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Detection of systemic inflammation in severely impaired chronic pain patients and effects of a multimodal pain rehabilitation program
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Statistics. Univ Edinburgh, Sch Math, Kings Bldg, Edinburgh EH9 3FD, Midlothian, Scotland;Univ Edinburgh, Maxwell Inst Mathemat Sci, Kings Bldg, Edinburgh EH9 3FD, Midlothian, Scotland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.ORCID iD: 0000-0003-3923-4093
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2019 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 19, no 2, p. 235-244Article in journal (Refereed) Published
Abstract [en]

Background and aims: Recent research indicates a previously unknown low-grade systemic or neurogenic inflammation in groups of chronic pain (CP) patients. Low-grade inflammation may have an important role in symptoms that have previously not been well depicted: widespread pain, tiredness and cognitive dysfunctions frequently seen in severely impaired CP patients. This study aimed to investigate the plasma inflammatory profile in a group of very complex CP patients at baseline and at a 1-year follow-up after participation in a cognitive behavior therapy (CBT)-based multimodal pain rehabilitation program (PRP).

Methods: Blood samples were collected from 52 well-characterized CP patients. Age- and sex-matched healthy blood donors served as controls. The samples were analyzed with a multiple Proximal Extension Analysis allowing a simultaneous analysis of 92 inflammation-related proteins consisting mainly of cytokines, chemokines and growth-factors. At follow-up, 1-year after participation in the RPR samples from 28 patients were analyzed. The results were confirmed by a multi-array technology that allows quantitative estimation.

Results: Clear signs of increased inflammatory activity were detected in the CP patients. Accepting a false discovery rate (FDR) of 5%, there were significant differences in 43/92 inflammatory biomarkers compared with the controls. In three biomarkers (CXCL5, SIRT2, AXIN1) the expression levels were elevated more than eight times. One year after the PRP, with the patients serving as their own controls, a significant decrease in overall inflammatory activity was found.

Conclusions: Our results indicate that the most impaired CP patients suffer from low-grade chronic systemic inflammation not described earlier with this level of detail. The results may have implications for a better understanding of the cluster of co-morbid symptoms described as the "sickness-syndrome" and the wide-spread pain seen in this group of patients. The decrease in inflammatory biomarkers noted at the follow-up after participation in the PRP may reflect the positive effects obtained on somatic and psycho-social mechanisms involved in the inflammatory process by a rehabilitation program. Besides the PRP, no major changes in medication or lifestyle factors were implemented during the same period. To our knowledge, this is the first study reporting that a PRP may induce inflammatory-reducing effects. Further studies are needed to verify the objective findings in CP patients and address the question of causality that remains to be solved.

Place, publisher, year, edition, pages
WALTER DE GRUYTER GMBH , 2019. Vol. 19, no 2, p. 235-244
Keywords [en]
inflammatory biomarkers, severely impaired pain patients, central inflammation, systemic inflammation, pain rehabilitation program
National Category
Neurology
Identifiers
URN: urn:nbn:se:uu:diva-382511DOI: 10.1515/sjpain-2018-0340ISI: 000463370000003PubMedID: 30893060OAI: oai:DiVA.org:uu-382511DiVA, id: diva2:1308050
Funder
VinnovaSwedish Research Council, P29797-1Available from: 2019-04-30 Created: 2019-04-30 Last updated: 2019-04-30Bibliographically approved

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Hysing, Eva-BrittSmith, LenaThulin, MånsKarlsten, RolfBothelius, KristofferGordh, Torsten

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Anaesthesiology and Intensive CareDepartment of Surgical SciencesDepartment of StatisticsDepartment of Psychology
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