Linking Pain to Metabolic Disease

By Dr. Peter Abaci

The experience of pain impacts so many different things in a person’s life, and it is fair to say that it can really disrupt the homeostatic balance of the body. Living beings naturally try to maintain internal stability of their operating systems, so when things get disrupted, actions take place to restore a new sense of order. A prime example of that would be with temperature control of the body where shivering is a way of maintaining a desired core temperature in response to a cold shift. 

When pain transitions into something more chronic, then the body likely goes through changes to maintain some level of stability with certain key functions. I frequently see patients develop basic changes in their general health and well-being that coincide with their pain problems. For instance, patients with chronic pain will frequently see elevations in their baseline blood pressure. They may go from not having any blood pressure problems to needing treatment for hypertension. Perhaps the stress response and fight or flight mechanism that gets prolonged by ongoing pain leads to elevations in things like adrenaline and cortisol that contribute to persistent changes in blood pressure, which is a key indicator of cardiovascular health.

With this in mind, it is worth looking at the relationship between pain and metabolic syndrome. Metabolic syndrome is a constellation of certain risk factors that come together resulting in an increased risk of dangerous diseases like heart disease, strokes and diabetes. These risk factors include abdominal obesity, elevated triglycerides, low HDL, hypertension, and elevated fasting blood glucose levels. When someone has at least three of these risk factors, then they meet the qualifications for metabolic syndrome. Interestingly, these different risk factors can be significantly reduced through lifestyle changes like exercise and reducing sugar intake, as examples. About 40% of Americans over the age of 60 are now considered to have metabolic syndrome.

The presence of chronic pain seems to also correlate with metabolic syndrome, as well. For example, there seems to be a strong association between fibromyalgia and metabolic syndrome. One study found that women with fibromyalgia were 5.5 times as likely to have metabolic syndrome compared to healthy control subjects. Another found that fibromyalgia was linked to larger waist sizes, bigger BMI, increased triglycerides, and lower HDL, and that the more painful body sites a person had, the more likely they were to have metabolic syndrome. A different study noted that the higher the pain intensity, the greater the chance of also having metabolic syndrome. Studies on work-related stress in Britain also show significant links with metabolic syndrome.

What the research can’t tell us is that being in pain directly causes metabolic syndrome or, alternatively, having cardiac risk factors creates pain. What I think it does suggest, though, is that all of the body’s processes are strongly interconnected, and that when certain ones get disrupted, then this changes the equation for all of them. Things like stress and over-excitation of the central nervous system can impact a whole host of systems including cardiovascular, endocrine, neurological, and psychological, leading to chronic diseases like diabetes, heart disease, Alzheimer’s, and chronic pain. While we know lifestyle and behavior modification can successfully treat metabolic syndrome and lower risk factors for things like heart disease and diabetes, it is hard to quantify how much of an impact doing so will have on concurrent pain symptoms or conditions like fibromyalgia. For example, if we studied a group with a certain pain problem who also had metabolic syndrome, and were able to successfully treat the metabolic syndrome for say 6 months, what impact would that have on their pain, level of function and quality of life? These are the types of next step studies that we need to see.

If you have chronic pain then it just might be worth talking to your doctor about metabolic syndrome, too.


Image courtesy of Vichaya Kiatying-Angsulee /



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