Last year, I provided a link on this blog to a lecture I gave in 2023, about how lifestyle changes can improve arthritis and other musculoskeletal pains. If for some reason you want to watch that lecture, I will link to it here.
But to give you the brief summary of what I covered in that talk: being overweight doesn’t just cause arthritis by increasing physical pressure on the joint, but also because fat cells have the effect of up-regulating inflammatory signals in the body, which in turn lead to weakening of muscle, increased pain receptors, and other factors that create more pain.
Now a new study published in JAMA supports this point.
In the study, researchers randomized patients with osteoarthritis of the knee to receive either the drug metformin or placebo. They found after a few months that the folks receiving metformin had less knee pain than the ones who got the placebo.
This wasn’t a “home run” kind of finding that promises an end to knee pain for arthritis sufferers- the effect was only a modest one. But still it was a clear signal that metformin can reduce the pain of arthritis. You can read the paper by clicking here.
The reason this is fascinating is that metformin is not a pain relief medication at all. Rather it is a fairly old drug (first introduced to the market in 1957) that lowers blood sugar, and is usually used to treat type 2 diabetes and sometimes pre-diabetes. Importantly, metformin works by increasing our body’s sensitivity to insulin, thus reducing the insulin resistance that is the underlying driver for Type 2 diabetes (not to mention a number of other chronic diseases, which I have previously blogged about at length). For this reason, metformin is in fact an excellent medication for the treatment of type 2 diabetes, and while it is not the topic of today’s blog post, I will state that it is one of the drugs that I most favor using for my diabetic patients when they are not able to cure their diabetes with lifestyle interventions alone.
But back to the study at hand: we now have proof that a drug that lowers insulin resistance reduces pain in people with arthritis. This should reinforce the emerging belief that joint pain is NOT simply a result of damage to a joint, but rather a complex interaction between that joint damage and systemic factors, including our metabolic health. It is becoming increasingly clear that a comprehensive approach to musculoskeletal pains does not include only the use of joint replacements and pain medications.
