Endocrine and immunologic parameters indicative of 6-month prognosis after the onset of low back pain or neck/shoulder pain.
METHODS
Prospective study.


OBJECTIVE
To evaluate the prognosis of spine disease by investigating biologic parameters reflecting different physiologic or psychophysiological systems in men and women with acute onset of low back or neck/shoulder complaints.


BACKGROUND
Psychosocial factors may be of importance to the etiology and prognosis of musculoskeletal disorders. The possible mechanisms, however, remain unclear. Stress-induced long-lasting energy mobilization resulting in inhibited anabolism has been discussed. Using a theoretical framework within stress physiology, such psychophysiological processes were recorded by measures of substances representing the anabolic, catabolic, immunologic, and opioid systems.


METHODS
The study comprised 67 working men and women 21 to 59 years of age seeking care by any caregiver for acute low back and/or neck/shoulder pain. Blood samples were taken and analyzed for 3 methyl 5hydroxy phenylethylene glycol (MHPG, reflecting sympathoadrenomedullary activity), DHEA-s (anabolism), immunoglobulin E, interleukin 6 (immune activity), and beta-endorphin (pain regulation). The participants were followed up for 6 months after the blood samples had been drawn.


RESULTS
In women, low MHPG, low DHEA-s, and low beta-endorphin predicted persistent disability due to low back complaints. Few significant findings were made for self-reported pain, for neck/shoulder complaints, and for men.


CONCLUSIONS
Disturbances of the regulation of certain biologic parameters might be indicators of a prolonged course of low back disease in women. Prospective studies are necessary to enable causal conclusions.
Department of Occupational Medicine, University of Wuppertal, Germany. hans-martin.hasselhorn@arbmed.uni-wuppertal.de
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Hasselhorn
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Theorell
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Vingård
D000328:Adult; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D004703:Endocrine System / Q000378:metabolism / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D017116:Low Back Pain / Q000097:blood* / Q000276:immunology* / Q000503:physiopathology; D008297:Male; D008734:Methoxyhydroxyphenylglycol / Q000097:blood; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000276:immunology / Q000378:metabolism / Q000503:physiopathology; D019547:Neck Pain / Q000097:blood* / Q000276:immunology* / Q000503:physiopathology; D010147:Pain Measurement; D011237:Predictive Value of Tests; D011379:Prognosis; D020069:Shoulder Pain / Q000097:blood* / Q000276:immunology* / Q000503:physiopathology; D013997:Time Factors; D001615:beta-Endorphin / Q000097:blood
D015850:Interleukin-6; D007073:Immunoglobulin E; D008734:Methoxyhydroxyphenylglycol; D019314:Dehydroepiandrosterone Sulfate; D001615:beta-Endorphin