Dynamics of proinflammatory and anti-inflammatory cytokines in blood plasma in the treatment of back pain with non-steroidal anti-inflammatory drugs

Abstract

The objectification of non-specific back pain is still limited by subjective methods - interviewing the patient, using pain scales. In some cases, degenerative-dystrophic changes in the spine, increased muscle tone of the back are determined, but morphological changes in the spine do not always correlate with the presence and severity of pain. Therefore, the search for biomarkers that objectify the presence of pain, its intensity, would help in the differential diagnosis and in the treatment of pain, is relevant. The aim: to search for biomarkers to objectify the presence of pain and facilitate the differential diagnosis and further treatment. Materials and methods: 20 patients were studied - 14 women and 6 men - with vertebrogenic dorsalgia. For all patients, a standard vertebral neurological examination was performed using neuroimaging methods (radiography, MRI or CT of the spine). All patients were prescribed NSAID treatment in the same way: in the first two days, ketorolac was prescribed, then meloxicam or celecoxib, depending on the patients' comorbid pathology, during the 10 days of hospital stay, and then another 10 days for outpatient use. On days 1 and 10, we evaluated the intensity of the pain syndrome using a visual analogue scale (VAS). In parallel, in those days we took blood tests from all patients to measure the levels of cytokines - interleukin 1 β (IL-1β), interleukin 6 (IL-6), interleukin 10 (IL-10). We determined the level of pro-inflammatory (interleukin -1β, IL -1β, interleukin -6-IL-6) and anti-inflammatory cytokines (interleukin-10, IL -6) blood enzyme-linked immunosorbent assays using kits of the company Vector Best in the clinical laboratory of the Institute of neurosurgery named after academician A.P. Romodanova NAMS of Ukraine. The indicators were expressed in conditional units (cu). The results revealed a reliable direct correlation between the change in the intensity of the pain syndrome with dorsalgia and the levels of pro-inflammatory interleukins IL-1β, and the coefficient of IL-6 / IL-10. A reliable correlation of long-term pain indicators with a change in blood levels of IL-6 / IL-10 cytokines in the blood during the first days of NSAID treatment was first revealed. Conclusions: according to the study, the level of pain with dorsalgia of various localization correlates with changes in the pro-inflammatory cytokines of IL-1β. A change in the ratio of pro-inflammatory and anti-inflammatory cytokines (IL6 / IL-10) correlates with a change in pain intensity. The level and rate of change of the IL6 / IL-10 coefficient are markers of the severity of the inflammatory process and reflect the likelihood of chronic pain in the future