GLP-1-Based Therapies in Pain Medicine: A Narrative Review and Expert Opinion on Obesity-Related Low Back and Knee Pain.

PURPOSE OF REVIEW: Obesity is highly prevalent among patients with chronic musculoskeletal pain and is associated with low back pain, knee osteoarthritis, reduced mobility, and poorer functional outcomes. Glucagon-like peptide-1 (GLP-1) receptor agonists and related therapies have transformed obesity medicine and may become more relevant to pain medicine specialists. This narrative review examines whether GLP-1-based medications should be considered within pain practice, particularly for obesity-associated low back pain and knee osteoarthritis. RECENT FINDINGS: Chronic pain impacts a substantial portion of adults, while low back pain and osteoarthritis remain leading causes of disability worldwide. Obesity is associated with low back pain and knee osteoarthritis, and weight reduction has been shown to improve pain and function in these conditions. GLP-1-based therapies can produce clinically meaningful weight loss in patients with obesity and chronic pain. Literature also suggests possible anti-inflammatory and chondroprotective effects relevant to pain. GLP-1-based medications should not be viewed as primary analgesics or replacements for standard pain evaluation, rehabilitation, pharmacologic care, or interventional treatment. However, they are reasonable to consider as part of comprehensive pain management in patients with obesity when excess weight plausibly contributes to chronic pain, impaired mobility, or reduced rehabilitation tolerance. Pain physicians familiar and comfortable with obesity pharmacotherapy may consider prescribing within appropriate indications and safety parameters. Alternatively, referral to obesity medicine, endocrinology, primary care, or another experienced clinician is appropriate.