Back pain is a widespread and debilitating condition affecting millions worldwide. Whether stemming from injury, poor posture, or age-related degeneration, excess body weight is a significant contributor. An estimated 619 million people globally suffer from back pain, which can severely diminish a person’s quality of life. While traditional treatments include pain medication, physical therapy, and lifestyle modifications, a new approach is gaining attention: weight loss, particularly with the aid of GLP-1 receptor agonists.
The Link Between Obesity and Back Pain
Low back pain has been associated with obesity or with being overweight. Back pain, especially in the lower back, often has a mechanical component, meaning it's related to the structures of the spine and surrounding musculature. There is a growing number of studies suggesting an association between being overweight/obese and having LBP. Excess weight puts undue stress on the spine, particularly the lumbar region, leading to discomfort and pain. Studies have shown that individuals with higher body mass index (BMI) are more likely to experience back pain. One proposed mechanism of association between LBP and weight is that high BMI leads to additional mechanical load on the spine, predisposing individuals to spinal overload. A systematic review reported that 32% of 65 epidemiological studies identified a statistically significant positive association between body weight and LBP.
Moreover, there is a significant relationship between obesity and chronic low back pain. Being overweight and obese is associated with high blood pressure, type 2 diabetes, heart disease, and stroke. It’s also not surprising that excess weight raises the likelihood of back pain, joint discomfort, and muscle strain. Our spines help to keep us upright as we fight gravity every day to perform our daily tasks, but if you’re overweight, your spine is going to have a much harder time fighting that war. This pressure compresses the lumbar spine in the lower back, often resulting in a pinched nerve and lingering pain.
Traditional Back Pain Management and Its Limitations
Back pain management traditionally includes physical therapy, pain medications (like NSAIDs or muscle relaxants), lifestyle modifications, and in severe cases, surgery. However, these methods have limitations. Chronic use of pain medications can lead to dependency or side effects, and surgery doesn’t guarantee lasting results if the underlying weight issues persist.
The Role of GLP-1 Receptor Agonists
GLP-1 (glucagon-like peptide-1) receptor agonists, such as semaglutide (Ozempic, Wegovy) and liraglutide (Saxenda, Victoza), are medications originally designed to help manage blood sugar in people with type 2 diabetes. The result? Substantial and sustained weight loss, even in individuals without diabetes.
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While GLP-1 medications don’t directly treat back pain, the secondary effects of weight loss can have profound benefits on spinal health.
Benefits of Weight Loss on Spinal Health
- Reduced Stress on the Spine and Joints: Losing weight reduces the stress on the spine and joints, particularly the lumbar region. Less compression leads to decreased irritation of spinal discs, nerves, and facet joints.
- Improved Mobility and Energy Levels: As weight decreases, people often experience improved mobility and energy levels.
- Decreased Inflammation: Fat tissue contributes to systemic inflammation. By reducing fat mass, GLP-1 users can experience lower levels of inflammatory markers like CRP (C-reactive protein), which are often elevated in individuals with chronic pain. Similarly, there is evidence of a relationship between obesity, systemic inflammation, and LBP, with pro-inflammatory pathways amplified in obesity due to the presence of increased cytokines in adipose tissue.
- Improved Sleep Quality: Obesity is strongly linked with sleep apnea and poor sleep quality. Poor sleep amplifies the perception of pain and impairs the body’s natural healing processes.
Patients using GLP-1 medications often report being able to resume physical activities they had long given up due to pain-whether it’s gardening, walking, or returning to the gym. This improvement isn’t magic-it’s biomechanics.
GLP-1 Medications: Considerations and Precautions
GLP-1 medications are not for everyone and should be prescribed and monitored by a healthcare provider. It’s also important to remember that these medications are tools, not standalone solutions. Additionally, patients should avoid the temptation of using GLP-1 medications as a “quick fix” or without medical supervision.
Weight Loss Programs and Back Pain Relief
While reducing your weight to a healthy level is always recommended and can help alleviate your back pain, weight loss programs may offer additional benefits for back pain relief. However, it may not be enough. If your back pain persists or escalates, you should seek medical attention.
The Impact of Weight Loss on Chronic Pain
Living with chronic pain can be debilitating, especially for individuals experiencing joint or back pain. However, there is a powerful tool that can significantly improve their quality of life: weight loss. Beyond its aesthetic benefits, shedding excess pounds plays a crucial role in reducing chronic pain symptoms. Excess weight places undue stress on joints and the spine, exacerbating chronic pain. Each additional pound increases the load on weight-bearing joints, such as the knees and hips, which can lead to inflammation, deterioration, and increased pain levels. Weight loss directly lessens the mechanical stress on joints and the spine. For every pound lost, there is a substantial decrease in the pressure exerted on weight-bearing areas.
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Enhancing Mobility and Function
Losing weight contributes to enhanced mobility and range of motion. Decreasing Inflammation: Adipose tissue, or fat, secretes substances that promote inflammation in the body. Weight loss positively impacts the body's hormonal balance. Excess weight can disrupt hormonal regulation, leading to increased pain sensitivity and heightened discomfort. Effective weight loss for chronic pain reduction requires a multidisciplinary approach, combining dietary changes, physical activity, and medical guidance. It is essential to consult with healthcare professionals, such as physicians, nutritionists, and physical therapists, to develop a tailored plan that addresses individual needs, restrictions, and medical conditions. It is important to emphasize that even a modest amount of weight loss can have a significant impact on reducing chronic pain. Every pound lost contributes to less strain on joints and the spine, leading to improved mobility and decreased inflammation.
Weight Loss Strategies for Back Pain Relief
To effective treat back pain an overweight person will want to start losing weight.
- Get Moving: A gym is not the only place to work out. The side walk works, or even the living room of a home. Jog around the house, on the sidewalk or at the park.
- Maintain Proper Posture: It is hard to notice, but many people with back pain are sleeping or carrying things the wrong way. An unhealthy posture can lead to neck and back pain. Before going to sleep or getting up from a chair, check for proper posture. Also, a certain amount of neck and back muscle is necessary to maintain a healthy posture.
- Try Water Therapy: Water therapy will be as complex as a person wants it to be. The easiest thing someone can do for water therapy is jog, lift weights, or swim in a pool.
- Eat Healthier: Shopping at whole foods does not make a person healthy. A person becomes healthier when they stop eating unhealthy foods - candy, fast food and soda - and instead eat more vegetables, rice and water. Keep in mind, the effect of exercise is minimal without a healthy diet to supplement it.
- Get a Good Night’s Sleep: Many studies show lack of sleep increases risk of weight gain.
- Get a Dog: Getting a pet dog is surprisingly a great way to lose weight fast. By simply walking a dog once a day someone can lose weight without realizing it.
Studies on Weight Loss Programs and Back Pain
An electronic search was conducted on CINAHL (1981 to June 2020), Web of Science (1900 to June 2020), Ovid Medline (1946 to June 2020), Ovid Embase (1974 to June 2020), and AMED (1985 to June 2020) to identify relevant articles. The search was not restricted to any specific language or year of publication. Key terms for weight loss and LBP were used and a search strategy was constructed in consultation with an experienced university librarian (Appendix 1). Eleven studies (n = 689 participants) including one randomized controlled trial, two non-randomized studies of intervention and eight single-arm studies were included (seven of which evaluated bariatric surgery). There was low-quality evidence that a lifestyle intervention was no better than waitlist for improving back pain and very low-quality evidence from single-arm studies that back pain improved from baseline after bariatric surgery. The one RCT by Williams et al. (2018) evaluated a healthy lifestyle intervention (consisting of telephone-based advice, clinical consultation, and healthy lifestyle coaching) compared to waitlist. The results of the study show that the healthy lifestyle intervention did not improve back pain intensity, decrease disability or improve quality of life for patients with LBP who were overweight/obese.
Silisteanu et al. conducted a NRSI that allocated 175 patients diagnosed with chronic LBP to the control (analgesic drug treatment, physiotherapy, and massage) and treatment groups (same as control plus nutritional counselling and physical activity). The study demonstrated that when nutritional counselling was applied, the VAS pain index (p < 0.01) and QOLS (p < 0.05) (except for men in urban areas) were further improved in the treatment group compared to the control group.
Surgical Options and Considerations
On occasion, degenerative spinal conditions may need to be treated with surgery. Obesity has been associated with a greater risk of complication or infection in individuals who require surgery. Bariatric surgery is usually considered for individuals whose body mass index is above 35 to 40, if safer and healthier methods of weight loss have not proven effective over 6 to 12 months. Bariatric surgery poses numerous short-term and long-term risks, such as bleeding of the digestive tract, bowel obstruction, nutritional deficiencies, hernia, a venous blood clot that moves into the lungs (venous thromboembolism), reoperation, and rarely, death. Bariatric surgery can only do so much to help an individual lose weight and to help curb food cravings. It is important that bariatric surgery is combined with a nutritional program and regular exercise. The patient has to be highly motivated to not only lose weight but also to keep the weight off.
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