Abdominal fat causes back and nerve pain

Danielle.Steilen.ProlotherapistDanielle R. Steilen-Matias, MMS, PA-C

Before you read on, if you have questions about Obesity and Back Pain, get help and information form our Caring Medical staff.

Most researchers believe there is a link between a big belly and back pain.

A long-term report from researchers at the Medical University of Graz in Australia conducted over 35 years reported that:

We have to agree with the last statement, we find that people with back pain do need to move to help prevent symptoms and address degenerative disc disease progression.

For many people, it would seem obvious, a large belly is putting mechanical stress on the spine and that is the cause of back problems. When there is back pain there is problems of being sedentary.

Big belly causes stress and mechanical load in a bad back

And so and so on, numerous studies on mechanical load as the cause of back pain in obese people.

Big belly causes inflammation and nerve pain in a bad back

There have been many studies that suggest that it is not the physical load of carrying the extra weight that is causing back pain in obese and overweight patients, but inflammation caused by excess fat changing the body environment to that of chronic inflammation.  Please see our article: Excessive weight and joint pain – the inflammation connection.

Now researchers are suggesting a relationship between neuropathic pain and obesity with an inflammation connection. In a paper from the University of Tokyo, doctors made these observations:

Pain in your back was clearly made worse by carrying a belly load. Now add to that high blood sugar.

A well cited 2005 study in the Journal of the peripheral nervous system, found that nerve sensory thresholds were metabolically altered which could lead to a future clinical neuropathy.(6) What was suspected of metabolically altering the spinal nerves? Hyperinsulinemia and insulin sensitivity. 

Doctors at the University of Calgary writing in the journal Osteoarthritis and Cartilage examined obese laboratory animals and found that obesity causes inflammatory osteoarthritis. The inflammation attacking the joints of the animals was caused by a high fat/high sugar diet.(7)

This type of research is helping doctors understand metabolic inflammation, obesity and back pain

This was confirmed by French researchers in Current opinion in rheumatology, who suggested that the rising prevalence of hand osteoarthritis is from obesity and since the hand does not bear weight, this suggests that the role of systemic inflammatory mediators in fat cells cause inflammation signaling to be sent out and attack joints.(8)

Please see our article Excessive weight and joint pain – the inflammation connection for more on this subject.

Back surgery and the problems of obesity on back pain

A 2016 study published in the Chiropractic & manual therapies made these observations:

In a recently published article in the American Journal of Bone and Joint Surgery, researchers examined the effect that obesity has on patients managed for symptomatic lumbar disc herniation. They studied a group of patients who underwent back surgery and a group of patients who had more conservative non-surgical treatments. Both groups showed significantly less improvement as it related to problems of obesity.(10)

The same was found in newer research from St. Olavs University Hospital, in Norway for patients having surgery for lumbar spinal stenosis. The researchers noted: “Obese patients were less likely to achieve a minimal clinically important difference.”(11)

In February 2017, researchers at Cornell, Clemson, the University of Georgia, and Xi’an Jiaotong University in China, completed a study which found that :

A component of failed spinal surgery is obesity

A study in The Spine Journal said that a component of failed spinal surgery was obesity. This recent research was the first to examine obesity’s role in recurrent disc herniation after spinal surgery.

“Obesity was a strong and independent predictor of recurrent (disc herniation) after lumbar microdiscectomy. Surgeons should incorporate weight loss counseling into their preoperative discussions with patients.”(13)

There is even suggestion from University researchers in Rome, who wrote in the European spine journal that elevated cholesterol levels and triglycerides have a role: “patients with symptomatic herniated lumbar disc showed statistically significant higher triglyceride concentration  and total cholesterol concentration. Serum lipid levels may be a risk factor for [symptomatic disc herniation]. An enhanced understanding of these factors holds the promise of new approaches to the prevention and management.”(14)

How beneficial is spinal surgery for obese patients?

Any procedure that offers a patient relief of their symptoms is a good procedure. But how much risk should a patient take and for how much relief?

Let’s look at two studies FAVORABLE to spinal surgery for obese patients

The question of how obese patients respond to surgery as compared to non-obese patients was tackled by doctors at the Department of Neurosurgery, University of Alabama at Birmingham. In this September 2017 study, the doctors looked at obese and non-obese patients treated with lumbar laminectomy for symptomatic lumbar spinal stenosis.

What to make of this?

The researchers concluded: “obese patients with symptomatic lumbar spinal stenosis may require longer to recover after decompression but can expect to reach equivalent outcomes of similarly treated (non-obese) patients”(15)

In the second favorable study, Spanish doctors writing in the medical journal Neurocirugia (Neurosurgery) write of the growing evidence that connects the metabolic processes within the adipose tissue, preferentially abdominal fat, with a low-intensity chronic inflammatory state that causes back pain.

They suggest: Some meta-analyses have confirmed an increase of complications following lumbar spine surgery (mainly infections and venous thrombosis) in obese subjects.

However, functional outcomes after lumbar spine surgery are favorable although inferior to the non-obese population, acknowledging that obese patients present with worse baseline function levels and the prognosis of conservatively treated obese cohorts is much worse.(16)

A 2015 study from doctors at University hospital researchers in the United Kingdom also suppoted surgery for obese patients.

For obese and non-obese patients pain and functional outcome are similar to non-obese patients. So if the surgery failed, it was not the fault of the obesity.

Again, this all comes down to lifestyle choices to accelerate healing or make healing more difficult.

Addressing obesity and back pain

It should be obvious that if you have joint deterioration, a change in lifestyle in addition to any treatment will be beneficial.

Recent research stated : There is a need for prevention strategies with lifestyle interventions such as:

  • maintaining an ideal body weight to prevent obesity,
  • regular exercises,
  • avoidance of smoking and alcohol abuse,
  • intake of a balanced diet and nutrients to include adequate calcium and vitamin D,
  • modification of the work environment and avoidance of certain repetitive activities

will prevent or ameliorate disorders such as osteoarthritis, osteoporosis, rheumatoid arthritis, gout and musculoskeletal pain syndromes including low back pain and work-related pain syndromes.(18)

The most successful Prolotherapy offices are those that work with patients on a healthy lifestyle along with Prolotherapy for back pain to achieve the most efficient healing.

If you have questions about Obesity and Back Pain, get help and information form our Caring Medical staff

1 Großschädl F, Freidl W, Rásky É, Burkert N, Muckenhuber J, Stronegger WJ. A 35-year trend analysis for back pain in Austria: the role of obesity. PloS one. 2014 Sep 10;9(9):e107436.[Google Scholar]
2. Jentzsch T, Geiger J, Slankamenac K, Werner CM.Obesity measured by outer abdominal fat may cause facet joint arthritis at the lumbar spine. J Back Musculoskelet Rehabil. 2014 Jun 24.[Google Scholar.]
3. Hajihosseinali M, Arjmand N, Shirazi-Adl A. Effect of body weight on spinal loads in various activities: a personalized biomechanical modeling approach. Journal of biomechanics. 2015 Jan 21;48(2):276-82.[Google Scholar.]
4. Singh D, Park W, Hwang D, Levy M. Severe obesity effect on low back biomechanical stress of manual load lifting. Work. 2015 Jan 1;51(2):337-48.[Google Scholar]
5. 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.[Google Scholar]
6. Miscio G, Guastamacchia G, Brunani A, Priano L, Baudo S, Mauro A. Obesity and peripheral neuropathy risk: a dangerous liaison. Journal of the peripheral nervous system. 2005 Dec 1;10(4):354-8.[Google Scholar]
7 Collins KH, Reimer RA, Seerattan RA, Leonard TR, Herzog W. Using diet-induced obesity to understand a metabolic subtype of osteoarthritis in rats. Osteoarthritis Cartilage. 2015 Feb 3. pii: S1063-4584(15)00028-X. doi: 10.1016/j.joca.2015.01.015.[Google Scholar]
8 Berenbaum F, Eymard F, Houard X. Osteoarthritis, inflammation and obesity. Curr Opin Rheumatol. 2013 Jan;25(1):114-8.[Google Scholar]
9 Ewald SC, Hurwitz EL, Kizhakkeveettil A. The effect of obesity on treatment outcomes for low back pain. Chiropractic & Manual Therapies. 2016;24:48. doi:10.1186/s12998-016-0129-4.[Google Scholar]
10 Rihn JA, Kurd M, Hilibrand AS, Lurie J, Zhao W, Albert T, Weinstein J. The influence of obesity on the outcome of treatment of lumbar disc herniation: analysis of the Spine Patient Outcomes Research Trial (SPORT). The Journal of bone and joint surgery. American volume. 2013 Jan 2;95(1):1.[Google Scholar]
11 Giannadakis C, Nerland US, Solheim O, Jakola AS, Gulati M5, Weber C6, Nygaard ØP, Solberg TK, Gulati S. Does obesity affect outcomes after decompressive surgery for lumbar spinal stenosis? – A multicenter observational registry-based study. World Neurosurg. 2015 Jun 19. pii: S1878-8750(15)00768-8. doi: 10.1016/j.wneu.2015.06.020.[Google Scholar.]
12.Sheng B, Feng C, Zhang D, Spitler H, Shi L. Associations between Obesity and Spinal Diseases: A Medical Expenditure Panel Study Analysis. Int J Environ Res Public Health. 2017 Feb 13;14(2). pii: E183.[Google Scholar.]
13. Meredith DS, Huang RC, Nguyen J, Lyman S. Obesity increases the risk of recurrent herniated nucleus pulposus after lumbar microdiscectomy. The Spine Journal. 2010 Jul 31;10(7):575-80.[Google Scholar.]
14. Longo UG, Denaro L, Spiezia F, Forriol F, Maffulli N, Denaro V. Symptomatic disc herniation and serum lipid levels. European Spine Journal. 2011 Oct 1;20(10):1658-62.[Google Scholar.]
15 Elsayed G, Davis MC, Dupépé EC, McClugage SG, Szerlip P, Walters BC, Hadley MN. Obese (Body Mass Index> 30) Patients Have Greater Functional Improvement and Reach Equivalent Outcomes at 12 Months Following Decompression Surgery for Symptomatic Lumbar Stenosis. World Neurosurgery. 2017 Sep 1;105:884-94.[Google Scholar.]
16 Delgado-López PD, Castilla-Díez JM. Impact of obesity in the pathophysiology of degenerative disk disease and in the morbidity and outcome of lumbar spine surgery. Neurocirugia (Asturias, Spain). 2017 Jul 24.[Google Scholar.]
17. Lingutla KK, Pollock R, Benomran E, Purushothaman B, Kasis A, Bhatia CK, Krishna M, Friesem T. Outcome of lumbar spinal fusion surgery in obese patients: a systematic review and meta-analysis. Bone Joint J. 2015 Oct;97-B(10):1395-404. doi: 10.1302/0301-620X.97B10.35724[Google Scholar]
18. Mody GM, Brooks PM. Improving musculoskeletal health: global issues. Best Pract Res Clin Rheumatol. 2012 Apr;26(2):237-49.[Google Scholar]


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