Can Ozempic (semaglutide) cause back pain?

Ozempic (Semaglutide) and Back Pain

Ozempic (semaglutide) can cause back pain in rare cases, with one documented case showing an association with portal vein thrombosis presenting as low back pain. 1

Relationship Between Ozempic and Back Pain

Direct Evidence

• A recent case report documented a 59-year-old woman with type 2 diabetes who developed low back pain associated with nausea and poor oral intake within six months of starting semaglutide 1
• Investigation revealed intrahepatic portal vein thrombosis without evidence of liver cirrhosis or abdominal malignancy 1
• The patient had no known risk factors for venous thromboembolism or thrombophilia 1

Mechanism and Risk Assessment

Back pain associated with Ozempic may occur through several potential mechanisms:

1. Vascular effects:

   • GLP-1 receptor agonists like semaglutide may increase the risk of thrombotic events in rare cases 1
   • Portal vein thrombosis can manifest as low back pain

2. Weight loss effects:

   • Rapid weight loss from semaglutide may affect bone mineral density
   • Recent research shows semaglutide was associated with lower lumbar spine and total hip bone mineral density after 52 weeks compared to placebo 2
   • The same study showed higher levels of bone resorption markers in the semaglutide group 2

Potential Benefits for Pain Conditions

Interestingly, while back pain may occur as an adverse effect, semaglutide has shown potential benefits for certain pain conditions:

• Semaglutide demonstrated significant reduction in allodynia and hyperalgesia in diabetic neuropathic pain models 3
• It reduced pro-inflammatory cytokines in the spinal cord and dorsal horn 3
• Recent research shows semaglutide had analgesic effects in animal models of fibromyalgia 4

Management Recommendations for Back Pain

If a patient on Ozempic develops back pain:

1. Evaluate for red flags:

   • Cauda equina syndrome, vertebral infection, cancer with potential spinal cord compression, and vertebral compression fracture require immediate attention 5
   • Consider imaging if red flags are present - MRI of the thoracic/lumbar spine without IV contrast is preferred 5

2. First-line treatments:

   • Non-pharmacological approaches:

     • Supervised exercise programs with individually tailored exercises 5
     • Heat therapy for short-term pain relief 5
     • Mind-body approaches (mindfulness, tai chi, yoga) 5

   • Pharmacological options:

     • Acetaminophen (maximum daily dose 3000mg) 5
     • NSAIDs used with caution, especially in elderly patients 5

3. Consider medication adjustment:

   • If back pain persists or worsens, discuss potential relationship with Ozempic
   • Consider temporary dose reduction or medication holiday to assess if symptoms improve
   • If thrombosis is suspected, prompt evaluation and anticoagulation may be necessary 1

Important Considerations

• Monitor for thrombosis risk: The case report suggests physicians should understand the possible risks of thrombosis before initiating GLP-1 receptor agonist treatment 1
• Bone health: Consider bone health monitoring in patients on long-term semaglutide therapy, especially those with pre-existing osteoporosis 2
• Balance risks and benefits: For patients with diabetes or obesity, the metabolic benefits of semaglutide may outweigh the potential risk of back pain in most cases

When to Seek Medical Attention

Patients should seek immediate medical attention if they experience:

• Severe or worsening back pain
• Back pain accompanied by neurological symptoms (weakness, numbness, bladder/bowel dysfunction)
• Back pain with fever, unexplained weight loss, or history of cancer
• Back pain with nausea and poor oral intake (potential sign of thrombosis) 1

While back pain is not listed among the common side effects of Ozempic in major guidelines, clinicians should be aware of this potential association, particularly in the context of possible thrombotic events.