Correlation Between Lipid Profiles and Chronic Low Back Pain: A Systematic Review

Abstract

Background: Chronic low back pain (CLBP) is a leading cause of disability worldwide. Emerging evidence suggests that metabolic factors, particularly lipid profile abnormalities, may contribute to the pathogenesis of CLBP through vascular, inflammatory, and degenerative mechanisms.
Objective: To systematically review the association between lipid profiles and chronic low back pain.
Methods: A systematic review was conducted in six electronic databases (PubMed, Scopus, Web of Science, Embase, Cochrane Library, and Google Scholar) following PRISMA 2020 guidelines. Observational and genetic epidemiological studies published between 2020 and 2025 examining lipid parameters (total cholesterol, LDL-C, HDL-C, triglycerides, and lipid subclasses) in adults with CLBP were included. Study quality was appraised using a STROBE-based checklist.
Results: Ten studies met the inclusion criteria. Large population-based studies demonstrated that low HDL-C levels and elevated LDL-C/HDL-C ratios were associated with an increased risk of CLBP (odds ratios ranging from approximately 1.15 to 1.34). Mendelian randomization analyses consistently indicated a protective causal effect of genetically higher HDL-C on low back pain risk (OR ≈ 0.92). Lipidomic studies further revealed increased monoacylglycerol and diacylglycerol levels, alongside reduced triacylglycerol levels, suggesting altered lipid metabolism and low-grade inflammation in CLBP.
Conclusion: Dyslipidemia, particularly low HDL-C and atherogenic lipid patterns, is consistently associated with chronic low back pain. Lipid profiles may serve as complementary risk markers in CLBP assessment and support a multidisciplinary management approach integrating metabolic, biomechanical, and lifestyle interventions.