilize free radicals and prevent damage. If free radicals outnumber antioxidants, cells tend to become strained by the damage; this strain is referred to as oxidative stress.
Diabetes is connected with high levels of sugar, namely glucose and sorbitol, which is a by-product of glucose. High blood sugar tends to change the extracellular matrix5 leading to increased rate of cell death, particularly for cells that form the inner ring of the intervertebral spinal disc. The inference here is that the natural aging of the disc accelerates due to these cellular changes.6
High levels of insulin in the blood, associated most closely with type 2 diabetes, leads to a slight change in the profile of proteoglycans (protein molecules that have attached carbohydrate chains). Excess insulin increases the amount of chondroitin sulfate, a type of proteoglycan, in the outer ring of the intervertebral discs of rats.3
Loss of this chondroitin sulfate lowers the water content of the disc, decreasing the disc’s flexibility and function. The proteoglycan profile in patients with diabetes has lower buoyant density and fewer sugar side chains compared to patients without diabetes.4 Consistently elevated insulin levels alter the proteoglycans in several ways, leading to changes in the shape and function of the disc; the disc degenerates more quickly than in cases of controlled diabetes or cases without diabetes.
Additional studies of diabetic rats found that high glucose levels lead to oxidative stress, which occurs when the number of free radicals outweighs the number of antioxidants. Oxidative stress leads to damaged cells in the inner ring of the disc, contributing to accelerated aging of the disc. The effect of hyperglycemia worsened with higher glucose levels and with longer duration of hyperglycemia, demonstrating that diabetes may have a dose-dependent and time-dependent relationship with disc degeneration.7-9
Research suggests that hyperglycemia, hyperinsulinemia, and oxidative stress lead to significant changes, such as the composition of the proteoglycans in the spinal discs. These studies indicate that diabetes is likely to contribute to cellular changes and degeneration in the spine, beyond that of obesity or physical inactivity alone. More research needs to be done before a clear relationship between diabetes and disc degeneration can be truly established.
Read more about Causes of Degenerative Disc Disease Pain
Markers of Diabetes Correlate with Chronic Back Pain
In a study of tens of thousands of cases of diabetes, comparisons were made across 3 categories1:
- Diabetes with no chronic back pain
- Diabetes with chronic back pain
- Diabetes with surgical intervention for chronic back pain
Several variables were found to be associated with development of chronic back pain or having spinal surgery, such as neuropathy, retinopathy, insulin use, and higher body mass index (BMI), and more.1
The patients who underwent surgery for spinal disorders related to chronic back pain tended to have stronger indicators of diabetes progression than did the individuals who did not receive surgical treatment for their pain. An additional variable may be time; with every year that passes, the risk for developing chronic back pain increased in patients with diabetes.1
It is thought that the toll of uncontrolled diabetes on the body may contribute to specific spinal conditions and eventually a need for surgical treatment.