Evaluation of Pain İntensity and Oxidative Stress Levels in Patients with İnflammatory and non-İnflammatory Back Pain

Yıl 2013, Cilt: 10 Sayı: 4, 185 - 190, 01.12.2013

Ahmet İnanır Erkan Sogut

Öz

To investigate the relationship between pain threshold and oxidative stress levels in patients with acute and chronic inflammatory or non-inflammatory back pain. A total of 137 patients were recruited for the study, including 33 acut back pain (32 lumbar disk herniation, 1 lumbar spondilosis) (16 men, 17 women), 35 with chronic back pain (33 lumbar disk herniation, 1 lumbar spondilosis, 1 sacralisation) (16 men, 19 women), 34 with ankylosing spondylitis (21 men, 13 women) (AS) and 35 without any back pain (15 men, 20 women). The visual analogue scale (VAS) was used to evaluate pain levels and algometry was used to evaluate the pain threshold in all cases. In addition, serum malondialdehyde (MDA) levels were assessed in all patients. The mean ages for groups 1, 2, 3, and 4 were 40.3±10.3, 39.9±9.7, 40.6±10.4, and 38.5±8.1 years, respectively. There was no significant difference between the ages of the groups (p=0.851) (Table 1). The VAS scores of all groups were significantly higher compared to the control group. Particularly, the acute and chronic back pain groups had significantly higher VAS scores than those of the AS group. All three back pain groups had significantly higher serum MDA levels compared to those of the control group (p

Anahtar Kelimeler

Back pain, ankylosing spondylitis, oxidative stress, pain threshold

Evaluation of Pain İntensity and Oxidative Stress Levels in Patients with İnflammatory and non-İnflammatory Back Pain

Öz

Akut ve kronik inflamatuar veya non-inflamatuar bel ağrılı hastalarda ağrı eşiği ve oksidatif stres düzeyleri arasındaki ilişkiyi değerlendirmek amaçlandı. 33 akut bel ağrılı (16 erkek, 17 kadın), 45 kronik bel ağrılı (16 erkek, 19 kadın), 34 Ankilozan spondilitli (21 erkek, 13 kadın) ve 35 sağlıklı gönüllü (15 erkek, 20 kadın) olmak üzere toplam 137 birey çalışmaya dahil edildi. Bütün bireylerin ağrı düzeyleri VAS ile, ağrı eşikleri ise algometri ile değerlendirildi. İlaveten, tüm bireylerin serum malondialdehyde (MDA) düzeyleri değerlendirildi. 1, 2, 3. ve 4. grupların ortalama yaşları 40.3 ± 10.3, 39.9 ± 9.7, 40.6 ± 10.4 ve 38.5 ± 8.1 yıl idi, Grupların yaşları arasında istatistiksel olarak anlamlı fark yoktu (p=0.851) (Tablo 1). Bel ağrılı grupların herbiri kontrol grubu ile karşılaştırıldığında anlamlı şekilde daha yüksek MDA düzeylerine sahipti (p<0.01), ve serum MDA düzeyleri akut bel ağrılı grupta kronik bel ağrılı ve AS gruplarından anlamlı şekilde daha yüksek idi (p=0.004, p=0.032). Ağrı eşiği düzeyleri akut ve kronik bel ağrılı gruplarda control grubu ile karşılaştırıldığında anlamlı derecede daha düşük idi (p=0.002, p=0.001). Aksine, AS grubunun ağrı eşiği düzeyleri control grubuna göre anlamlı şekilde daha yüksek saptandı (p=0.024). İnflamatuar ve non-inflamatuar bel ağrılı hastalarda oksidatif stres düzeyleri control grubuna göre daha yüksek saptanmış olması oksidatif stresin bu hastalıkların patogenezinde rol oynayabilceğini gösteriyor olabilir. İlginç bir şekilde, AS’li hastaların ağrı eşiği düzeyleri daha yüksek saptandı, bu durum bu hastalarda var olan desensitizasyon sürecinin varlığına işaret ediyor olabilir

Anahtar Kelimeler

Bel ağrısı, ankilozan spondilit, oksidatif stres, ağrı eşiği

Kaynakça

• Kandel ER, Schwartz JH, Jessell TM. Learning and mem- ory in Principles or neural science, McGraw Hill Company New York, 2000:1227-46
• Cast-Baril WL, Frymoyer JW. Identifying patients at risk of becoming disabled because of low back pain. Spine 1991;16: 605-7
• Goertz MN (1990) Prognostic indicators for acute low back pain. Spine 15:1307-10
• Volat JP (1994) Low back pain, sciatica and lumbar inter- vertebral disc disease. Rheum Europ 2:55-8
• Buchbinder R, jolley D, Wyatt M (2001) Population based intervention to change back pain beliefs and disability: three part evalution. Br Med J 322:1516-20
• Yazici C, Köse K, Calis M et al (2004) Protein oxidation sta- tus in patients with ankylosing spondylitis. Rheumatology (Oxf) 43:1235-9
• Koehler L, Kuipers JG, Zeidler H (2000) Managing sero- negative spondyloarthritis. Rheumatology 39:360-8.
• Ha HC, Sirisoma NS, Kuppusamy P et al (1998) The natural polyamine spermine functions directly as a free radical scavenger. Proc Natl Acad Sci USA 95:11140–5
• Halliwell B, Vitamin C (1999) Poison, prophylactic or pan- acea? Trends Biochem Sci 24:255–9
• Jenkinson SG (1988) Oxygen toxicity. J Intensive Care Med 3:137–52
• Jackson MJ, O Farrell SO (1993) Free radicals and muscle damage. Br Med Bull 49:630–41
• Beck AT, Ward CH, Mendelson M et al (1961) An Inventory For Measuring Depression. Arch Gen Psychiatry 4:561-71.
• Cast-Baril WL, Frymoyer JW (1991) Identifying patients at risk of becoming disabled because of low back pain. Spine 16: 605-7.
• Brosseau L, Milne S, Robinson V at al (2002) Efficacy of the transcutaneous electrical nevre stimulation for the treatment of chronic low back pain. Spine 27:596-603
• Ho KJ, Chen PQ, Chang CY et al (2000) The oxidative me- tabolism of circulating phagocytes in ankylosing spondy- litis: determination by whole blood chemiluminescence. Ann Rheum Dis 59:338–41
• Van der Unden (1997) Ankylosing spondylitis. İn: Kelley WN, Haris ED, Ruddy S, Sledge CB. Texbook of Rheumatology. Philâdelphia: W.B. Saunders Company 969-82
• Han D, Canali R, Rettori D et al (2003) Effect of gluta- thione depletion on sites and topology of superoxide and hydrogen peroxide production in mitochondria, Mol Pharmacol 64:1136-44
• Tunc O, Bakos HW, Tremellen K (2011) Impact of body mass index on seminal oxidative stress. Andrologia 43:121-8.
• Codoñer-Franch P, Tavárez-Alonso S, Murria-Estal R et al (2011) Nitric oxide production is increased in severely obese children and related to markers of oxidative stress and inflammation. Atherosclerosis 215:475-80
• McCord JM (2000) The evolution of free radicals and oxi- dative stress. Am J Med 108(8):652-9.
• Wendling D, Didier JM, Vuitton DA (1991) The phagocyte oxidative metabolism function in ankylosing spondylitis. Rheumatol Int 11:187–9
• Biasi D, Carletto A, Caramaschi P et al (1995) Neutrophil functions, spondylarthropathies and HLA-B27: a study of 43 patients. Clin Exp Rheumatol 13:623–7
• Tsai KJ, Hung IJ, Chow CK et al (1998) Impared production of nitric oxide, superoxide and hydrogen peroxide in glu- cose 6-phosphate dehydrogenase-deficient granulocytes. FEBS Lett 436:411–4.
• Ozgocmen S, Sogut S, Ardicoglu O et al (2004) Serum ni- tric oxide, catalase, superoxide dismutase, and malondi- aldehyde status in patients with ankylosing spondylitis, Rheumatol Int 24: 80–3
• Wang ZQ, Porreca F, Cuzzocrea S et al (2004) A newly identified role for superoxide in inflammatory pain. J Pharmacol Exp Ther 309:869–78
• Evans AR, Junger H, Southall MD et al (2000) Isoprostanes, novel eicosanoids that produce nociception and sensitize rat sensory neurons. J Pharmacol Exp Ther 293:912–20
• Karakoc M, Altindag O, Keles H et al (2007) Serum oxi- dative–antioxidative status in patients with ankylosing spondilitis, Rheumatol Int 27:1131–4
• Kozaci LD, Sari İ, Alacacioglu A et al (2010) Evaluation of inflammation and oxidative stress in ankylosing spondy- litis: a role for macrophage migration inhibitory factor, Mod Rheumatol 20:34–9
• Dib M, Garrel C, Favier A, et al (2002) Can malondial- dehyde be used as a biological marker of progression in neurodegenerative disease? J Neurol 249:367–74
• Brisby H, Ashley H, Diwan AD (2007) In vivo measurement of facet joint nitric oxide in patients with chronic low back pain. Spine 15:1488-92.
• Bagis S, Tamer L, Sahin G et al (2005) Free radicals and antioxidants in primary fibromyalgia: an oxidative stress disorder? Rheumatol Int 25:188–90
• Yudoh K, Nguyen T, Nakamura H et al (2005) Potential in- volvement of oxidative stress in cartilage senescence and development of osteoarthritis: oxidative stress induces chondrocyte telomere instability and downregulation of chondrocyte function. Arthritis Res Ther 7:380-91
• Poveda L, Hottiger M, Boos N et al (2009) Peroxynitrite Induces Gene Expression in Intervertebral Disc Cells. Spine (Phila Pa 1976) 34:1127-33.
• Incel NA, Erdem HR, Ozgocmen S et al (2002) Pain pressure threshold values in ankylosing spondylitis. Rheumatol Int 22:148–50
• Gerecz-Simon EM, Tunks ER, Heale JA et al (1989) Measurement of pain threshold in patients with rheuma- toid arthritis, osteoarthritis, ankylosing spondylitis, and healthy controls. Clin Rheumatol 8:467-74