Klyne David M, Hodges Paul W
The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Australia.
Pain Med. 2020 Nov 1;21(11):2975-2985. doi: 10.1093/pm/pnaa052.
Cytokines such as tumor necrosis factor (TNF) contribute to the transition from acute to persistent pain. Despite increasing incidence of obesity and its linkage with chronic pain and inflammation, cytokines predominantly produced by adipose tissue (adipokines) have received little attention. Here we aimed to explore the longitudinal trajectory of adipokines from the onset of acute low back pain (LBP) and identify combinations of adipokines and/or other features that predict outcome.
Individuals with acute LBP (less than two weeks after onset) who had either recovered (no pain, N = 15) or remained unrecovered (no reduction/increase in pain, N = 13) at six months and 15 controls were retrospectively selected from a larger prospective cohort. Participants provided blood for the measurement of TNF, interleukin-6 (IL-6), resistin, visfatin, adiponectin, leptin, and C-reactive protein (CRP), and completed questionnaires related to pain/disability, depression, and sleep at baseline. LBP participants repeated measurements at six months.
Compared with controls, acute LBP individuals had higher TNF and CRP but lower adiponectin. In LBP, unrecovered individuals had higher TNF at both time points, but lower CRP at baseline and leptin at six months. Although combined low CRP, high TNF, and depressive symptoms at baseline predicted poor recovery, the primary adipokines leptin, resistin, visfatin, and adiponectin did not.
Primary adipokines did not add to the prediction of poor LBP outcome that has been identified for the combination of low CRP, high TNF, and depressive symptoms in acute LBP. Whether adipokines play a role in LBP persistence in overweight/obese individuals requires investigation.
肿瘤坏死因子（TNF）等细胞因子有助于从急性疼痛向持续性疼痛的转变。尽管肥胖发病率不断上升且与慢性疼痛和炎症相关，但主要由脂肪组织产生的细胞因子（脂肪因子）却很少受到关注。在此，我们旨在探讨急性下腰痛（LBP）发作后脂肪因子的纵向变化轨迹，并确定能够预测预后的脂肪因子组合和/或其他特征。
从一个更大的前瞻性队列中回顾性选取急性LBP患者（发病后不到两周），这些患者在6个月时要么已经康复（无疼痛，N = 15），要么仍未康复（疼痛无减轻/加重，N = 13），并选取15名对照。参与者提供血液用于检测TNF、白细胞介素-6（IL-6）、抵抗素、内脂素、脂联素、瘦素和C反应蛋白（CRP），并在基线时完成与疼痛/残疾、抑郁和睡眠相关的问卷。LBP患者在6个月时重复测量。
与对照组相比，急性LBP患者的TNF和CRP较高，但脂联素较低。在LBP患者中，未康复个体在两个时间点的TNF均较高，但基线时的CRP较低，6个月时的瘦素较低。尽管基线时低CRP、高TNF和抑郁症状的组合预测恢复较差，但主要脂肪因子瘦素、抵抗素、内脂素和脂联素并非如此。
主要脂肪因子并未增加对急性LBP中低CRP、高TNF和抑郁症状组合所确定的LBP预后不良的预测。脂肪因子在超重/肥胖个体的LBP持续中是否起作用需要进一步研究。
