Åström Reitan Jenny L M, Karshikoff Bianka, Holmström Linda, Lekander Mats, Kemani Mike K, Wicksell Rikard K
Behavioral Medicine, Theme Women's Health and Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Social Studies, University of Stavanger, Stavanger, Norway.
Psychoneuroendocrinology. 2024 Sep;167:107094. doi: 10.1016/j.psyneuen.2024.107094. Epub 2024 Jun 13.
Approximately one in five adults experiences chronic pain, often in co-occurrence with depression, insomnia, anxiety, and lower self-rated health. Elevated levels of cytokines, e.g. tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), interleukin 8 (IL-8), and interleukin 10 (IL-10), have been identified in patients with chronic pain. Depression, insufficient sleep, poor self-rated health, and pain intensity have also been associated with inflammatory biomarkers. This study aimed to investigate the interrelationships between inflammatory biomarkers and depression, insomnia, anxiety, self-rated health, sickness behavior, and pain intensity in patients with chronic pain.
Self-report questionnaires and blood samples analyzed for plasma levels of inflammatory biomarkers were collected from 80 adult patients with chronic pain. Associations between inflammatory biomarkers (TNF-α, IL-6, IL-8, IL-10, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)) and depression, insomnia, anxiety, self-rated health, sickness behavior, and pain intensity, were analyzed using bivariate Spearman rank correlation coefficients and regression analyses.
Participants were mainly women (72.5 %), with a mean age of 50.8 years, and a reported mean pain duration of 16.7 years. There were significant correlations between insomnia and CRP (r =.26, p <.05); sex and ESR (r =.29, p <.05); age and IL-6 (r =.29, p <.05) and IL-8 (r =.30, p <.05); BMI and IL-6 (r =.50, p <.001), CRP (r =.63, p <.001) and ESR (r =.42, p <.001). Ratings of depression were positively and significantly related to ratings of sickness behavior and anxiety (β =.32 and β =.40, respectively), explaining 49 % of the total variance in depression ratings. Insomnia was positively and significantly related to sickness behavior (β =.37) explaining 31 % of the total variance in insomnia ratings. Inflammatory biomarkers, however, did not contribute significantly to the models.
Participants reported high levels of symptoms, yet the associations between these ratings and the inflammatory biomarkers were either absent or weak. Also, despite high levels of self-reported sickness behavior, overall the inflammatory status remained within the normal range. Ratings of sickness behavior contributed more than inflammatory markers in explaining ratings of depression and insomnia. The present results point to the complexity of chronic pain, and the challenges of identifying biomarkers that explain symptomatology.
约五分之一的成年人患有慢性疼痛，且常伴有抑郁症、失眠、焦虑症以及较低的自我健康评分。在慢性疼痛患者中已发现细胞因子水平升高，如肿瘤坏死因子α（TNF-α）、白细胞介素6（IL-6）、白细胞介素8（IL-8）和白细胞介素10（IL-10）。抑郁症、睡眠不足、自我健康评分低以及疼痛强度也与炎症生物标志物有关。本研究旨在调查慢性疼痛患者炎症生物标志物与抑郁症、失眠、焦虑症、自我健康评分、疾病行为和疼痛强度之间的相互关系。
从80名成年慢性疼痛患者中收集自我报告问卷和用于分析炎症生物标志物血浆水平的血样。使用双变量Spearman等级相关系数和回归分析，分析炎症生物标志物（TNF-α、IL-6、IL-8、IL-10、C反应蛋白（CRP）、红细胞沉降率（ESR））与抑郁症、失眠、焦虑症、自我健康评分、疾病行为和疼痛强度之间的关联。
参与者主要为女性（72.5%），平均年龄50.8岁，报告的平均疼痛持续时间为16.7年。失眠与CRP之间存在显著相关性（r = 0.26，p < 0.05）；性别与ESR之间存在显著相关性（r = 0.29，p < 0.05）；年龄与IL-6（r = 0.29，p < 0.05）和IL-8（r = 0.30，p < 0.05）之间存在显著相关性；BMI与IL-6（r = 0.50，p < 0.001）、CRP（r = 0.63，p < 0.001）和ESR（r = 0.42，p < 0.001）之间存在显著相关性。抑郁症评分与疾病行为评分和焦虑症评分呈显著正相关（β分别为0.32和0.40）,解释了抑郁症评分总方差的49%。失眠与疾病行为呈显著正相关（β = 0.37），解释了失眠评分总方差的31%。然而，炎症生物标志物对模型的贡献并不显著。
参与者报告了高水平的症状，但这些评分与炎症生物标志物之间的关联要么不存在，要么很弱。此外，尽管自我报告的疾病行为水平较高，但总体炎症状态仍在正常范围内。在解释抑郁症和失眠评分方面，疾病行为评分比炎症标志物的作用更大。目前的结果表明慢性疼痛的复杂性，以及识别解释症状学的生物标志物所面临的挑战。
