Interactions between Musculoskeletal Dysfunction, Emotional Distress and Cytokines in Patients with Chronic Low Back Pain Syndrome

Daina Šmite,Gunta Ancāne,Pēteris Tretjakovs

doi:10.33607/rmske.v1i6.865

Abstract

Despite different treatment methods, for approximately 30% of patients acute back pain turns into chronic pain syndrome which accompanied by disability creates remarkable material damage to patients themselves, to health care and to the society. The aim of the study was to analyse the interaction between musculoskeletal dysfunction, emotional distress and related disability, and their underlying neuroimonological pathophysiological mechanisms, in patients with chronic low back pain syndrome. The subjects were 43 patients, mean age 45 ± 1.3 years, with clinical diagnosis of lumbar spine disk pathology with chronic low back pain syndrome and present manifestation of emotional distress. All patients had complex assessment that included lumbar spine and pelvic motor control tests, muscle and ligaments palpation tests, Hospital Anxiety and Depression Scale, PF subscale of SF-36 survey, Visual Analogue Scale, immunological analysis of blood to detect the level of cytokines. The results approved interaction (p < 0.05) between motor control and palpation tests results, emotional distress features and pain intensity. Therefore musculoskeletal dysfunction in patients with chronic low back pain is connected both with physical and psycho-emotional factors, which has to be taken into account both when evaluating functional tests and during the treatment process. Clinically important finding is that limitation in physical activities in chronic low back pain patients are affected both by motor control impairment and depression symptoms, as well as pain intensity, which has to be remembered during rehabilitation planning process. Some of cytokines (TNF-a, IL-6, IL-8, IL-10, IL-2) correlated with emotional disturbances physical disturbances, pain syndrome characteristics and physical disability in patients with chronic low back pain. IL-10 and IL-8 appeared to be two of the most characteristic cytokines. It is interesting to note, that in literature studies have approved the role of IL-10 in the pathogenesis of chronic, widespread pain syndrome, but IL-8 has been shown in the role of the pathogenesis of radicular pain syndrome in patients with lumbar spine disk pathology [1, 2]. Studies of cytokines extend the understanding of bio-psycho-social aspects of chronic pain syndrome pathogenesis therefore improving process of assessment, clinical reasoning and therapy.Keywords: musculoskeletal dysfunction, emotional distress, chronic pain, cytokines.

Highlights

Chronic low back pain problem is a challenge for scientists as well for clinical practitioners
For approximately 30% of patients acute back pain turns into chronic pain syndrome which accompanied by disability creates remarkable material damages to patients themselves, to health care and to the society in general
In our previous research we found that chronic low back pain patients with same clinical diagnosis – lumbar spine disk pathology with radiculopathy – differed by their emotional state and could be divided into two clinically diverse subgroups – patients with emotional distress symptoms and patients without them, generating the necessity for various treatment and rehabilitation tactics [9]

Summary

Introduction

Chronic low back pain problem is a challenge for scientists as well for clinical practitioners. Still unanswered remains the question why on the background of overall increasing well-being and medical development the number of patients suffering from lower back pain is not decreasing but it increases and becomes the main problem for economically active patients. Due to the increase in chronic back pain and disability caused by it, it has been called the social epidemic, the cause of which has been related to cultural and psychosocial factors, as no relevant biological pathology changes are observed. The results of clinical studies, performed during last 10 years have confirmed a model of the multidimensional lower back pain, integrating physical, emotional and social pathogenetic factors [4, 5, 6, 7, 8]

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