RESUMO
OBJECTIVE: To identify clinical and laboratory indicators associated with the development of chronic musculoskeletal pain syndrome in young and middle-aged patients with degenerative changes of the spine. MATERIAL AND METHODS: The study included 103 patients (59 women and 44 men) with a mean age 42 [36; 47] years with chronic musculoskeletal back pain. To verify degenerative changes of the spine, MRI was performed using Magnetom Symphony (Siemens; Germany), Magnetom Verio (Siemens; Germany) devices. The intensity of the pain syndrome, the neuropathic component of pain sensations, and affective disorders were assessed. Blood levels of osteocalcin, parathyroid hormone, thyroid stimulating hormone were determined using an immunochemiluminescent analyzer Immulite 2000 (Siemens, USA), vitamin D - using an immunochemical analyzer Architect i2000SR (Abbott, USA), vitamin PP and 17-hydroxyprogesterone by sandwich-type ELISA on a plate reader VICTOR 2 (Perken Elmer, USA). The levels of interleukin-1ß, interleukin-6 and interleukin-8 and tumor necrosis factor alpha (TNF-α) in the blood were determined by enzyme-linked immunosorbent assay (ELISA) on a Real-best plate ELISA analyzer (Russia) using Cloud Clone Corparation kits (USA, China). RESULTS: The main causes of musculoskeletal pain in the main group (83 patients) with a mean age of 42 [38; 46] years, were degenerative changes of the spine without signs of compression of the spinal nerves and spinal canal stenosis. In the control group (20 patients) with a mean age of 41 [34; 47] years, main causes were static and functional disorders. Patients with degenerative changes of the spine often led a sedentary lifestyle and had an increased body mass index. Tobacco smoking was noted in 48.2% of patients of the main group and 25% of patients in the control group (p=0.080). The intensity of pain in patients in both groups had a moderate degree, the neuropathic component of pain was not detected. Asthenia, situational and personal anxiety were mild or elevated in both groups In the main group, there was an increase in the levels of pro-inflammatory factors (C-reactive protein, TNF-α, IL-1ß, IL-6 and IL-8), as well as a decrease in the level of osteocalcin. CONCLUSION: The revealed increase in the levels of pro-inflammatory factors (C-reactive protein, TNF-α, IL-1ß, IL-6 and IL-8) in the blood confirms the role of inflammatory reactions in the pathogenesis of degenerative changes of the spine and the associated musculoskeletal pain syndrome. A decrease in the level of osteocalcin with a normal content of parathyroid hormone in the blood in patients of main group may be associated with desorganized bone remodeling and increased bone resorbtion.
