The association between pro-inflammatory biomarkers and nonspecific low back pain: a systematic review

Publication date: Available online 28 June 2018
Source:The Spine Journal
Author(s): R. van den Berg, E.M. Jongbloed, E.I.T. de Schepper, S.M.A. Bierma-Zeinstra, B.W. Koes, P.A.J. Luijsterburg
Background contextAbout 85% of the patients with low back pain seeking medical care have nonspecific low back pain (NsLBP), implying that no definitive cause can be identified. NsLBP is defined as LBP and disability which cannot be linked to a underlying pathology, such as cancer, spinal osteomyelitis, fracture, spinal stenosis, cauda equine, ankylosing spondylitis and visceral-referred pain. Many pain conditions are linked with elevated serum levels of pro-inflammatory biomarkers. Outcomes of interest are NsLBP and the level of pro-inflammatory biomarkers.PurposeTo unravel the etiology and get better insight in the prognosis of NsLBP, the aim of this study was to assess the association between proinflammatory biomarkers and the presence and severity of NsLBP.Study designA systematic literature search was made in Embase, Medline, Cinahl, Webof- science, and Google scholar up to January 19th 2017.MethodsIncluded were cross-sectional and cohort studies reporting on patients aged over 18 years with NsLBP, in which one or more pro-inflammatory biomarkers were measured in blood plasma. The methodological quality of the included studies was assessed using the Newcastle Ottawa Scale (NOS). A best-evidence synthesis was used to summarize the results from the individual studies, meaning that the included studies were ranked according to the consistency of the findings and according to their methodological quality score using the NOS.ResultsIncluded were 10 studies which assessed 4 different pro-inflammatory biomarkers. For the association between the presence of NsLBP and Creactive protein (CRP), interleukin 6 (IL-6) and tumor necrosis factor (TNF)-α limited, conflicting and moderate evidence, respectively, was found. For the association between the severity of NsLBP and CRP and IL- 6, moderate evidence was found. For the association between the severity of NsLBP and TNF-α and RANTES (Regulated on Activation, Normal T Cell Expressed and Secreted) conflicting and limited evidence, respectively, was found.ConclusionsThis study found moderate evidence for i) a positive association between the pro-inflammatory biomarkers CRP and IL-6 and the severity of NsLBP, and ii) a positive association between TNF-α and the presence of NsLBP. Conflicting and limited evidence was found for the association between TNF-α and RANTES and severity of NsLBP, respectively.



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