Dynamics of TNF-? and IL-1? Indicators in Patients with Discogenic Pain Syndromes of the Lumbar Spine in the Background of Osteopathic Treatment

Abstract

The aim was to study the elimination dynamics of pro-inflammatory cytokines: tumor necrosis factor alpha (TNF-?) and interleukin 1? (IL-1?) in patients with discogenic pain syndromes of the lumbar spine in the background of osteopathic treatment in comparison with other therapeutic techniques. The study involved 120 patients. Patients were divided into three experimental groups (EG) depending on the treatment, and control group (CG): EG 1 - with the use of manual therapy (osteopathy) (n = 30), EG 2 - with the use of homeopathy (n = 30), EG 3 - with the use of drug therapy (ksefokam) (n = 30); CG - control group - placebo (n = 30). All patients undergo neurological examination, manual (osteopathic) diagnostics, magnetic resonance imaging of the lumbar spine, immunologic study of blood serum on the pro-inflammatory IL-1? and TNF-? cytokines. The mean values of TNF-? in the onset of the disease did not exceed 10.70 pg/ml, while in the group with chronic relapsing disease course excess reached 17.10 pg/ml, i.e. it is more than 2 times. Acute discogenic pain syndrome was quickly arrested that is reflected in the TNF-? dynamics which decreased to normal in EG 1, EG 2 and EG 3. In the control group TNF-? did not reach normal values (9,50 ± 5,23). The content of IL-1? in the serum in all patients did not exceed normal values (5 pg/ml). This may be due to the fact that patients consulted a doctor in 5 to 7 days from the onset of the disease, and IL-1? is a predictor of inflammation in the acute period and starts the autoimmune process in the first hours and days (no later than 5-days) from the onset of the disease, that is confirmed by the results of our study. Clinical and MRI studies revealed the relationship between TNF-? increasing and degree of damage to the intervertebral disc. The more pronounced the destruction process of the disk, the higher is the level of TNF-?. Thus, in groups of patients with frequent exacerbations and longer period of disease the TNF-? level is significantly higher than normal and slowly returns to normal in all experimental groups. The study showed that manual (osteopathic) treatment of patients with discogenic pain syndromes of the lumbar spine actively affects not only on the clinical picture, but also on the elimination of pro-inflammatory cytokines. The same efficacy of osteopathic treatment and drug therapy of these patients was also shown significantly (p <0,001). However, osteopathic treatment has no side effects as a group of non-steroidal pro-inflammatory drugs, and can be recommended as the most safe and effective treatment of discogenic pain syndromes.