The association of biomarkers with pain and function in acute and subacute low back pain: a secondary analysis of an RCT

Abstract

Background Low back pain (LBP) is a common musculoskeletal condition and a major cause of disability worldwide. Previous studies have found associations of biomarkers with pain and pain-related disability in LBP patients. This study aimed to explore the association between serum biomarkers and pain and disability in patients with acute or subacute axial LBP. Methods This study was ancillary to a parent randomized controlled trial. Enrolled participants were randomized into three intervention groups: one of two types of spinal manipulation or medical care. In the parent study, 107 adults who experienced a new episode of LBP within 3 months prior to enrollment were recruited. For this study, 90 of these 107 participants consented to have blood samples obtained, which were drawn immediately before the beginning of treatment. Seven biomarkers were chosen based on previous literature and analyzed. Clinical outcomes were pain and Oswestry Disability Index (ODI) evaluated at baseline and 4 weeks. Spearman’s |r| was used to study the association of initial levels of each biomarker with pain and ODI scores at baseline and with changes in outcome scores from baseline to 4 weeks (end of treatment) within each intervention group. Results At baseline, 4 of 7 biomarkers had an association with pain that was |r| ≥ .20: neuropeptide Y (NPY) (r = 0.23, p = .028), E-Selectin (r = 0.22, p = .043), vitamin D ((r = − 0.32, p = .002), and c-reactive protein (CRP) (r = 0.37, p = .001). No baseline biomarker had an association with disability that was |r| ≥ 0.20. For the correlations of baseline biomarkers with 4-week change in outcomes, vitamin D showed a correlation with change in disability and/or pain (|r| ≥ 0.20, p > .05) in manipulation-related groups, while CRP, NPY, and E-selectin along with TNFα, Substance P and RANTES showed at least one correlation with change in pain or disability (|r| ≥ 0.20, p > .05) in at least one of the treatment groups. Conclusions In 90 LBP patients, the analyzed biomarkers, especially vitamin D, represent a small set of potential candidates for further research aimed at individualizing patient care. Overall, the associations investigated in the current study are an initial step in identifying the direct mechanisms of LBP and predicting outcomes of manipulation-related treatments or medical care. Trial registration ClinicalTrials.gov Identifier: NCT01211613, Date of Registration: September 29, 2010, https://clinicaltrials.gov/ct2/show/NCT01211613?term=schneider&cond=Low+Back+Pain&cntry=US&state=US%3APA&draw=2&rank=1

Vertebral Subluxation and Systems Biology: An Integrative Review Exploring the Salutogenic Influence of Chiropractic Care on the Neuroendocrine-Immune System

“…Two reviews [ 86 , 175 ] offer consideration of the three available early original research studies (including Brennan et al [ 318 ] which is not specifically included within the present dataset since it was published in 1991) and discuss limited evidence that substance P increases after spinal manipulation. Of the available original research studies meeting our inclusion criteria, two describe positive immediate and short-term changes in substance P after spinal manipulation [ 176 , 177 ], and one paper was identified in our search that describes no change in substance P [ 92 ]. Further research will be necessary to clarify this apparent discrepancy; however, the results observed in the two former studies suggest that examination of changes in substance P levels in response to chiropractic care merits further consideration.…”

“…The impact of chiropractic care on substance P has been examined in four reports [86,[175][176][177]. Two reviews [86,175] offer consideration of the three available early original research studies (including Brennan et al [318] which is not specifically included within the present dataset since it was published in 1991) and discuss limited evidence that substance P increases after spinal manipulation.…”

Cuidados Paliativos Em Idosos: Uma Pesquisa Bibliográfica

“…Por fim, um estudo clínico randomizado recente apontou outras substâncias que podem ser consideradas como um potencial marcador inflamatório da DLC tais como o neuropeptídeo Y (NPY), a molécula de adesão E-selectina e a vitamina D (ENRICO et al, 2022). A vitamina D apresenta um importante papel no metabolismo do Ca2+ e na regulação imunológica, sendo encontrado em baixas concentrações em indivíduos com maior intensidade de dor referida (ZADRO et al, 2017).…”

“…A vitamina D apresenta um importante papel no metabolismo do Ca2+ e na regulação imunológica, sendo encontrado em baixas concentrações em indivíduos com maior intensidade de dor referida (ZADRO et al, 2017). Apesar de não haver clareza na literatura científica que evidencie essa relação, o NPY e a E-selectina estão associados à condições de dor crônica e demonstraram-se elevados em indivíduos com DLC ( DIAZ-DELCASTILLO, WOLDBYE, HEEGAARD, 2018;ENRICO et al, 2022).…”