Backache in diabetics : Never ignore it

Dr KK Pandey *

Quite often you would have heard your family members who are diabetics, complaining of backache. If you talk to them, you will come to know this backache is less in severity while sitting, but as soon as they start walking, the intensity of backache also increases. If he stops walking at once, the severity of backache too drops and finally pain in the back disappears.

Diabetics generally mistake this type of pain in the back, for lumbar spondylosis or sciatic pain and therefore go to a bone specialist and there starts a battery of investigations like x-ray of back bone, MRI and estimation of calcium in blood.

In the name of treatment is prescribed calcium tablets, some exercises and above all a variety of pain killers. In spite of all these treatments, there occurs no significant relief as expected. The end result is that every month doctors who had treated previously are changed one by one and despite this, no relief occurs.

When a normal non-diabetic person complains of backache, there are generally two reasons. One is the old injury in the back caused generally by an accidental fall on the ground. The second reason is the overweight and absence of regular walking.

When an individual adopts a life style wherein a person is supposed to sit for long hours and there is no walking or exercise, the connecting ligaments between the bones of the back lose their elasticity and get toughened and rigid. Such people when they get into action start complaining of backache.

On the other hand, when a diabetic person complains of pain in back and thigh, the reason is something else other than the customary loss of elasticity in back bone as occurs in a non diabetic person. In a diabetic patient the cause of backache is generally due to permanently decreased supply of a pure oxygenated blood to waist and thigh.

If a diabetic person complains of backache while sitting, it simple means a significant loss of pure blood supply. The pain caused due to inadequate supply of blood is called 'angina' in medical terms. As 'chest angina' is caused due to decreased supply of pure blood to wall of the heart, the same way, fall in blood supply to waist muscles and organs give rise to complaint of waist angina or backache. If a complaint of chest angina is neglected, the risk of an impending heart attack increases, in the same way if waist angina is not treated promptly, it may lead to gangrene of foot.

Why does a backache occur in diabetics?

A large blood pipe emerges from the heart and goes down towards the abdomen where in it supplies pure oxygenated blood to abdominal organs like liver and intestines. The same blood pipe also supplies organs and abdomen that supply blood to lower back muscles in abdomen muscles of lower back, then after it divides into two different tubes which go to left and right thighs and supplies further down pure blood to feet.

As all of us know there is a constant deposition of fat, cholesterol and calcium into the wall of the arteries and gradually the blood pipes get narrowed and there occurs a drop in supply of pure blood. If a person's daily routine lacks excercise and discipline, the sugar level in blood of a diabetic becomes uncontrolled and blood pipes gets constricted very fast due to rapid deposition of calcium and fat.

In a diabetic, the blood pipe generally gets narrowed exactly at the bifurcation spot in the abdomen where it divides into two major branches. When there occurs an excessive deposition of calcium and fat into the abdominal blood pipe, this leads to a significant and persistent drop in supply of pure oxygenated blood to back and thighs, and the sufferer starts complaining of backache or waist angina on walking. This condition is known as "Leriche syndrome" in medical terms.

Neglect in Backache may cost dearly

If you neglect the waist angina and do not get proper treatment, this may cause harm in two ways. One it may lead to a significant drop in sexual performance because of decreased supply of pure oxygenated blood to penis with the result, penis lacks the expected hardness and therefore a person gets devoid of sexual pleasure.

The second disadvantage is the constant and gradual decrease in the blood supply to feet which finally lead to severe pain, blackening and gangrene. Therefore one must remember a backache or waist angina spoils both sex as well as feet, if neglected.

Avoid pain killers

Quite frequently in backache, people keep on changing doctors and along with that brand of pain killers are also regularly changed. Some people, instead of consulting a doctor, while donning the role of doctors, go on purchasing various kinds of pain killers from over the counters of drugs stores. Even on slight pain, they take pain killers and this goes on for years.

This practice of taking pain killers harms in two ways. On one hand, a patient of waist angina due to lack of proper treatment reaches on the verge of losing his feet, and secondly a possibility of his kidney failure may arise due to an extensive damage of kidney caused by excessive use of pain killers.

Probably you might not be aware of the fact, 65 percent of all the patients undergoing kidney dialysis and later on kidney transplant are ones, who had had taken regular pain killers for years to treat their backache or knee pain. This observation highlights the fact that all these pain killer medicines damage the kidney permanently especially in diabetics. Among all pain killers, only "crocin"or "paracetamol" is a lone pain killer that is almost safe for kidney.

What to do if you have backache ?

First of all, you should understand the use of pain killer is not a permanent solution to your backache prdblem. If you are a diabetic and suffer also from backache, you should consult a vascular surgeon. You should get investigated your blood pipes situated inside the abdomen which carry blood to thighs and get the accurate information about adequacy of supply of pure blood.

A diabetic suffering from backache problem should always go to a hospital where availability of an experienced vascular or a cardio vascular surgeon is there. By now you must have understood it is very essential to know the causes of backache. Therefore one should select a hospital whose facility of modern specialized investigations like Doppler study, 64-slice CT angiography, and MR angiography is available.

It is also essential to know whether in the hospital, facility of limb bypass surgery, or vascular bypass surgery and angiography is available or not. At the same time it is also important to know about the availability of facility of spinal surgery or surgery of back bone in the hospital.

A diabetic must never smoke.

If a diabetic has a problem of backache and he is regularly using tobacco or smoking, believe me, he will lose his legs sooner or later. Smoking in diabetics is just like adding insult to injury and is doubly dangerous. Due to smoking or tobacco-chewing in diabetics, already inadequate blood supply to legs gets further decreased significantly and this leads to gangrene and to amputation of feet.

The second most important disadvantage of smoking is post operative failure of limb bypass surgery or angioplasty and stenting even if how successfully these procedures were done. All efforts of operation are bound to fail, if a sufferer continues to smoke, because artificial blood pipe or stent will get blocked completely due to smoking. The net result you will be back to square one. Decreasing the number of cigarettes smoked per day does not make any difference from medical point of view. One has to stop smoking altogether for success of treatment.

Treatment modalities in waist Angina

On the basis of result of angiography one can know where and how far the blood pipe is blocked inside the lower abdomen. After obtaining this vital information, the correct treatment strategy is planned. In majority of the cases, arterial bypass surgery is required.

For this procedures, artificial blood pipes (Prosthetic grafts) are needed which are imported from outside. In a few patients, method of angioplasty and stenting is required for conducting this procedure of angioplasty, a proper selection of patients is of almost importance.

What treatment modality will suit which patient is decided by your vascular surgeon. For a successful outcome of any procedure, regular walk and some special exercise play an important role.

* Dr KK Pandey wrote this article for The Sangai Express
The writer is Senior Consultant, Dept. of Vascular and Cardio Thoracic Surgery, Indraprastha Apollo Hospitals, New Delhi,
and can be contacted at drpandeykk(AT)gmail(DOT)com
This article was posted on September 28, 2022.

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