Tirzepatide versus placebo in adults with back pain and obesity: a secondary analysis of the SURMOUNT 1, 2, and 3 randomised trials

Back pain is one of the leading causes of disability worldwide. Although obesity is consistently associated with back pain, current clinical guidelines do not recommend weight-loss interventions for back pain. This reflects, in part, the limited effectiveness of previously trialed behavioural weight-loss interventions in people with back pain, which have generally failed to achieve clinically meaningful and sustained reductions in either bodyweight or back pain.

Tirzepatide is a dual incretin-based medication, which means it affects two hormones that regulate appetite and blood sugar levels - glucose-dependent insulinotropic polypeptide (GIP) and glucagon‐like peptide‐1 (GLP‐1). It is approved for the treatment of type 2 diabetes (high or uncontrolled blood sugar) and obesity. While tirzepatide has demonstrated substantial and durable weight-loss benefits in large randomised trials, its effects on pain and physical function in individuals with back pain have not been established.

This study is a secondary analysis of data from three randomised, placebo-controlled trials (SURMOUNT-1, -2, and -3) that evaluated tirzepatide in adults with overweight or obesity. Building on these trials, we will focus on participants with a history of back pain to assess whether once-weekly tirzepatide, compared with placebo, leads to greater improvements in patient-reported physical functioning and bodily pain over 72 weeks, in the context of standard lifestyle modification advice.

This analysis will provide the first published evidence on the effects of tirzepatide on pain and physical function in people with back pain. By clarifying its potential benefits in this population, the findings may inform both clinical decision-making and the design of future trials evaluating tirzepatide as a novel treatment approach for back pain in adults with overweight or obesity.