Abstract
Diabetes mellitus with its increasing prevalence is one of the four major non-communicable diseases. It is characterized by hyperglycemia, which may progress to chronic complications such as peripheral vascular disease and neuropathy. This paper highlights the pathophysiology associated with diabetes, which is restricted to not only hyperglycemia but also other comorbidities including chronic lower back pain.Diabetes is a metabolic disorder associated with hypercholesteremia, hypertriglyceridemia, and hypertension. This chain of events leads to free plasma fatty acids and a pro-inflammatory state, therefore promoting calcification of blood vessels, which may block the blood supply to vertebral discs and thereby increase vulnerability in the patients with ongoing inflammatory disease such as osteoarthritis and also causing costochondritis. Functional limitation due to increased load on the weight-bearing joints is a common mechanical complication of diabetes. Obesity in diabetes is more prevalent due to a disturbed metabolism, which is aggravated with a persistent inflammatory state.Moreover, the aim of this review is to encourage further conduction of clinical studies to explore the definite cause and potential therapy for chronic lower back pain in diabetes, thereby investigating the association of lipid metabolism and skeletal muscle atrophy leading to chronic back pain, the role of diabetic medications, and vulnerability in the female gender. Diminished physical activity and depression in diabetic patients disrupt the hypothalamic-pituitary-adrenal axis (HPA), which further contributes to lower back pain. Further clinical investigation and research in this regard will establish substantial data for the linkage between depression in diabetes and back pain. However, despite all the advancements of medical literature, the exact cause of lower back pain in diabetes is arguable.Pain impedes the health status and life quality; therefore, it is essential to maintain the quality of health in patients with diabetes by treating not only hyperglycemia but also other multifactorial causes leading to lower back pain.
Highlights
BackgroundAccording to the World Journal of Diabetes, diabetes mellitus is a chronic metabolic disorder in which the body's ability to produce or reciprocate to insulin is lost, resulting in impaired carbohydrate metabolism and increased levels of glucose in the blood [1]
Diabetes is mainly of two types; type 1 diabetes mellitus, called insulin-dependent which occurs due to the destruction of insulin-secreting beta cells and lack of insulin secretion most common in children and adolescents, and type 2 diabetes mellitus, which comprises 90% of the diabetic cases, is non-insulindependent, caused by impaired sensitivity of target tissue receptors to insulin, and is most commonly associated with obesity [5]
Diabetes and lower back pain both can have a considerable impact on a patient's life when acting alone and or in combination, causing severe health deterioration
Summary
According to the World Journal of Diabetes, diabetes mellitus is a chronic metabolic disorder in which the body's ability to produce or reciprocate to insulin is lost, resulting in impaired carbohydrate metabolism and increased levels of glucose in the blood [1]. Type 2 diabetes in higher age groups shows an increased reduction in lean mass of legs and decreased muscle strength and functional competency as compared to the people having a normal amount of glucose in the blood [32]. In the legs, in patients with type 2 diabetes could be one of the important contributing factors in developing chronic lower back pain, as lack of support leads to constant wear and tear due to extra load on the intervertebral disc [38]. Correspondence between depression and increased inflammation by HPA axis dysfunction makes depression a cofounder for back pain in diabetes Individuals with both depression and diabetes have a functional disability, resulting in poor posture causing back pain and lack of substantial activities more, as compared with the individuals struggling with diabetes and depression alone [43,44,45]. The role of these diabetic medications in causing lower back pain should be investigated further
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