Abstract
BackgroundLow back pain (LBP) is one of the greatest contributors to disability in the world and there is growing interest on the role of biomarkers in LBP. To purpose of this review was to analyze available evidence on the relationship between inflammatory biomarkers, clinical presentation, and outcomes in patients with acute, subacute and chronic non-specific low back pain (NSLBP).MethodsA search was performed in Medline, Embase, Cinahl and Amed databases. Studies which measured levels of inflammatory biomarkers in participants with NSLBP were included. Two reviewers independently screened titles and abstracts, full-texts, and extracted data from included studies. Methodological quality was assessed using the Newcastle Ottawa Quality Assessment Scale. Level of evidence was assessed using the modified GRADE approach for prognostic studies.ResultsSeven primary studies were included in this review. All results assessed using the modified GRADE demonstrated low to very low quality evidence given the small number of studies and small sample. Three studies examined C-reactive protein (CRP), one of which found significantly higher CRP levels in an acute NSLBP group than in controls and an association between high pain intensity and elevated CRP. Three studies examined tumor necrosis factor alpha (TNF-α), two of which found elevated TNF-α in chronic NSLBP participants compared to controls. Two studies examined interleukin 6 (IL-6), none of which found a significant difference in IL-6 levels between NSLBP groups and controls. Two studies examined interleukin 1 beta (IL-β), none of which found a significant difference in IL-β levels between NSLBP groups and controls.ConclusionsThis review found evidence of elevated CRP in individuals with acute NSLBP and elevated TNF-Α in individuals with chronic NSLBP. There are a limited number of high-quality studies evaluating similar patient groups and similar biomarkers, which limits the conclusion of this review.
Highlights
Low back pain (LBP) is one of the greatest contributors to disability in the world and there is growing interest on the role of biomarkers in LBP
In Klyne et al’s [25, 26], .study, the following four biomarkers were measured in individuals with acute non-specific low back pain (NSLBP): hsCRP (CRP), interleukin 6 (IL-6), IL-1β, and TNF-α
In patients with chronic NSLBP there is low level of evidence of an increase in TNF-α as compared to healthy controls there is low level evidence that TNF-α is not associated with pain or function
Summary
Low back pain (LBP) is one of the greatest contributors to disability in the world and there is growing interest on the role of biomarkers in LBP. LBP was ranked in the Global Burden of Diseases by Vos et al [1, 2], as one of the greatest contributors to global disability. It is estimated that up to 85% of working people can expect to experience LBP during their lifetime [3]. LBP causes an enormous economic burden on individuals, families, industries and government [4, 5] The direct and indirect costs of LBP in the United States have been estimated to be approximately $100–200 billion dollars annually [5, 6]. In Canada, medical costs alone are estimated to be between $6–12 billion, without factoring time lost at work and costs to society [6]
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