Chronic back pain, often the first step to healing is losing weight – how can it be done

from Laura Cuppini

The extra pounds limit the effectiveness of the therapies: a multidisciplinary treatment is needed. The role of the GLP-1 analogue in weight control

Back pain is one of the biggest human problems: according to the World Health Organization the first cause of disability. As well as a (frequent) reason for absence from work. They exist for solutions: the important thing is to find the right specialist for your case and commit to changing your lifestyle. In many cases, in fact, back pain is not due to a full-blown pathology (hernias, arthritis, spinal problems, osteoporosis), but to a set of bad habits and discomforts: sedentarity, a wrong diet, excess kilos affect the low back painas well as stress (and the resulting muscle tension), anxiety, depression.

The meeting in Milan

Vertebral pain can have many causes, but it is often detected in the diagnosis an incorrect postural load, associated with being overweight. A factor that limits the effectiveness of therapies (including those aimed at functional recovery) since it strongly influences the level of pain, even if the patient is at rest. This is why multidisciplinary treatment of the problem, including orthopedists, physiatrists, physiotherapists, pain therapists, nutritionists, dieticians and general practitioners, is important. On Friday 23 September these issues will be discussed in Milan (Aula Magna, Gaetano Pini Orthopedic Institute – Cto, via G. Pini 9; from 1pm to 6.30pm, registration on the website www.mzevents.it), in a meeting entitled Postural load, overweight, obesity and the treatment of chronic pain. We will try to provide the basis for a combined treatment expertisefrom diagnosis to pain modulation procedures, up to rehabilitation treatment – he explains Paolo Grossi, scientific coordinator of the course and director of the Anesthesia, resuscitation and pain therapy unit at the Gaetano Pini Institute – Cto -. We will also talk about the role ofanalogue of Glp-1 (glucagon-like peptide 1) in the control of the patient’s weight: the works that demonstrate its applicability and safety of use in this context will be presented, with the necessary rules of engagement and monitoring, together with the introduction of the concept of diet and inflammatory phenomenon.

How the Glp-1 hormone works

The glucagon-like peptide 1 a hormone produced by the intestine that stimulates insulin secretion and inhibits that of glucagon by the pancreas. Glp-1 is activated only when the blood sugar rises due to the carbohydrates introduced with food. It slows down gastric emptying, increasing the sense of satiety, and reduces appetite, acting directly on the hunger regulation centers of the central nervous system. Once activated, the hormone is then rapidly degraded by an enzyme, Dpp-4 (dipeptyl-peptidase 4). In order to overcome the problem of the rapid degradation of Glp-1, some analogues have been developed, defined Glp-1 receptor agonists, with a structure more or less similar to the hormone, which resist the degradation action exerted by Dpp-4. Initially reserved for diabetic patients, these drugs then entered clinical practice also for their slimming effect.

Decrease the weight load

These are hypoglycemic drugs, which lower blood sugar only when the level is high (therefore they do not act on it if in adequate quantity), and may have an interesting role in weight control – explains Paolo Grossi -. They are offered in particular to those patients, of all ages, who live a sort of “vicious circle”: overweight (or obesity) such as to prevent the effectiveness of any diet or physical exercise. Often these patients have pain all the time, except when they are in bed, the only position in which the load on the column is minimized. If, through the analogue of Glp-1 (liraglutide or semaglutide), we decrease the weight load and improve the postural one, we stress less all the related nervous structures to support the situation. Thus the vicious circle is broken and the patient can embark on the road to recovery.

An organism that works

Liraglutide or semaglutide lead to a 5-10% weight reduction over three months. During the first month the modest effect, from the second it becomes more evident. The patient’s eating behavior tends to change spontaneously, because feel less hungry – continues Grossi -. At the same time the subject treated with painkillers and anti-inflammatories, which are injected near the spine and not taken by mouth to limit side effects. The problem that, to date, there is no protocol for the use of Glp-1 analogs in low back pain, while in various Centers we are seeing that with weight loss the pain in the back decreases and therefore it is possible to start physiotherapy. At that point the “virtuous circle” is established: muscles and joints work better and the patient feels so gratified that he can continue with his new lifestyle (healthy diet, exercise) even without the weight control drug. There is a shift of interest towards a functioning organism.

September 23, 2022 (change September 23, 2022 | 09:49)

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Chronic back pain, often the first step to healing is losing weight – how can it be done


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