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PLoS One. 2019 Feb 21;14(2):e0212030. doi: 10.1371/journal.pone.0212030. eCollection 2019.

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

Author information

Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
Musculoskeletal Health Research Group, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia.
School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
Discipline of Physiotherapy, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil.
Department of Gynaecology and Obstetrics, Botucatu Medical School, UNESP-Paulista State University, Botucatu, São Paulo, Brazil.



Approximately half of the population will experience either low back pain or neck pain, at some point in their lives. Previous studies suggest that people with diabetes are more likely to present with chronic somatic pain, including shoulder, knee and spinal pain. This study aimed to systematically review and appraise the literature to explore the magnitude as well as the nature of the association between diabetes and back, neck, or spinal (back and neck) pain.


A systematic search was performed using the Medline, CINAHL, EMBASE, and Web of Science electronic databases. Studies which assessed the association between diabetes and back or neck pain outcomes, in participants older than 18 years of age were included. Two independent reviewers extracted data on the incidence of pain and reported associations.


Eight studies were included in the meta-analyses. Meta-analyses showed that people with diabetes are more likely to report low back pain [5 studies; n: 131,431; odds ratio (OR): 1.35; 95% Confidence Interval (CI): 1.20 to 1.52; p<0.001] and neck pain (2 studies; n: 6,560; OR: 1.24; 95% CI: 1.05 to 1.47; p = 0.01) compared to those without diabetes. Results from one longitudinal cohort study suggested that diabetes is not associated with the risk of developing future neck, low back or spinal pain.


Diabetes is associated with low back and neck individually, and spinal pain. The longitudinal analysis showed no association between the conditions. Our results suggest that diabetes co-exists with back pain; however, a direct causal link between diabetes and back pain was not established.


PROSPERO registration CRD42016050738.

Conflict of interest statement

The authors have declared that no competing interests exist.

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