GLP-1 RAs Tirzepatide and Semaglutide Significantly Reduce Chronic Low Back Pain and Improve Quality of Life in Obese Patients

Chronic low back pain (cLBP) is a debilitating condition, often exacerbated in individuals with obesity, where excess weight and associated inflammation contribute to pain and disability. Current non-surgical treatments frequently fall short, leaving many patients with persistent pain and reduced quality of life. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are established therapies for obesity and type 2 diabetes, known for their weight-reducing and anti-inflammatory properties. This study explored whether these metabolic benefits could translate into improvements for cLBP, addressing a critical gap in non-surgical pain management for this population.

This prospective, single-arm cohort study enrolled 35 adults (median age 41 years, 86% women) with obesity (median BMI 39.9 kg/m²) and cLBP who were initiating GLP-1 RAs. Participants received either tirzepatide (n=24) or semaglutide (n=11). They completed questionnaires at baseline, 3, 6, 9, and 12 months, assessing primary outcome BPI-SF pain severity, and secondary outcomes including BMI, BPI-SF pain interference, NRS back pain, Oswestry Disability Index (ODI), and SF-12 quality of life. A subset (n=24) also underwent quantitative sensory testing, physical performance testing, and blood draws for inflammatory biomarkers (C-reactive protein, TNF-α, IL-6, IL-10), adipokines (leptin, adiponectin), and hemoglobin A1c at baseline and 6 months.

Over 12 months, participants experienced a significant reduction in BMI of 12.5% (median 39.9 to 34.9 kg/m², 95% CI [-6.6, -4.2]). BPI-SF pain severity improved markedly from a median of 4.8 to 2.0 (95% CI [-2.1, -0.8]), indicating a substantial clinical benefit.

BPI-SF pain severity improved from a median of 4.8 to 2.0, representing a 58% reduction in reported pain. Significant improvements were also observed in pain interference, Oswestry Disability Index (ODI), NRS back pain, and SF-12 physical component scores. Furthermore, hemoglobin A1c, leptin, and C-reactive protein levels decreased, while adiponectin increased, though the latter two did not reach statistical significance for improvement in physical performance. Experimental pain sensitivity remained unchanged.