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 is chronic metabolic inflammation?

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.

Which tissues does metabolic inflammation damage in chronic pain?

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.

How common is poor metabolic health?

In the general adult population, under 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, and under 7% do on the tighter criteria applied after 2021 — so more than nine in ten US adults do 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.

Does this mean chronic pain is caused by weight?

No. This page 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 when metabolic health is measured?

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.

Frequently asked questions

How is chronic inflammation different from inflammation after an injury?

Inflammation after an injury, like a sprained ankle, is local and short-lived, and it resolves. Chronic metabolic inflammation is different. It is inflammation without infection: a low-grade state that runs through the whole body, driven by metabolic disturbance rather than by injury. It persists, and it changes both how pain is generated and how it is perceived.

How do you tell if you have chronic inflammation?

Measure it. Chronic metabolic inflammation damages nerves, blood vessels and the autonomic system, yet almost nobody measures it in a pain workup. The measurement takes an hour. Small-fiber nerve function can be tested directly, and the metabolic contribution becomes a tracked number rather than general advice, so you can see whether it is present and whether it is changing.

Can chronic inflammation be cured?

Metabolic inflammation is a modifiable contributor to pain, not a fixed one, and that is the reason to measure it. Once it is a tracked number, changes to diet, sleep and activity get a feedback loop, and you can see whether they are working. That feedback is the difference between advice that is followed and advice that is only nodded at.

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