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Somatosensory Temporal Discrimination and Neutrophil/Lymphocyte Ratio in Patients with Chronic Low Back Pain

Year 2022, Volume: 11 Issue: 3, 377 - 382, 04.10.2022
https://doi.org/10.53424/balikesirsbd.1057129

Abstract

Objective: Central sensitization is known in the pathogenesis of chronic low back pain. We aimed at this study considering that somatosensory temporal discrimination (STD) may also be impaired in this process. We also looked at the neutrophil-lymphocyte ratio in terms of its contribution to inflammation suggested in the pathogenesis. Materials and Methods: A total of 52 participants have been enrolled in this study. They were divided into two groups, 27 patients with chronic low back pain (pain caused by facet, sacroiliac joint arthropathy and intervertebral disc degeneration) and 25 healthy volunteers. STDT (somatosensory temporal discrimination threshold) stimulus intensity and STD measurements were obtained in the dorsum of the hands and foot in four extremities of both groups, and neutrophil-lymphocyte ratio was evaluated. Results: STD thresholds in patients with chronic low back pain were found significantly prolonged in all four extremities compared to the control group. Neutrophil-lymphocyte ratio was also found to be statistically significantly higher in the low back pain group compared to the control group. Conclusion: Prolonged STD thresholds indicate that pain perception of patients with chronic low back pain is disrupted. In addition, the high rate of neutrophils-lymphocytes indicates that the inflammatory process continues even if low back pain becomes chronic.

References

  • Airaksinen, O., Brox, J.I., Cedraschi, C., Hildebrandt, J., Klaber-Moffett, J., Kovacs F, Mannion, A. F., Reis, S., Staal, J. B., Ursin, H., & Zanoli, G. (2006). European guidelines for the management of chronic nonspecific low back pain. European Spine Journal, 2006; 15 (2), 192–300. https://doi: 10.1007/s00586-006-1072-1.
  • Will, J.S., Bury, D.C., & Miller, J.A. (2018). Mechanical Low Back Pain. American Family Physician, 98(7), 421-428.
  • Giesecke, T., Gracely, R.H., Grant, M.A., Nachemson, A., Petzke, F., Williams, D.A., & Clauw, D. J. (2004). Evidence of augmented central pain processing in idiopathic chronic low back pain. Arthritis and Rheumatism, 50 (2), 613-623. https://doi: 10.1002/art.20063.
  • Hoshiyama, M., Kakigi, R., & Tamura, Y. (2004). Temporal discrimination threshold on various parts of the body. Muscle Nerve, 29 (2), 243-247. https://doi: doi: 10.1002/mus.10532.
  • Wand, B.M., Parkitny, L., O'Connell, E., Luomajoki, H., McAuley, H.J., Thacker, M. & Moseley, G. L. (2011). Cortical changes in chronic low back pain: current state of the art and implications for clinical practice. Manuel Therapy, 16(1), 15-20. https://doi: 10.1016/j.math.2010.06.008.
  • Aktürk, S., & Büyükavcı, R. (2017). Evaluation of blood neutrophil-lymphocyte ratio and platelet distribution width as inflammatory markers in patients with fibromyalgia. Clinical Rheumatology , 36 (8), 1885- 1889. https://doi: 10.1007/s10067-017-3647-0.
  • Khan, A.N., Jacobsen, H.E., Jansher, K., Filippi, G.C., Levine, M., Jr, R.A. L., Riew, K. D., Lenke, L. G., & Chahine, N.O. (2017). Inflammatory biomarkers of low back pain and disc degeneration: a review. Annals of the New York Academy of Sciences, 1410 (1), 68-84. https://doi: 10.1111/nyas.13551.
  • Conte, A., Modugno, N., Lena, F., Dispenza, S., Gandolfi, B., Iezzi, E., Fabbrini, & G. Berardelli, A. (2010). Subthalamic nucleus stimulation and somatosensory temporal discrimination in Parkinson’s disease. Brain, 133 (9), 2656-2663. https://doi: 10.1093/brain/awq191.
  • Vlaeyen, J.W.S., Maher, C.G., Wiech, K., Zundert, J.V., Meloto, C.B., Diatchenko, L., Battié, M.C., Goossens, M., Koes, B., & Linton, S.J. (2018). Low back pain. NatureReviews. Disease Primers, 4 (1), 52. https://doi: 10.1038/s41572-018-0052-1.
  • Jeffrey, A.S., & Walter, S.B. (2009). Treatment of Facet and Sacroiliac Joint Arthropathy: Steroid Injections and Radiofrequency Ablation. Techniques in Vascular and Interventional Radiology , 12 (1), 22-32. https://doi: 10.1053/j.tvir.2009.06.009.
  • Brinjikji, W., Diehn, F.E., Jarvik, J.G., Carr, C.M., Kallmes, D.F., Murad, M.H., & P H Luetmer. (2015). MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: a systematic review and meta-analysis. American. Journal of Neuroradiology, 36 (12), 2394–2399. https://doi: 10.3174/ajnr.A4498.
  • Endea, A., Palmer, K..T., & Coggon, D. (2011). Potential of magnetic resonance imaging findings to refine case definition for mechanical low back pain in epidemiological studies: a systematic review. Spine ,36 (2), 160–169. https://doi: 10.1097/BRS.0b013e3181cd9adb.
  • Nijs, J., Apeldoorn, A., Hallegraeff, H., Clark, J., Smeets, R., Malfliet, A., Girbes, E. L., Kooning, M. D., & Ickmans, K. (2015). Low back pain: guidelines for the clinical classification of predominant neuropathic, nociceptive, or central sensitization pain. Pain Physician, 18 (3), 333-346.
  • O’Neill, S., Manniche, C., Graven-Nielsen, T., & Arendt-Nielsen, L. (2007). Generalized deep-tissue hyperalgesia in patients with chronic low-back pain. European Journal of Pain, 11(4), 415- 420. https://doi: 10.1016/j.ejpain.2006.05.009.
  • Pastor, M.A., Day, B.L., Macaluso, E., Friston, K..J., & Frackowiak, R.S.J. (2004). The functional neuroanatomy of temporal discrimination. The Journal of Neuroscience, 24 (10), 2585-2591. https://doi: 10.1523/JNEUROSCI.4210-03.2004.
  • Moseley, G.L., & Flor, H. (2012). Targeting cortical representations in the treatment of chronic pain: a review. Neurorehabilitation Neural Repair , 26 (6), 646-52. https:// doi: 10.1177/1545968311433209.
  • Lim, M., Roosink, M., Kim, J.S., Kim, D.J., Kim, H.W., Lee, E.B., Kim, H.A., & Chung, C. K. (2015). Disinhibition of the primary somatosensory cortex in patient with fibromyalgia. Pain, 156 (4), 666-74. https:// doi: 10.1097/j.pain.0000000000000096.
  • Sommer, C., & Kress, M. (2004). Recent findings on how proinflammatory cytokines cause pain:peripheral mechanisms in inflammatory and neuropathic hyperalgesia. Neuroscience Letters, 361(1-3), 184-187. https:// doi: 10.1016/j.neulet.2003.12.007.
  • Torun S, Tunc BD, Suvak B, Yildiz H, Tas A, Sayilir A, Ozderin, Y. O., Beyazit, Y., & Kayacetin, E. (2012). Assessment of neutrophil lymphocyte ratio in ulcerative colitis: a promising marker in predicting disease severity, Clinics and Research in Hepatology and Gastroenterology, 36 (5), 491-7. https:// doi: 10.1016/j.clinre.2012.06.004.
  • Proctor, M.J., McMillan, D.C., Morrison, D.S., Fletcher, C.D., Horganet, P.G., & Clarke, S.J. (2012). A derived neutrophil to lymphocyte ratio predicts survival in patients with cancer. British Journal of Cancer , 107: 695- 9. https:// doi: 10.1038/bjc.2012.292.
  • Uslu, A.U., Deveci, K., Korkmaz, S., Aydin, B., Senel, S., Sancakdar, E., & Sencan, M. (2013). Is neutrophil/lymphocyte ratio associated with subclinical inflammation and amyloidosis in patients with familial Mediterranean fever? BioMed Research International ,2013, 185317. https:// doi: 10.1155/2013/185317.
  • Yılmaz, A., Altaş, H., Yıldırım, T., Kaygısız, Ş. , & Işık, H.S. (2019). The Clınıcal Predıctıve Value Of The Neutrophıl To Lymphocyte Ratıo As A Bıomarker In Lumbar Dısc Hernıatıon. Middle Black Sea Journal of Health Science , 5 (2), 145-150. https://doi.org/10.19127/mbsjohs.594555.
  • Kjersti, S., Ansgar, E., Lars, G., Skouen, J.S., Aßmus, J., Audny, A., Froholdt, A., Pedersen, L. M., Haugen, A. J., Fors, T., Schistad, E., Lutro, O., Marchand, G.H., Kadar, T., Vetti, N., Randen, S., Nygaard, Ø.P., Brox, J.I., Grotle, M., & Zwart, J.A. (2017). Antibiotic treatment In patients with chronic low back pain and Modic changes (the AIM study): study protocol for a randomised controlled trial. Trials , 18 (1), 596. https://doi: 10.1186/s13063-017-2306-8.

Kronik Bel Ağrılı Hastalarda Somatosensoryel Temporal Diskriminasyon ve Nötrofil / Lenfosit Oranı

Year 2022, Volume: 11 Issue: 3, 377 - 382, 04.10.2022
https://doi.org/10.53424/balikesirsbd.1057129

Abstract

Amaç: Kronik bel ağrısının patogenezinde santral duyarlılaşma bilindiğinden, somatosensoriyel temporal diskriminasyonun (STD) da bu süreçte bozulabileceğini düşünerek bu çalışmayı amaçladık. Nötrofil lenfosit oranına da patogenezde ileri sürülen inflamasyona katkısı açısından baktık. Gereç ve Yöntem: Bu çalışmaya toplam 52 katılımcı katılmıştır. Kronik bel ağrılı (faset, sakroiliak eklem artropatisi ve intervertebral disk dejenerasyonu kaynaklı ağrı) 27 hasta ve 25 sağlıklı gönüllü olmak üzere iki gruba ayrıldı. Her iki grubun dört ekstremitesinde el ve ayak dorsumundan somatosensoriyel temporal diskriminasyon eşik (STDT) uyarı şiddeti ve STD ölçümleri yapıldı ve nötrofil/lenfosit oranı değerlendirildi. Bulgular: Kronik bel ağrısı olan hastalarda STD eşikleri, kontrol grubuna kıyasla dört ekstremitede önemli ölçüde uzamış bulundu. Nötrofil/lenfosit oranı da bel ağrısı grubunda kontrol grubuna göre istatistiksel olarak anlamlı derecede yüksek bulundu. Sonuç: Uzamış STD eşikleri, kronik bel ağrılı hastaların ağrı algısının bozulduğuna işaret etmektedir. Ayrıca nötrofil/lenfosit oranının yüksek olması da bel ağrısı kronikleşse bile inflamatuar sürecin devam ettiğini gösterir.

References

  • Airaksinen, O., Brox, J.I., Cedraschi, C., Hildebrandt, J., Klaber-Moffett, J., Kovacs F, Mannion, A. F., Reis, S., Staal, J. B., Ursin, H., & Zanoli, G. (2006). European guidelines for the management of chronic nonspecific low back pain. European Spine Journal, 2006; 15 (2), 192–300. https://doi: 10.1007/s00586-006-1072-1.
  • Will, J.S., Bury, D.C., & Miller, J.A. (2018). Mechanical Low Back Pain. American Family Physician, 98(7), 421-428.
  • Giesecke, T., Gracely, R.H., Grant, M.A., Nachemson, A., Petzke, F., Williams, D.A., & Clauw, D. J. (2004). Evidence of augmented central pain processing in idiopathic chronic low back pain. Arthritis and Rheumatism, 50 (2), 613-623. https://doi: 10.1002/art.20063.
  • Hoshiyama, M., Kakigi, R., & Tamura, Y. (2004). Temporal discrimination threshold on various parts of the body. Muscle Nerve, 29 (2), 243-247. https://doi: doi: 10.1002/mus.10532.
  • Wand, B.M., Parkitny, L., O'Connell, E., Luomajoki, H., McAuley, H.J., Thacker, M. & Moseley, G. L. (2011). Cortical changes in chronic low back pain: current state of the art and implications for clinical practice. Manuel Therapy, 16(1), 15-20. https://doi: 10.1016/j.math.2010.06.008.
  • Aktürk, S., & Büyükavcı, R. (2017). Evaluation of blood neutrophil-lymphocyte ratio and platelet distribution width as inflammatory markers in patients with fibromyalgia. Clinical Rheumatology , 36 (8), 1885- 1889. https://doi: 10.1007/s10067-017-3647-0.
  • Khan, A.N., Jacobsen, H.E., Jansher, K., Filippi, G.C., Levine, M., Jr, R.A. L., Riew, K. D., Lenke, L. G., & Chahine, N.O. (2017). Inflammatory biomarkers of low back pain and disc degeneration: a review. Annals of the New York Academy of Sciences, 1410 (1), 68-84. https://doi: 10.1111/nyas.13551.
  • Conte, A., Modugno, N., Lena, F., Dispenza, S., Gandolfi, B., Iezzi, E., Fabbrini, & G. Berardelli, A. (2010). Subthalamic nucleus stimulation and somatosensory temporal discrimination in Parkinson’s disease. Brain, 133 (9), 2656-2663. https://doi: 10.1093/brain/awq191.
  • Vlaeyen, J.W.S., Maher, C.G., Wiech, K., Zundert, J.V., Meloto, C.B., Diatchenko, L., Battié, M.C., Goossens, M., Koes, B., & Linton, S.J. (2018). Low back pain. NatureReviews. Disease Primers, 4 (1), 52. https://doi: 10.1038/s41572-018-0052-1.
  • Jeffrey, A.S., & Walter, S.B. (2009). Treatment of Facet and Sacroiliac Joint Arthropathy: Steroid Injections and Radiofrequency Ablation. Techniques in Vascular and Interventional Radiology , 12 (1), 22-32. https://doi: 10.1053/j.tvir.2009.06.009.
  • Brinjikji, W., Diehn, F.E., Jarvik, J.G., Carr, C.M., Kallmes, D.F., Murad, M.H., & P H Luetmer. (2015). MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: a systematic review and meta-analysis. American. Journal of Neuroradiology, 36 (12), 2394–2399. https://doi: 10.3174/ajnr.A4498.
  • Endea, A., Palmer, K..T., & Coggon, D. (2011). Potential of magnetic resonance imaging findings to refine case definition for mechanical low back pain in epidemiological studies: a systematic review. Spine ,36 (2), 160–169. https://doi: 10.1097/BRS.0b013e3181cd9adb.
  • Nijs, J., Apeldoorn, A., Hallegraeff, H., Clark, J., Smeets, R., Malfliet, A., Girbes, E. L., Kooning, M. D., & Ickmans, K. (2015). Low back pain: guidelines for the clinical classification of predominant neuropathic, nociceptive, or central sensitization pain. Pain Physician, 18 (3), 333-346.
  • O’Neill, S., Manniche, C., Graven-Nielsen, T., & Arendt-Nielsen, L. (2007). Generalized deep-tissue hyperalgesia in patients with chronic low-back pain. European Journal of Pain, 11(4), 415- 420. https://doi: 10.1016/j.ejpain.2006.05.009.
  • Pastor, M.A., Day, B.L., Macaluso, E., Friston, K..J., & Frackowiak, R.S.J. (2004). The functional neuroanatomy of temporal discrimination. The Journal of Neuroscience, 24 (10), 2585-2591. https://doi: 10.1523/JNEUROSCI.4210-03.2004.
  • Moseley, G.L., & Flor, H. (2012). Targeting cortical representations in the treatment of chronic pain: a review. Neurorehabilitation Neural Repair , 26 (6), 646-52. https:// doi: 10.1177/1545968311433209.
  • Lim, M., Roosink, M., Kim, J.S., Kim, D.J., Kim, H.W., Lee, E.B., Kim, H.A., & Chung, C. K. (2015). Disinhibition of the primary somatosensory cortex in patient with fibromyalgia. Pain, 156 (4), 666-74. https:// doi: 10.1097/j.pain.0000000000000096.
  • Sommer, C., & Kress, M. (2004). Recent findings on how proinflammatory cytokines cause pain:peripheral mechanisms in inflammatory and neuropathic hyperalgesia. Neuroscience Letters, 361(1-3), 184-187. https:// doi: 10.1016/j.neulet.2003.12.007.
  • Torun S, Tunc BD, Suvak B, Yildiz H, Tas A, Sayilir A, Ozderin, Y. O., Beyazit, Y., & Kayacetin, E. (2012). Assessment of neutrophil lymphocyte ratio in ulcerative colitis: a promising marker in predicting disease severity, Clinics and Research in Hepatology and Gastroenterology, 36 (5), 491-7. https:// doi: 10.1016/j.clinre.2012.06.004.
  • Proctor, M.J., McMillan, D.C., Morrison, D.S., Fletcher, C.D., Horganet, P.G., & Clarke, S.J. (2012). A derived neutrophil to lymphocyte ratio predicts survival in patients with cancer. British Journal of Cancer , 107: 695- 9. https:// doi: 10.1038/bjc.2012.292.
  • Uslu, A.U., Deveci, K., Korkmaz, S., Aydin, B., Senel, S., Sancakdar, E., & Sencan, M. (2013). Is neutrophil/lymphocyte ratio associated with subclinical inflammation and amyloidosis in patients with familial Mediterranean fever? BioMed Research International ,2013, 185317. https:// doi: 10.1155/2013/185317.
  • Yılmaz, A., Altaş, H., Yıldırım, T., Kaygısız, Ş. , & Işık, H.S. (2019). The Clınıcal Predıctıve Value Of The Neutrophıl To Lymphocyte Ratıo As A Bıomarker In Lumbar Dısc Hernıatıon. Middle Black Sea Journal of Health Science , 5 (2), 145-150. https://doi.org/10.19127/mbsjohs.594555.
  • Kjersti, S., Ansgar, E., Lars, G., Skouen, J.S., Aßmus, J., Audny, A., Froholdt, A., Pedersen, L. M., Haugen, A. J., Fors, T., Schistad, E., Lutro, O., Marchand, G.H., Kadar, T., Vetti, N., Randen, S., Nygaard, Ø.P., Brox, J.I., Grotle, M., & Zwart, J.A. (2017). Antibiotic treatment In patients with chronic low back pain and Modic changes (the AIM study): study protocol for a randomised controlled trial. Trials , 18 (1), 596. https://doi: 10.1186/s13063-017-2306-8.
There are 23 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Articles
Authors

Oktay Faysal Tertemiz 0000-0002-6131-1756

Nermin Tepe 0000-0003-4148-2539

Publication Date October 4, 2022
Submission Date January 13, 2022
Published in Issue Year 2022 Volume: 11 Issue: 3

Cite

APA Tertemiz, O. F., & Tepe, N. (2022). Somatosensory Temporal Discrimination and Neutrophil/Lymphocyte Ratio in Patients with Chronic Low Back Pain. Balıkesir Sağlık Bilimleri Dergisi, 11(3), 377-382. https://doi.org/10.53424/balikesirsbd.1057129

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