Marc Darrow MD, JD 

When we see a patient in our office who has joint or back pain and they have clear issues of excessive weight, we try to reassure the patient that we understand that it can be difficult to lose weight. We tell them that we are not going to lecture them and that we will try to present solutions that are realistic. We do have a diet program in our office that can help people, but the choice to diet or make a lifestyle change is up to the patient.

There has been a large amount of published research, recently released, that suggests that it is not only the mechanical stress that a big belly puts on your lower spine that can cause back pain, but the runaway inflammation that the belly fat is producing that may be attacking your spinal nerves.

Research: Overweight people have more neuropathic back pain, tingling sensations, severe back pain, and acute back pain compared to normal weight people with back pain.

A 2016 study published in the journal Pain research and management (1made these suggestions:

  • Obesity could be the cause of neuropathic (nerve) pain that is distinct from musculoskeletal pain. Neuropathic may not have an obvious source, such as the degenerative damage seen in disc disease. This pain may be originating from the inflammation the body fat of the obese people is producing.
    • Study Finding: Results showed that the overweight patients with neuropathic pain complained of more severe pain than the normal-weight patients in spite of comparable analgesic dosages (i.e., on a proportional body-weight basis).
    • In addition, the overweight patients seemed to experience more serious paroxysmal (sudden acute attacks of pain or spasm) pain, and their neuropathic negative symptoms (for example an increase in tingling or numbness) might tend to be aggravated. (It can be suggested that patients who suffer from spasms, acute pain, numbness and tingling sensations, have these symptoms caused not by a pinched nerve, but by the inflammation being generated by their abdominal fat.)

The researchers of this study then made this point:

Lumbar radiculopathy pain can be caused by obesity related inflammation

  • In obese patients, an increased secretion of proinflammatory cytokines (an oxidant or inflammatory) and a decreased secretion of anti-inflammatory cytokines from adipose tissues are observed, and these can lead to increased levels of proinflammatory cytokines and systemic inflammation.
  • This inflammation can lead to peripheral and central sensitization in the pain transmission system and result in hyperalgesia (heightening sense of pain) and allodynia (in some cases, acute pain for no reason, as we mentioned above, sudden acute spasms in the lower back for seemingly no reason).
  • It can be suggested that lumbar radiculopathy pain can be associated with obesity related inflammation.

Inflammation may be a crucial player in Intervertebral Disc Degeneration

An April 2019 published study in the International journal of molecular sciences (2) further advanced the idea that obesity creates inflammation that creates back pain.

“Recent evidence indicates that besides abnormal and excessive mechanical loading, inflammation may be a crucial player in Intervertebral Disc Degeneration. Furthermore, obese adipose tissue is characterized by a persistent and low-grade production of systemic pro-inflammatory factors. In this context, chronic low-grade inflammation associated with obesity has been hypothesized as an important contributor to Intervertebral Disc Degeneration through different, but still unknown, mechanisms”

The researchers go on to suggest that thickened vertebral marrow adipose tissue was pointed as a source of inflammatory adipokines (fat cells) that trigger degenerative pathways in degenerative disc disease via metabolism disturbance and the establishment of an initial inflammatory environment.

Diet can help with your back pain but it is only one aspect

An April 2019 study in the International journal of molecular sciences (3) continued the research into the obesity causing inflammatory factors affecting people with back pain. This research made these suggestions:

  • Recent evidence indicates that besides abnormal and excessive mechanical loading (degenerative disc disease), inflammation may be a crucial player in Intervertebral Disc Degeneration. Furthermore, obese adipose (fat) tissue is characterized by a persistent and low-grade production of systemic pro-inflammatory factors. In this context, chronic low-grade inflammation associated with obesity has been hypothesized as an important contributor to degenerative disc disease.
  • It is also important to recognize that degenerative disc disease is a complex and multi-factorial disease and thus, further basic and clinical research is needed to fully understand the extent role of inflammation is back pain.

The research suggests that there is a connection between the inflammation your abdominal fat is causing and your back pain. However, there are many factors in play to limit back pain to solely a problem of abdominal fat.

Obesity causes mechanical stress on the lower spine

In the studies above, the inflammatory factors related to obesity were linked to back pain. This included the production of chronic, damaging inflammation, and the environment to produce this inflammation. Obesity now delivers its second blow to the spine. The weight load of mechanical stress.

In the April 2019 issue of the European Journal of Pain, (4) researchers made this observation:

  • Patients who lost more than 5% of their body weight (a modest 10 pound loss on a 200 pound frame for example) had significant reductions in their low back pain.

This research team concluded: “Weight loss can reduce musculoskeletal pain, particularly for those who lose more weight. Imbedding pain management strategies within these services may provide a more holistic approach to obesity management.”

On this website my back pain articles include:

These articles discuss the various problems and challenges we have seen in our patients over the past 20 years. We have found that incorporating these treatments for our problems, with a sensible diet plan, can offer our patients significant back pain relief and make them feel good again.


Do you have questions? Ask Dr. Darrow



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References:

1. Hozumi J, Sumitani M, Matsubayashi Y, Abe H, Oshima Y, Chikuda H, Takeshita K, Yamada Y. Relationship between Neuropathic Pain and Obesity. Pain Research and Management. 2016 Mar 29;2016.
2 Ruiz-Fernández C, Francisco V, Pino J, Mera A, González-Gay MA, Gómez R, Lago F, Gualillo O. Molecular Relationships among Obesity, Inflammation and Intervertebral Disc Degeneration: Are Adipokines the Common Link?. International journal of molecular sciences. 2019 Jan;20(8):2030.
3 Ruiz-Fernández C, Francisco V, Pino J, Mera A, González-Gay MA, Gómez R, Lago F, Gualillo O. Molecular Relationships among Obesity, Inflammation and Intervertebral Disc Degeneration: Are Adipokines the Common Link? Int J Mol Sci. 2019 Apr 25;20(8):2030. doi: 10.3390/ijms20082030. PubMed PMID: 31027158; PubMed Central PMCID: PMC6515363.
4 Dunlevy C, MacLellan GA, O’Malley E, Blake C, Breen C, Gaynor K, Wallace N, Yoder R, Casey D, Mehegan J, Fullen BM. Does changing weight change pain? Retrospective data analysis from a national multidisciplinary weight management service. European Journal of Pain. 2019 Apr 9.

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