Diabetes mellitus with its increasing prevalence is one of the four major non-communicable diseases. It is characterized by hyperglycemia, which may progress to chronic complications such as peripheral vascular disease and neuropathy. This paper highlights the pathophysiology associated with diabetes, which is restricted to not only hyperglycemia but also other comorbidities including chronic lower back pain.Diabetes is a metabolic disorder associated with hypercholesteremia, hypertriglyceridemia, and hypertension. This chain of events leads to free plasma fatty acids and a pro-inflammatory state, therefore promoting calcification of blood vessels, which may block the blood supply to vertebral discs and thereby increase vulnerability in the patients with ongoing inflammatory disease such as osteoarthritis and also causing costochondritis. Functional limitation due to increased load on the weight-bearing joints is a common mechanical complication of diabetes. Obesity in diabetes is more prevalent due to a disturbed metabolism, which is aggravated with a persistent inflammatory state.Moreover, the aim of this review is to encourage further conduction of clinical studies to explore the definite cause and potential therapy for chronic lower back pain in diabetes, thereby investigating the association of lipid metabolism and skeletal muscle atrophy leading to chronic back pain, the role of diabetic medications, and vulnerability in the female gender. Diminished physical activity and depression in diabetic patients disrupt the hypothalamic-pituitary-adrenal axis (HPA), which further contributes to lower back pain. Further clinical investigation and research in this regard will establish substantial data for the linkage between depression in diabetes and back pain. However, despite all the advancements of medical literature, the exact cause of lower back pain in diabetes is arguable.Pain impedes the health status and life quality; therefore, it is essential to maintain the quality of health in patients with diabetes by treating not only hyperglycemia but also other multifactorial causes leading to lower back pain.

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IntroductionThe cutaneous polymorphic eruption of pregnancy (PEP) is presented by skin lesions usually in the third trimester of gestation and about 13% of women also suffer from perinatal depression.ObjectiveTo determine the frequency of pruritic urticarial papules of gestation with and without perinatal depression.AimTo assess the maternal causes for polymorphic eruption of pregnancy (PEP) in patients with and without perinatal depression.MethodsCases and controls were matched on the grounds of maternal weight gain in gestation, hormonal changes, deficit in iron and zinc, dysregulation of hypothalamic pituitary axis, pre-maturity, pre-eclampsia, pre-term labour. Univariate and multivariate analysis, adjusting for important demographic factors and comorbodities was conducted to assess the relationship of PEP with and without perinatal depression in reduced and full models of ANOVA in regression analysis. (Reduced model Y = β0 + β1X1 + … and the full model Y = β0 + β1X1 + β2X2 + β3X3 + β4X4 + β5X5 + β6X6 + …)ResultsPolymorphic eruption of pregnancy with perinatal depression was statistically significant in maternal weight gain in gestation [odds ratio (OR) 1.20; 95% (CI): 1.15–1.30], hormonal changes [(OR) 2.78; 95% (CI): 2.52–2.82], deficit in iron and zinc [(OR) 2.18; 95% (CI): 2.04–2.38], dysregulation of hypothalamic pituitary axis [(OR) 1.37; 95% (CI): 1.18–1.49] and was not statistically significant in pre-maturity, pre-eclampsia and pre-term labour in cases and controls.ConclusionPruritic urticarial papules and plaques of gestation are commonly associated in patients with perinatal derpession.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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