Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
Division of Clinical Education, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
Chiropr Man Therap. 2021 Jan 8;29(1):3. doi: 10.1186/s12998-020-00357-y.
The inflammatory profiles of patients with acute and chronic nonspecific low back pain (LBP) patients are distinct. Spinal manipulative therapy (SMT) has been shown to modulate the production of nociceptive chemokines differently in these patient cohorts. The present study further investigates the effect(s) of SMT on other inflammatory mediators in the same LBP patient cohorts.
Acute (n = 22) and chronic (n = 25) LBP patients with minimum pain scores of 3 on a 10-point numeric scale, and asymptomatic controls (n = 24) were recruited according to stringent exclusion criteria. Blood samples were obtained at baseline and after 2 weeks during which patients received 6 SMTs in the lumbar or lumbosacral region. The in vitro production of tumor necrosis factor (TNFα), interleukin-1 β (IL-1β), IL-6, IL-2, interferon ɣ (IFNɣ), IL-1 receptor antagonist (IL-1RA), TNF soluble receptor type 2 (sTNFR2) and IL-10 was determined by specific immunoassays. Parametric as well as non-parametric statistics (PAST 3.18 beta software) was used to determine significance of differences between and within study groups prior and post-SMT. Effect size (ES) estimates were obtained using Cohen's d.
Compared with asymptomatic controls, SMT-related change scores were significant (P = 0.03-0.01) in reducing the production levels of TNFα in both patient cohorts and those of IL-6, IFNɣ and sTNFR2 (P = 0.001-0.02) in patients with chronic LBP. Above-moderate to large ES (d > 0.6-1.4) was observed for these mediators. Compared with respective baselines, a significant post-SMT reduction (P = 0.01) of IL-6 production was detected only in patients with chronic LBP while a significant increase of IL-2 production (P = 0.001 vs. control, and P = 0.004 vs. chronic LBP group) and a large ES (d = 0.87) were observed in patients with acute LBP. Pain and disability scores declined significantly (P < 0.001) in all LBP patients, and were positively correlated (P = 0.03) with IFNɣ and IL-2 levels in the acute LBP cohort.
The short course of SMT treatments of non-specific LBP patients resulted in significant albeit limited and diverse alterations in the production of several of the mediators investigated in this study. This exploratory study highlights the potential of SMT to modulate the production of inflammatory components in acute and chronic non-specific LBP patients and suggests a need for further, randomized controlled clinical trials in this area.
This study was prospectively registered April 2012 with Clinical Trials.gov ( #NCT01766141 ). https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0003ZIL&selectaction=Edit&uid=U0001V74&ts=2&cx=-axvqtg.
急性和慢性非特异性下腰痛（LBP）患者的炎症特征明显不同。脊柱手法治疗（SMT）已被证明可在不同程度上调节这些患者群体中疼痛趋化因子的产生。本研究进一步研究了 SMT 对同一 LBP 患者群体中其他炎症介质的影响。
根据严格的排除标准，招募了疼痛评分至少为 3（10 分制）的急性（n=22）和慢性（n=25）LBP 患者和无症状对照者（n=24）。在接受 6 次腰椎或腰骶部 SMT 治疗的 2 周内，分别在基线和治疗后采集血液样本。通过特定的免疫测定法确定肿瘤坏死因子（TNFα）、白细胞介素-1β（IL-1β）、IL-6、IL-2、干扰素ɣ（IFNɣ）、IL-1 受体拮抗剂（IL-1RA）、TNF 可溶性受体类型 2（sTNFR2）和 IL-10 的体外产生情况。在 SMT 前后使用参数和非参数统计（PAST 3.18 beta 软件）来确定研究组之间和组内差异的显著性。使用 Cohen's d 获得效应大小（ES）估计值。
与无症状对照组相比，SMT 相关的变化分数在两组患者中均显著（P=0.03-0.01）降低了 TNFα的产生水平，慢性 LBP 患者中 IL-6、IFNɣ 和 sTNFR2 的产生水平也显著降低（P=0.001-0.02）。对于这些介质，观察到中等到较大的效应大小（d>0.6-1.4）。与各自的基线相比，仅在慢性 LBP 患者中观察到 SMT 后 IL-6 产生的显著降低（P=0.01），而急性 LBP 患者中观察到 IL-2 产生的显著增加（P=0.001 与对照组相比，P=0.004 与慢性 LBP 组相比）和较大的效应大小（d=0.87）。所有 LBP 患者的疼痛和残疾评分均显著下降（P<0.001），急性 LBP 组中 IFNɣ 和 IL-2 水平与疼痛和残疾评分呈正相关（P=0.03）。
非特异性 LBP 患者的 SMT 短期治疗导致了所研究的几种介质产生的显著但有限和多样化的改变。这项探索性研究强调了 SMT 调节急性和慢性非特异性 LBP 患者炎症成分产生的潜力，并表明需要在该领域进行进一步的、随机对照临床试验。
本研究于 2012 年 4 月前瞻性地在 ClinicalTrials.gov 上注册（#NCT01766141）。https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0003ZIL&selectaction=Edit&uid=U0001V74&ts=2&cx=-axvqtg。
