An increasing number of chronic pain sites was associated with a higher risk of type 2 diabetes in older adults, partly through reduced physical activity and elevated body mass index.
Key Findings
Results
Pain at two or more chronic pain sites was associated with significantly higher risk of incident type 2 diabetes compared to no chronic pain.
Adjusted hazard ratios were 1.102 (95% CI: 1.027-1.181) for two sites, 1.143 (95% CI: 1.049-1.246) for three sites, 1.198 (95% CI: 1.078-1.331) for four to seven sites, and 1.181 (95% CI: 1.023-1.363) for pain all over the body.
Pain at only one site was not reported as significantly associated with increased type 2 diabetes risk.
The study used Cox proportional hazards models with adjusted hazard ratios.
The sample included 84,565 participants aged ≥60 years from the UK Biobank who were free of type 2 diabetes at baseline.
Results
A dose-response relationship was observed between the number of chronic pain sites and type 2 diabetes risk.
Risk increased progressively from two sites (HR 1.102) to three sites (HR 1.143) to four to seven sites (HR 1.198).
Pain classified as 'all over the body' had an HR of 1.181, similar in magnitude to the four to seven sites group.
Chronic pain was self-reported and classified into six groups: none, one, two, three, four to seven sites, and pain all over the body.
Incident type 2 diabetes was the primary outcome.
Results
Physical activity and body mass index jointly mediated the association between chronic pain and type 2 diabetes risk.
Physical activity mediated 6.25% of the effect of chronic pain on type 2 diabetes risk.
Body mass index mediated 45.83% of the effect of chronic pain on type 2 diabetes risk.
Mediation analysis was used to assess the roles of physical activity and BMI.
The authors suggest reduced physical activity and elevated adiposity as mechanistic pathways linking chronic pain to diabetes.
Methods
The study population consisted of older adults aged 60 years or older from the UK Biobank who were free of type 2 diabetes at baseline.
Total sample size was 84,565 participants.
Participants were aged ≥60 years.
This was a prospective study design.
Chronic pain was self-reported by participants.
Discussion
The authors highlight that chronic pain burden and impaired energy balance may contribute to type 2 diabetes, with implications for nociception-metabolic mechanisms.
The findings are described as informing 'future research on nociception-metabolic mechanisms.'
The authors note the importance of 'promoting physical activity and healthy weight in chronic pain management to prevent type 2 diabetes.'
Multisite chronic pain was identified as increasing type 2 diabetes risk 'partly through reduced physical activity and elevated adiposity.'
The study focuses specifically on older adults, a population in whom both chronic pain and type 2 diabetes are prevalent.
What This Means
This research suggests that older adults who experience chronic pain in multiple parts of their body are at greater risk of developing type 2 diabetes. Using data from over 84,000 people aged 60 and older in the UK Biobank, the study found that the more areas of the body affected by chronic pain, the higher the risk of developing type 2 diabetes over time. People with pain in two or more sites had between 10% and 20% higher risk compared to those with no chronic pain, even after accounting for other factors.
The study also investigated why this relationship exists. It found that reduced physical activity and higher body weight (BMI) together help explain the link, with BMI accounting for nearly half (45.83%) of the connection and physical activity accounting for a smaller but meaningful portion (6.25%). This suggests that chronic pain may lead people to move less, which in turn contributes to weight gain, and both of these factors increase diabetes risk.
This research suggests that managing chronic pain in older adults should include strategies to maintain physical activity and healthy body weight, as these could help reduce the risk of developing type 2 diabetes. It also points to the need for further research into how pain signals and metabolic processes in the body interact with each other.
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Liang J, He X, Ouyang Y, Song X, Li M, Qi T, et al.. (2026). Association between chronic pain and type 2 diabetes in older adults: A prospective study in the UK Biobank.. The journal of pain. https://doi.org/10.1016/j.jpain.2026.106272