Why metabolic health belongs in a pain practice
Chronic metabolic inflammation damages exactly the tissues a pain practice spends its time on — nerves, vessels and the autonomic system — and almost nobody measures it.
What chronic metabolic inflammation is
It is inflammation without infection: a whole-body, low-grade inflammatory state driven by metabolic disturbance rather than by injury. It is not the inflammation of a sprained ankle, which is local, acute and resolves. It is systemic, it persists, and it alters both how pain is generated and how it is perceived.
The overlap that makes it a pain problem
The tissues most affected are the ones a pain practice already works with.
- Small unmyelinated nerve fibers, which are damaged early by high glucose, inflammation and impaired skin microcirculation — and which carry pain and temperature.
- The autonomic nervous system, which regulates vascular tone, and which interacts with pain in both directions.
- The endothelium, whose function is tightly coupled to insulin signaling.
- Joint tissue, where metabolic abnormality including obesity and type 2 diabetes is strongly linked to osteoarthritis in both weight-bearing and non-weight-bearing joints — which points at a mechanism more complicated than mechanical load alone.
What the numbers look like
In the general adult population, 12.2% of American adults met a full definition of optimal metabolic health in the National Health and Nutrition Examination Survey for 2009 to 2016 — so roughly 88% of US adults did not. In the Padda Institute patient population the picture is starker still: fewer than 3% of patients overall, and fewer than 1% of chronic pain patients, meet the same definition of metabolic health. Those are practice-reported figures from our own population, not trial outcomes, and individual results vary.
Read those two carefully, because they describe different populations and must not be blended. The survey figure is about US adults. The clinic figures are about patients who have already sought care, and among chronic pain patients specifically.
What this is not saying
It is not saying pain is caused by weight. It is not saying structural disease is imaginary, or that a herniated disc is really a metabolic problem. Injuries are real, nerve damage is real and degenerative change is real.
What it says is narrower and more useful: a measurable, modifiable contributor is present in most of this population and is routinely left out of the assessment. Measuring it takes an hour and changes what can be offered.
What changes in the consultation
Three things. The patient with burning feet and normal imaging stops being a diagnostic dead end, because small-fiber function can be measured directly. The metabolic contribution becomes a tracked number rather than general advice. And dietary, sleep and activity changes acquire a feedback loop, which is the difference between advice that is followed and advice that is nodded at.
The patient-facing version and the specialty applications page.
References
- Araújo J, Cai J, Stevens J. Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009–2016. Metabolic Syndrome and Related Disorders. 2019;17(1):46–52. doi:10.1089/met.2018.0105
- Cortez M, Singleton JR, Smith AG. Glucose intolerance, metabolic syndrome, and neuropathy. Handbook of Clinical Neurology. 2014;126:109–122. doi:10.1016/B978-0-444-53480-4.00009-6
Related reading
- Chronic pain and metabolic health
- What insulin resistance looks like before diabetes
- Small-fiber versus large-fiber neuropathy
Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP, medical director of Measura. Last reviewed .