Neck pain, back pain, and osteoarthritis are common musculoskeletal conditions treated by pain practitioners. They rank among the leading causes of disability worldwide and are reportedly on the rise.
- Lower back pain accounts for the greatest global increase in years lived with disability (17·5%) from 2007 to 2017 (1).
- It is estimated that 9.6% of men and 18% of women aged ≥ 60 years have symptomatic osteoarthritis. After diabetes and dementia, it is the most rapidly rising condition associated with disability worldwide (2).
Neck pain, back pain, and osteoarthritis frequently occur alongside chronic conditions such as cardiovascular disease, cancer, diabetes, chronic respiratory disease, and obesity, raising the question:
Do musculoskeletal conditions increase the chance of chronic disease?
To answer this question, researchers from Australia, the UK, and Denmark conducted a systematic review and meta-analysis of studies looking into potential associations between neck or back pain, osteoarthritis of the knee or hip and the most prevalent chronic diseases: cardiovascular disease, cancer, diabetes, chronic respiratory disease, and obesity (3).
The authors chose to evaluate only longitudinal cohort studies (which collect data for the same subjects repeatedly over a period of time) to specifically assess whether having one of the above musculoskeletal conditions makes a person more likely to be diagnosed with a chronic disease.
Literature search on electronic databases yielded 13 cohort studies involving a total of 3,086,612 people (most older than 50). Meta-analysis (a statistical analysis that combines the results from related studies) was performed over 10 studies where osteoarthritis (n = 8) and back pain (n = 2) were the exposure and cardiovascular disease (n = 8), cancer (n = 1) and diabetes (n = 1) were the outcomes.
Muscle and Joint Pain Correlate with Higher Chronic Disease Rates Click To Tweet
Pooled results from these 10 studies (2,686,113 people) showed that the chances of developing a chronic disease are 17% greater in people with a musculoskeletal condition, compared to people without. However, because most studies (n = 7) addressed osteoarthritis as the exposure and cardiovascular disease as the outcome, the authors point out that this risk can be more specifically ascribed to this particular combination of musculoskeletal condition/chronic disease.
Although combined estimates for the risk of chronic disease in people with back or neck pain could not be obtained due to the limited number of studies assessing these conditions, individual studies offered evidence of their relationship.
- A study that followed over 48,000 people for up to 10 years in the UK found that the incidence rate of cancer was higher (between 11%-25%) among people chronically affected with back, knee, shoulder, neck, or hip pain (4).
- Another study in the UK, showed that the incidence of some types of cancer was up to 3.7 times higher in people with widespread body pain (5).
- Two other studies reported an overall 16% increase in the rate of diabetes in patients with osteoarthritis, a correlation that is known to also occur the other way around (6, 7).
These estimations were adjusted for additional risk factors like age, BMI, socioeconomic indicators, and drinking and smoking status, so the correlations found relate specifically to the conditions assessed.
Musculoskeletal pain and chronic disease: Correlation or Causality?
There are three possible explanations for the associations shown above:
- Musculoskeletal conditions cause chronic disease
- Related or identical factors cause both musculoskeletal and chronic diseases
- Musculoskeletal conditions together with other factors combine to cause chronic disease
When assessing for potential explanations some distinctions can be made for neck and back pain, on the one hand, and for osteoarthritis on the other.
Being overweight is a risk factor for both osteoarthritis and diabetes; atherosclerosis may promote osteoarthritis development; and inflammatory changes during osteoarthritis may increase the risk for cardiovascular disease Click To Tweet
While no specific mechanisms linking neck and back pain to chronic disease have yet been defined, a more complicated, perhaps direct, relationship may exist between osteoarthritis and both diabetes and cardiovascular disease. Being overweight is a risk factor for both osteoarthritis and diabetes; atherosclerosis may promote osteoarthritis development; and inflammatory changes during osteoarthritis may increase the risk for cardiovascular disease (8).
To learn more about inflammatory pain and chronic disease, check out my blog, PRESCRIBING OPTIMAL NUTRITION AND PHYSICAL ACTIVITY FOR LOW-GRADE CHRONIC INFLAMMATION AND PAIN.
Nutrition to Prevent Pain and Disease
Chronic diseases (also called ‘lifestyle’ diseases) are largely preventable; although genetics can increase susceptibility in some people, environmental factors are mostly to blame. Chronic pain caused by musculoskeletal conditions usually restricts physical activity and leads to weight gain; it is well documented that sedentarism, malnutrition, obesity, and smoking, rather than genetic factors, are main precipitating factors of chronic disease (9, 10).
Though more research is needed, the overall results of the meta-analysis appear to be more in line with the main conclusion of one of the studies, which points to disability, rather than osteoarthritis, as the predictor of cardiovascular disease (11).
Seize the Opportunity: A Physical Therapist’s Role
People are living longer, and both musculoskeletal pain and chronic diseases are expected to grow in tandem. Physical therapists are in a unique position to prevent and reduce the burden of chronic disease, disability, and pain by promoting physical activity and healthy nutrition patterns. To help you meet this challenge, valuable insights and resources can be found in my blogs and podcasts.
1- Vos, T., Allen, C., Arora, M., Barber, R. M., Bhutta, Z. A., Brown, A., … & Coggeshall, M. (2016). Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet, 388(10053), 1545-1602.
2- Osteoarthritis Research Society International (OARSI). Osteoarthritis: A Serious Disease. New Jersey: December 2016.
3- Williams, A., Kamper, S. J., Wiggers, J. H., O’Brien, K. M., Lee, H., Wolfenden, L., Yoong, S. L., Robson, E., McAuley, J. H., Hartvigsen, J., … Williams, C. M. (2018). Musculoskeletal conditions may increase the risk of chronic disease: a systematic review and meta-analysis of cohort studies. BMC medicine, 16(1), 167. doi:10.1186/s12916-018-1151-2
4- Jordan, K. P., & Croft, P. (2010). Mortality and cancer in patients with new musculoskeletal episodes: a cohort study. The British journal of general practice : the journal of the Royal College of General Practitioners, 60(572), e105-11.
5- McBeth, J., Silman, A. J., & Macfarlane, G. J. (2003). Association of widespread body pain with an increased risk of cancer and reduced cancer survival: A prospective, population‐based study. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 48(6), 1686-1692.
6- Kendzerska, T., King, L. K., Lipscombe, L., Croxford, R., Stanaitis, I., & Hawker, G. A. (2018). The impact of hip and knee osteoarthritis on the subsequent risk of incident diabetes: a population-based cohort study. Diabetologia, 61(11), 2290-2299.
7- Rahman, M. M., Cibere, J., Anis, A. H., Goldsmith, C. H., & Kopec, J. A. (2014). Risk of type 2 diabetes among osteoarthritis patients in a prospective longitudinal study. International journal of rheumatology, 2014.
8- Sokolove, J., & Lepus, C. M. (2013). Role of inflammation in the pathogenesis of osteoarthritis: latest findings and interpretations. Therapeutic advances in musculoskeletal disease, 5(2), 77-94.
9- Booth, F. W., Roberts, C. K., & Laye, M. J. (2011). Lack of exercise is a major cause of chronic diseases. Comprehensive Physiology, 2(2), 1143-1211.
10- Bruins, M., Van Dael, P., & Eggersdorfer, M. (2019). The Role of Nutrients in Reducing the Risk for Noncommunicable Diseases during Aging. Nutrients, 11(1), 85.
11- Hoeven, T. A., Leening, M. J. G., Bindels, P. J., Castaño-Betancourt, M., van Meurs, J. B., Franco, O. H., … & Bierma-Zeinstra, S. M. (2015). Disability and not osteoarthritis predicts cardiovascular disease: a prospective population-based cohort study. Annals of the rheumatic diseases, 74(4), 752-756