Abstract
IntroductionChronic back pain is one of the most important socioeconomic problems that affects the global population. Elevated levels of inflammatory mediators, such as cytokines, have been correlated with pain, but their role in chronic back pain remains unclear. The effectiveness of anti-inflammatory drugs seems to be limited for chronic back pain. The authors wanted to investigate the levels of inflammatory mediators in long-term medically treated patients with persistent chronic back pain.MethodsCytokine plasma levels of patients with chronic back pain (n=23), compared to pain-free healthy controls (n=30), were investigated by immunoassay. Patients with chronic back pain were exposed to long-term conservative medical therapy with physiotherapy and anti-inflammatories, also combined with antidepressants and/or muscle-relaxants.ResultsThe patients with chronic back pain expressed lower levels of the chemokines MCP1, CCL5, and CXCL6 compared to pain-free healthy controls. Significantly lower concentrations of the anti-inflammatory cytokines, interleukin (IL)-4 and granulocyte-colony stimulating factor were also found. Interestingly, levels of proinflammatory cytokines (IL-2, IL-6, IL-1β, tumor necrosis factor alpha), IL-10, granulocyte-macrophage colony-stimulating factor, and stromal cell-derived factor 1 alpha showed no significant differences between both groups.ConclusionThis decrease of inflammatory mediators in medically treated patients with chronic back pain is of unclear origin and might be either a long-term side effect of medical therapy or related to chronic pain. Further longitudinal research is necessary to elucidate the underlying cause of these findings.
Highlights
Chronic back pain is one of the most important socioeconomic problems that affects the global population
By immunoassay, a circulating concentration of possible biomarkers related to pain, inflammation, and degeneration of the intervertebral disc (IVD), and we found that, in plasma of medically treated patients with chronic back pain, there were significantly lower concentrations of chemokines, such as
We found no differences between chronic back pain subgroups and, in most cases, the analysis confirmed a significant decrease of cytokines in chronic back pain subgroups compared to the healthy control group
Summary
Chronic back pain is one of the most important socioeconomic problems that affects the global population. The authors wanted to investigate the levels of inflammatory mediators in long-term medically treated patients with persistent chronic back pain. Patients with chronic back pain were exposed to long-term conservative medical therapy with physiotherapy and anti-inflammatories, combined with antidepressants and/or muscle-relaxants. Chronic back pain, defined as pain lasting at least 3 months duration,[1] is recognized as a major public health problem, producing significant economic and social burdens.[2] Several studies have demonstrated that chronic back pain condition interferes with everyday activities and results in direct medical costs and lost productivity.[3,4] Increased serum levels of pro-inflammatory cytokines (interleukin [IL]-1β, IL-2, IL-6, and tumor necrosis factor alpha [TNF-α]) have been previously correlated with increased pain intensity in patients with different types of chronic pain.[5] low concentrations of the anti-inflammatory cytokines IL-4 and IL-10 were found in patients with chronic widespread pain, and the lack of anti-inflammatory cytokine activity was associated with a possible contribution to pain pathogenesis.[6].
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