Association of Serum Minerals, Vitamin D, Total Protein, and Inflammatory Mediators and Severity of Low Back Pain

Abstract

Background: Low back pain (LBP) is a multifactorial disorder with multiple etiologies, which are not fully understood. In this study, we aimed to evaluate the relationship between serum levels of minerals, total protein, vitamin D (vit D), and inflammatory mediators with LBP and its severity. Materials and Methods: This case-control study was derived from the study nested in the Fasa Cohort Study. Overall, 148 individuals with LBP were compared with 150 individuals without LBP. Blood samples were evaluated for serum protein, iron (Fe), aluminum (Al), copper (Cu), phosphorus, vit D, IL-1B, IL-6, high-sensitive C-reactive protein (HS-CRP), and TNF-alpha. Severity of pain was measured with the McGill and Oswestry questionnaires. Results: The mean age of participants in the case and control groups was 49.2 ± 6.1 and 47.57 ± 5.85 years, respectively. In the case group, 61 patients (48.8%) were male. The mean serum levels of Fe, Al, vit D, Cu, IL-1B, IL-6, HS-CRP, and TNF-alpha were significantly different between case and control groups (P≤0.05). However, there were no significant differences between studied groups in the term of sex and serum phosphorus (P>0.05). Regarding pain severity, age was correlated with McGill score (r=0.18), body mass index with Oswestry (r=0.21), Fe with McGill (r=-0.15) and Oswestry (r=-0.13), protein with McGill (r=0.32) and Oswestry (r=-0.32), Al with McGill (r=0.56) and Oswestry (r=0.45), IL-1B with McGill (r=0.19) and Oswestry (r=0.13), TNF-alpha with McGill (r=0.34) and Oswestry (r=0.26), IL-6 with Oswestry (r=0.13), HS-CRP with McGill (r=0.60) and Oswestry (r=0.46), and vit D was correlated with McGill (r=0.21) and Oswestry scores (r=0.17). Higher Fe (odds ratio [OR]: 0.99), protein (OR: 0.47), Al (OR: 0.11), and vit D levels (OR: 0.97) were protective against LBP (P<0.001). Higher IL-1B (OR: 1.01), TNF-alpha (OR: 1.03), and HS-CRP (OR: 1.0003) presented as risk factors for LBP (P<0.001). Conclusion: Our study revealed except phosphorous, all the serum levels minerals and inflammatory markers was significantly different in LBP patients compared to healthy individuals. Also, in the LBP patients, serum levels of Fe, total protein, Al, and vit D aside to inflammatory mediators (i.e., IL-1B, TNF-alpha, and HS-CRP) shows a marked association with severity of LBP. [GMJ.2020;9:e1342]

Effects of age, gender and modifiable risk factors on low back pain

“…Dadkhah et al found a significant relationship between low back pain and vitamin D insufficiency in a study including 298 volunteers with 148 low back pain. In the same study, BMI and mean age were found to be higher in the group with low back pain [22]. In another study, in which only women were included, the relationship between obesity and vitamin D insufficiency was evaluated, and volunteers were divided into obese, morbidly obese, and control groups, and vitamin insufficiency was found to be statistically substantially lower in morbidly obese compared to normal-weights [23].…”

The importance of inflammatory biomarkers in non-specific acute and chronic low back pain: a systematic review

“…Within the eight studies evaluating interleukin 1 (IL-1) and IL-1β, in seven studies [33-35, 37, 39, 41, 43] no association was found with the presence of LBP. On the contrary, in a cross-sectional study including 148 patients with CLBP and 150 controls, Dadkhah et al [38] found a positive correlation between these variables. The pro-inflammatory biomarker interleukin 6 (IL-6) was assessed in ten studies, and a positive association was found between IL-6 and CLBP in six studies [19,34,35,38,39,43].…”

“…Other inflammatory biomarkers that were not analysed in more than one study are described in Table 1, but an exhaustive analysis of these was not carried out. Pain severity was evaluated most commonly using the visual analogue scale (VAS) in five studies [32,34,37,39,40], Roland-Morris Disability Questionnaire (RMDQ) in four studies [32,34,41,43], numerical rating scale (NRS) in three studies [35,41,43], McGill Pain Questionnaire (MPQ) in three studies [29,35,38] and Oswestry Disability Index (ODI) in two studies [37,38].…”

Causal associations of iron status and back pain risk: A Mendelian randomization study

“…A case-control study reported all serum levels of minerals including Fe were significantly different in low back pain patients compared to healthy individuals ( 16 ). A strong link between serum iron and the severity of low back pain was reported ( 16 ). Intervertebral disc degeneration has been linked to iron overload as a predominantly triggered condition for low back pain ( 17 ).…”

“…The iron homeostasis dysregulation is often associated with multiple pathologies, including aging in humans ( 13 ), and neurodegenerative diseases such as Alzheimer’s disease ( 14 ), and Parkinson’s disease ( 15 ). A case-control study reported all serum levels of minerals including Fe were significantly different in low back pain patients compared to healthy individuals ( 16 ). A strong link between serum iron and the severity of low back pain was reported ( 16 ).…”