Severity of intervertebral disc herniation regulates cytokine and chemokine levels in patients with chronic radicular back pain.

OBJECTIVE: The contributions of intervertebral disc disease and subject-specific covariates to systemic inflammation in low back pain are unknown. We examined the effects of symptomatic disc herniation (DH) and MRI herniation severity on serum cytokine levels in clinical subjects. DESIGN: Cytokine levels from lumbar DH subjects (N = 78) were compared to control subjects (N = 57) accounting for effects of DH, age, body mass index (BMI) and gender. Effect of DH severity on cytokine levels was analyzed on subsets of subjects with acute or chronic pain. Serum cytokines were also analyzed in a subset of patients between pre- and 3 months post-surgery. RESULTS: Cytokine levels were elevated in the serum of patients with symptomatic DH, and the covariates age, BMI and gender significantly contributed to levels of some cytokines. Severity of herniation was a significant contributor to pain intensity (VAS), serum levels of HMGB1, PDGFbb, and IL-9. The relationship between DH severity and cytokine levels was confirmed in subjects with chronic, but not acute symptoms. Serum levels of macrophage migration inhibitory factor (MIF) decreased, whereas levels of CCL3, CCL11, CXCL1, and CXCL10 were significantly elevated post surgery. CONCLUSIONS: This study is the first to show that DH severity is coordinately associated with changes in serum levels of inflammatory cytokines in chronic pain subjects. HMGB1, PDGFbb and IL-9 are novel mediators of increasing DH severity, indicative of cellular damage, neuro-inflammation and angiogenesis. Resolution of inflammation was observed with decrease in MIF post surgery. However, elevated chemokine levels indicate ongoing remodeling and wound healing at 3-month time point.

Psychologic and biologic factors associated with fatigue in patients with persistent radiculopathy.

Fatigue is a common symptom associated with neuropathic pain (NP) and can have negative consequences on psychosocial functioning, physical endurance, and quality of life. Recent evidence indicates that immune activation modulated through the increased release of proinflammatory cytokines can predict fatigue in some patient populations. Although earlier studies have shown that immune activation is a pathophysiologic feature of NP, there have been no studies to examine the relationship between immune activation and fatigue in persons with NP. Therefore, the purpose of this exploratory study was to: 1) determine the relationships among fatigue, pain, psychosocial factors, and selected biologic markers of immune activation (interleukin [IL] 6 and soluble IL-6 receptor [sIL-6R]) in participants with persistent radiculopathy; and 2) determine the differences in these variables based on fatigue severity. Participants (n = 80) were classified according to their level of fatigue as low (27.5%), moderate (32.5%), or high (40%), and significant differences were found between fatigue categories (p = .001). Multivariate analyses of variance revealed that individuals with moderate to high levels of fatigue differed from those with the lowest levels of fatigue in psychologic distress, depressive symptoms, IL-6, and sIL-6R, whereas the differences between moderate and high levels of fatigue were significant for psychologic distress and sIL-6R only. The findings suggest that immune activation affects fatigue severity and possibly other behavioral responses, offering important information when providing care to patients with persistent radiculopathy. The integration of biobehavioral nursing interventions in pain management may have a greater impact on quality of life than treatment focused only on pain.

[Experimental study on anti-inflammatory and analgesic effects of electroacupuncture combined with medium frequency therapy in model rats with lumbar nerve root compression].

OBJECTIVE: To explore the effects and mechanism of electroacupuncture combined with medium frequency therapy on lumbar nerve root compression. METHODS: Seventy-two Sprague-Dawley (SD) rats were randomly divided into a normal group, a sham operation group, a model group, an electroacupuncture group (EA group), a medium frequency group(MF group) and an electroacupuncture combined with medium frequency group (EA + MF group), twelve rats in each group. Models were established by surgery except the normal group and the sham operation group. Rats in the normal group, the sham operation group and the model group were not treated. In the EA group, the rats were treated by electroacupuncture at "Jiaji" (EX-B 2) and "Huantiao" (GB 30) etc., and by medium frequency at the "Jiaji" (EX-B 2) and "Huantiao"(GB 30) in the MF group. Rats in the EA + MF group were treated by both electroacupuncture and medium frequency. All treatments were started on the fifth day of established model, once a day for fourteen days. Rats' lower limb functions were observed before and after treatment, thromboxane B 2 (TXB 2) and prostacyclin F1alpha (PGF1alpha) in blood plasma were tested after treatment, and pathological changes in the local compressed nerve root were observed by light microscope. RESULTS: After treatment, the scores of rats' lower limb neurologic function in three therapy groups were significantly lower than before (all P < 0.01). Compared with the model group, TXB 2 in the EA group and the EA + MF group after treatment were decreased significantly (both P < 0.01), and PGF1alpha in the EA + MF group was increased significantly (P < 0.01), and TXB 2/PGF1alpha level were all regulated favorably in three therapy groups (all P < 0.01), and the pathological scores in the EA group and the EA + MF group were improved significantly (both P < 0.01). CONCLUSION: n Electroacupuncture combined with medium frequency has anti-inflammatory and analgesic effects in model rats with lumbar nerve root compression, and its mechanism may be related with the regulation of homeostasis M between TXB 2 and PGF1alpha so as to improve microcirculation.

[Functional activity of thrombocytes in patients with post-tuberculosis spinal osteochondrosis complicated by pain syndrome]. / Funktsional'naia aktivnost' trombotsitov u bol'nykh posttuberkuleznym osteokhondrozom pozvonochnika, oslozhnennym bolevym sindromom.

It was found that in patients with attenuated tuberculous spondylitis and post-tuberculous vertebral osteochondrosis there was a sharp increase in platelet aggregability and a decrease in their disaggregability at the peak of the pain syndrome. With the therapy followed by relief of the pain syndrome, a rise in the platelet aggregability was significantly less noticeable, without significant changes in their disaggregability.