Metabolic syndrome may worsen chronic low back pain

About 40% of patients with chronic low back pain (CLBP) have metabolic syndrome (MS), and patients with MS have more severe pain and disability, according to a study published in the Journal of Neurosciences in Rural Practice.

Metabolic syndrome is a cluster of conditions like increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels that occur together, increasing the risk of heart disease, stroke, and diabetes.

Diagnosis of MS was based on the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) and International Diabetic Federation (IDF) criteria. According to the NCEP III criteria, three of the following features were needed including central obesity.

1. 
   
   Central obesity: Waist circumference >102 cm in males and >88 cm in females


2. 
   
   Hypertriglyceridemia: >150 mg/dl or on specific medication


3. 
   
   Low high-density lipoprotein (HDL): <40 mg/dl in males and <50 mg/dl in females


4. 
   
   Blood pressure: >130 mmHg systolic or >85 mmHg diastolic blood pressure or on antihypertensive drugs


5. 
   
   Fasting plasma glucose: >100 mg/dl or on the specific medication or previously diagnosed type 2 diabetes


6. 
   
   The features of IDF criteria are similar to the NCEP III except (A) – abdominal circumference >90 cm in males and >80 cm in females. In the IDF criteria, the patients should fulfill the abdominal circumference criteria along with 2 or more other features of MS.

Jayantee Kalita and his associates conducted a study to report the frequency of metabolic syndrome (MS) in chronic LBA (CLBA) and its association with severity and disability of CLBA.

The study evaluated 201 patients with chronic low back pain with and without MS. Clinical and demographic parameters were recorded. The routine biochemical test was done. The severity of pain was assessed by a 0–10 Numeric Rating Scale (NRS) and disability by Oswestry Disability Index (ODI) version 2

The study found that 79 (39.3%) patients had MS as per the International Diabetic Federation (IDF) criteria and 68 (33.8%) as per the National Cholesterol Education Program Adult Treatment Panel III criteria. Abdominal obesity was the most common (171 [85.1%]) feature of MS. The patients with MS had a longer duration of sitting work and did less frequent exercise. The NRS and ODI score were higher in chronic lower back pain patients with MS compared to those without MS.

The authors said that for the first time any study has evaluated the frequency of MS in CLBA and its relationship with pain severity and disability. The relationship of increasing age with MS may be due to the distribution of MS in the age-specific population.

Low back pain (LBP) remains a clinical challenge and has the highest disability burden worldwide. After an episode of lower back pain, up to two-thirds of people still, experience variable levels of pain after 1 year.