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. 2020 Mar 3;21(1):142.
doi: 10.1186/s12891-020-3154-3.

A systematic review of the role of inflammatory biomarkers in acute, subacute and chronic non-specific low back pain

Patrick Morris  1 , Kareem Ali  1 , Mackenzie Merritt  1 , Joey Pelletier  1 , Luciana G Macedo  2
Affiliations

A systematic review of the role of inflammatory biomarkers in acute, subacute and chronic non-specific low back pain

Patrick Morris et al. BMC Musculoskelet Disord. .

Abstract

Background: Low back pain (LBP) is one of the greatest contributors to disability in the world and there is growing interest on the role of biomarkers in LBP. To purpose of this review was to analyze available evidence on the relationship between inflammatory biomarkers, clinical presentation, and outcomes in patients with acute, subacute and chronic non-specific low back pain (NSLBP).

Methods: A search was performed in Medline, Embase, Cinahl and Amed databases. Studies which measured levels of inflammatory biomarkers in participants with NSLBP were included. Two reviewers independently screened titles and abstracts, full-texts, and extracted data from included studies. Methodological quality was assessed using the Newcastle Ottawa Quality Assessment Scale. Level of evidence was assessed using the modified GRADE approach for prognostic studies.

Results: Seven primary studies were included in this review. All results assessed using the modified GRADE demonstrated low to very low quality evidence given the small number of studies and small sample. Three studies examined C-reactive protein (CRP), one of which found significantly higher CRP levels in an acute NSLBP group than in controls and an association between high pain intensity and elevated CRP. Three studies examined tumor necrosis factor alpha (TNF-α), two of which found elevated TNF-α in chronic NSLBP participants compared to controls. Two studies examined interleukin 6 (IL-6), none of which found a significant difference in IL-6 levels between NSLBP groups and controls. Two studies examined interleukin 1 beta (IL-β), none of which found a significant difference in IL-β levels between NSLBP groups and controls.

Conclusions: This review found evidence of elevated CRP in individuals with acute NSLBP and elevated TNF-Α in individuals with chronic NSLBP. There are a limited number of high-quality studies evaluating similar patient groups and similar biomarkers, which limits the conclusion of this review.

Keywords: CRP; Central sensitization; IL-1β; IL-6; Inflammatory biomarkers; Non-specific low back pain; Systematic review; TNF-α.

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Conflict of interest statement

Luciana Macedo is an Associate editor of BMC Musculoskeletal Disorders.

Figures

Fig. 1
Fig. 1
Flow diagram. *Klyne et al.’s study published as case control in 2017 and prospective cohort in 2018
See this image and copyright information in PMC

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