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Diabetes and Back Pain – What’s the Connection?

back pain and diabetesChronic back pain and diabetes often occur together, but the connection isn’t as simple as one causing the other. Sometimes the effects of diabetes can trigger pain but in other cases it may be that inactivity associated with back pain actually increases the risk of diabetes.

In this mini-series we take a look at the links between back pain and diabetes, how commonly they occur together, why sleep plays a major role in treating both, and how physical activity is vital for successfully managing both.


People with diabetes often report a variety of types of pain, including:

  • Back pain
  • Neuropathic pain (shooting pains in hands and feet)
  • Headaches
  • Arthritis
  • Fibromyalgia

These types of pain have multiple origins, some connected directly to diabetes, some indirectly, and some not really related to diabetes at all. Back pain, for example, may be a result of a previous injury many years prior, or could be caused by congenitally short pedicles and early onset of spinal stenosis symptoms and nerve pain. However, back pain may also be caused by systemic inflammation that is affecting the nerves in the spine, or it could be connected to a rapid weight gain and increased pressure on spinal structures. In some cases the back pain may predate the diabetes developing and have contributed through inactivity, stress, disturbed sleep, and so forth.

Immune Function, Back Pain and Diabetes

In the case of arthritis, diabetes may be linked through impaired immune function that has contributed to abnormal bone turnover and inflammation. There may be an underlying nutritional deficiency tied to both conditions, such as low vitamin D levels affecting immune health and predisposing a person to both diabetes and an autoimmune degenerative joint disease such as rheumatoid arthritis. Poorly managed diabetes can also increase a person’s risk of cancer, including bone cancer, and treatments for cancer may also adversely affect bone and joint health.

The Sensation of Pain

Pain is not a straightforward interaction between acute trauma and the feeling of pain as processed in the brain. Many things are involved in the sensation of pain, including sensory input, emotions, memories, and competing activity in the brain. This is how the gate control theory of pain management works as the actual signals from nerves sensing pain may be blocked by alternative forms of sensory stimulation.

Nerves can become hypersensitive, especially when injured and healing, or the brain can misinterpret signals to amplify pain or create pain where there is no mechanical cause (such as in the case of phantom limb pain). Those with fibromyalgia may have increased numbers of small nerve fibres and substance P, contributing to higher overall levels of pain perception. Conversely, some people with diabetic neuropathy may find that nerve function is impaired and they fail to recognise pain in the feet, leading to ulcers and infection and/or an increased risk of serious injury from burns or compression.

When Acute Back Pain Becomes Chronic

Acute pain can, over time, cause the brain to anticipate painful signals and lead to the feeling of persistent pain. Chronic back pain may originate from tired muscles or joint swelling and these signals can intermingle with feelings of depression, fatigue, sadness, stress, and anxiety and become amplified to make pain feel worse and ongoing. The brain may think that there is a persistent threat and create consistent feelings of pain even after an injury is healed.

Trauma, both emotional and physical can heighten our sensitivity to pain, which may be part of the mechanism behind increased levels of reported pain in those with chronic conditions such as diabetes, as well as in those who have suffered from acute stress in the military or in serious accidents.

Unfortunately, chronic pain can make us tense our muscles, which can actually make pain worse. It may also cause changes in posture and mobility over time, reducing muscle strength and spinal stability and predisposing us to injury, stiffness, and joint degeneration. Chronic pain can also increase feelings of frustration, anger, grief, anxiety, and fear, as well as lowering our resistance to stressful stimuli and disturbing good quality sleep, which is important for both back pain and diabetes management.

As you can see, the link between diabetes and back pain is far from simple, but that doesn’t mean that steps can’t be taken to reduce risks for both conditions and complications from each, including improving sleep, stress management, and overall health and well-being with physical activity.

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  1. […] pain can all seriously undermine efforts to exercise. Our latest article in this mini-series on back pain and diabetes looks at the role of physical activity in chronic pain relief and diabetes […]

  2. […] on February 19, 2014 In the second article in our mini-series looking at the link between back pain and diabetes we focus on how both conditions are not only affected by a lack of sleep but might actually be a […]

  3. […] LMatthews on February 15, 2014 In the second in our series looking at the links between diabetes and back pain we examine the research on how the two conditions overlap. Just how common is back pain in those […]

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