Abstract
Chronic low back pain (cLBP) is the second leading cause of disability in the United States, and disproportionately burdens Non-Hispanic Black (NHB) individuals compared to Non-Hispanic White (NHW) individuals. However, its biological underpinnings are poorly understood. The aim of this study was to investigate differences in basal inflammatory cytokine expression between individuals with cLBP and pain-free controls, and to examine whether these differences are consistent across racial backgrounds. Blood was collected from 155 individuals with cLBP (n=93 NHB, n=62 NHW) and 56 controls (n=32 NHB, n=28 NHW). ELISA and multiplex assays were used to quantify concentrations of pro-inflammatory markers (fibrinogen, CRP, serum Amyloid A, TNF-α, IL-1α, IL-1β, IL-6) as well as anti-inflammatory markers (IL-4, IL-13). A series of independent samples T-Tests were used to assess case-control differences and ANOVAs assessed race differences. Participants with cLBP presented with significantly greater concentrations of CRP (t = 2.14, p = .034), fibrinogen (t = 4.01, p < .001), IL-6 (t = 2.70, p = .007), and IL-4 (t = 2.73, p = .007), while controls presented greater amounts of IL-1α (t = 6.04, p < .001). Further analyses revealed that while concentrations of IL-6, and fibrinogen seem to be equally upregulated in individuals with cLBP regardless of race, TNF-α, IL-1α IL-4, and CRP seem to differ substantially by race. Our findings suggest that while there are case-control differences between patients with cLBP and controls, these profiles could very well differ as a function of race. Furthermore, IL-6 and fibrinogen could potentially be used as targets for cLBP treatment for NHB and NHW patients, while targeting TNF-α and IL-1α could offer additional cLBP relief for specific racial groups. More research with racially-inclusive samples is needed to elucidate the mechanisms that may contribute to racial disparities in cLBP.
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