Is there an association between diabetes and neck and back pain? An updated systematic review with meta-analyses

BACKGROUND: Spinal pain and disorders are a major burden on our population and health systems. Previous research showed people with diabetes were 1.35 times and 1.24 times more likely to report low back pain and neck pain than people without diabetes respectively, but diabetes was not a predictor of future spinal pain. Here we update a previous systematic review to determine whether in an adult population, diabetes is associated with low back, neck, or spinal pain. METHODS: The search was performed in PUBMED, Medline, CINAHL and EMBASE. Studies between 2017-2025, of cross-sectional, case-control, twin-control, and cohort designs, assessing diabetes and low back, neck, or spinal pain in adult populations, were included. Excluded were single-case studies, spinal pathologies, multiple chronic diseases, additional pain sites, and gestational or pre-diabetes. Two independent reviewers extracted data on the incidence of pain and reported associations. Odds ratios (ORs) of the association between the exposure (diabetes) and outcome (back, neck, or spinal pain) were calculated using a random effects model. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration CRD42022333064. RESULTS: A total of 15 studies were included with 11 studies included in the meta-analysis. When compared to people without diabetes, people with diabetes had 1.44 times higher odds of reporting low back pain (n = 592,901; OR 1.44; 95% Confidence Interval (CI) 1.20- 1.74; p = 0.001), a 1.11 times higher odds of reporting neck pain (n = 465,130; OR 1.11; 95%CI 1.13-1.20; p = < 0.001) and a 1.42 times higher odds of reporting spinal pain (n = 1,335,999; OR 1.42; 95%CI 1.26-1.63; p = < 0.001). Diabetes was significantly associated with 1.27 times higher odds of developing spinal pain (n = 35,435; OR 1.27; 95%CI 1.08-1.50; p = 0.004) and 1.44 higher odds of developing neck pain (n = 15,075; OR 1.44; 95%CI 1.09 -1.90; p = 0.010). There was no significant association between diabetes and developing low back pain (n = 21,215; OR 1.11; 95%CI 0.88-1.41, p = 0.388). CONCLUSIONS: With the inclusion of fifteen additional studies providing an overall sample size five and a half times larger than the previous review, diabetes was associated with prevalent neck, low back and spinal pain, as well as incident neck and neck and spinal pain. Clinicians must be adept at identifying co-morbid conditions and risk factors, understanding the interplay between them and creating well managed networks to address these complex presentations.