Four out of five diabetics will suffer at least one episode of back pain, but many have repeated/chronic pain that can affect work, home and relationships, even though there’s rarely a serious cause.
Our backs consist of bony blocks (vertebrae) cushioned by intervertebral discs and linked by side/back joints, creating bony tunnels that protect our spinal cords. Strong ligaments and muscles provide stability and flexibility so we can bend and twist. Nerve roots spread out between both sides of each pair of vertebrae, allowing our brains to control our movements and detect sensations.
Diabetes causes nerve damage and this triggers most problems compounded by poor posture (sometimes linked to pregnancy, obesity or a curved spine), prolonged standing, heavy lifting/carrying/manual work, slouching in unsupportive chairs or car seats, bending or overstretching, sudden awkward movements, or overdoing one particular activity. Inflammation, infection and trauma can damage vertebrae, which may crack because of osteoporosis or secondary cancer spread. Occasionally back pain is caused by chest or tummy problems, while under-16’s often have congenital or growth-related conditions and should always see their GPS.
The severity or site of the pain isn’t always an accurate guide to what’s wrong; even a minor tweak can be extremely painful. You may notice pain only on movement or in one position; stiffness, especially in the mornings, pain in a buttock or thigh, or numbness and/or weakness travelling down to the foot if your sciatic nerve is trapped (eg, by a ‘slipped’ disc). You’ll need blood tests if you have constant pain or night pain lasting six weeks, if pain is linked to weight loss, sweats or other body symptoms, or if you are known to have cancer. You should seek immediate medical help if pain/numbness affects both legs, or you have trouble urinating or opening your bowels.
You may need an MR (magnetic resonance) scan to show up soft tissues, such as discs and nerve roots ; X-rays and CT Scans are better at detecting bony or internal causes. Local policies often say only specialists, not GPS, can arrange these.
New guidelines from NICE (National Institute for Health and Care Excellence) list recommended non-surgical treatments and advise when a specialist opinion is needed. They also say epidural injections, radiofrequency denervation (to destroy a painful nerve) and disc or spinal bone surgery can be used if appropriate. Yoga isn’t included, but new international research says it sometimes helps chronic non-specific low back pain. Pilates can boost muscle strength and flexibility.
NICE also says some traditional treatments should no longer be offered, including corsets, orthotics (shoe inserts/ rocker soles), spinal traction, acupuncture, or TENS (transcutaneous electrical nerve stimulation). If you’ve found that they help you, you could still pay privately for them, if your doctor agrees.
E247 – Diabetes and Back Pain Go Beyond Red Flags – www.diabetic.today