Your pain physician should be addressing obesity and insulin resistance if they hope to ever reverse your pain. Metabolic inflammation (metainflammation) of obesity and hyperinsulinemia is an under-recognized cause of pain in the United States.
Musculoskeletal pain has been estimated to affect 13.5%–47% of the general population, and 75 percent of those affected have two or more areas of pain. Multi-joint pain and progression, including non-weight bearing joints, are linked independently to the inflammatory cascade triggered by obesity, not just simply the biomechanical forces.
Arthritis Care Res (Hoboken). 2017 Apr;69(4):509-516. DOI: 10.1002/acr.22963. Epub 2017 Feb 28.
Fibromyalgia pain is closely associated with insulin resistance, and elevated HgBA1C and fibromyalgia symptoms are improved with metformin therapy to reverse insulin resistance.
Pappolla MA, Manchikanti L, Andersen CR, Greig NH, Ahmed F, Fang X, et al. (2019) Is insulin resistance the cause of fibromyalgia? A preliminary report. PLoS ONE 14(5): e0216079.
I would suggest that most chronic pain pathologies are maintained by metainflammation, derived primarily from lifestyle choices leading to insulin resistance. In our chronic interventional pain clinic, we spend more than half of our time reversing the course of diabetes.
