title: Clinical Value of Serum Neuroplasticity Mediators in Identifying the Central Sensitivity Syndrome in Patients With Chronic Pain With and Without Structural Pathology.
abstract: OBJECTIVE
  Central sensitivity syndrome (CSS) encompasses disorders with overlapping symptoms in a spectrum of structural pathology from persistent somatic nociception (eg, osteoarthritis) to absence of tissue injury such as in fibromyalgia, chronic tension-type headache, and myofascial pain syndrome. Likewise, the spectrum of the neuroplasticity mediators associated with CSS might present a pattern of clinical utility.
  
  
  METHODS
  We studied the brain-derived neurotrophic factor (BDNF), tumor necrosis factor-α (TNF-α), and interleukins 6 (IL-6) and IL-10 in female patients with CSS absent of structural pathology (chronic tension-type headache [n=30], myofascial pain syndrome [n=29], fibromyalgia [n=22]); with CSS due to persistent somatic/visceral nociception (osteoarthritis [n=27] and endometriosis [n=32]); and in pain-free controls (n=37).
  
  
  RESULTS
  Patients with CSS absent of structural pathology presented higher serum TNF-α (28.61±12.74 pg/mL) and BDNF (49.87±31.86 ng/mL) than those with persistent somatic/visceral nociception (TNF-α=17.35±7.38 pg/mL; BDNF=20.44±8.30 ng/mL) and controls (TNF-α=21.41±5.74 pg/mL, BDNF=14.09±11.80 ng/mL). Moreover, CSS patients absent of structural pathology presented lower IL levels. Receiver operator characteristics analysis showed the ability of BDNF to screen CSS (irrespective of the presence of structural pathology) from controls (cutoff=13.31 ng/mL, area under the curve [AUC]=0.86, sensitivity=95.06%, specificity=56.76%); and its ability to identify persistent nociception in CSS patients when experiencing moderate-severe depressive symptoms (AUC=0.81; cutoff=42.83 ng/mL, sensitivity=56.80%, specificity=100%). When the level of pain measured on the visual analog scale was <5 and moderate-severe depressive symptoms were observed TNF-α discriminated structural pathology in the chronic pain conditions (AUC=0.97; cutoff=22.11 pg/mL, sensitivity=90%, specificity=91.3%).
  
  
  CONCLUSIONS
  Neuroplasticity mediators could play a role as screening tools for pain clinicians, and as validation of the complex and diffuse symptoms of these patients.
authors.affiliation: *Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS) †Laboratory of Pain and Neuromodulation ‡Postgraduate Program in Health and Human development, La Salle Universitary Center, Canoas §Physical Medicine and Rehabilitation Service ††Pain Treatment and Palliative Care Service, Hospital de Clínicas de Porto Alegre (HCPA) **Pharmacology Department, Instituto de Ciências Básicas da Saúde ‡‡Pain and Anesthesia at Department of Surgery in Medical School at Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil ∥Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown Departments of ¶Physical Medicine and Rehabilitation #Neurology, Harvard Medical School, Boston, MA.
authors.forename: Alícia
authors.initials: A
authors.lastname: Deitos
authors.forename: Jairo A
authors.initials: JA
authors.lastname: Dussán-Sarria
authors.forename: Andressa de
authors.initials: Ad
authors.lastname: Souza
authors.forename: Liciane
authors.initials: L
authors.lastname: Medeiros
authors.forename: Maria da Graça
authors.initials: Mda G
authors.lastname: Tarragô
authors.forename: Francislea
authors.initials: F
authors.lastname: Sehn
authors.forename: Mônica
authors.initials: M
authors.lastname: Chassot
authors.forename: Simone
authors.initials: S
authors.lastname: Zanette
authors.forename: André
authors.initials: A
authors.lastname: Schwertner
authors.forename: Felipe
authors.initials: F
authors.lastname: Fregni
authors.forename: Iraci L S
authors.initials: IL
authors.lastname: Torres
authors.forename: Wolnei
authors.initials: W
authors.lastname: Caumo
mesh_terms: D000328:Adult; D019208:Brain-Derived Neurotrophic Factor / Q000097:blood*; D059350:Chronic Pain / Q000097:blood* / Q000209:etiology* / Q000523:psychology; D003430:Cross-Sectional Studies; D003863:Depression / Q000097:blood; D004715:Endometriosis / Q000097:blood; D005260:Female; D005356:Fibromyalgia / Q000097:blood; D006801:Humans; D016753:Interleukin-10 / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D008875:Middle Aged; D009209:Myofascial Pain Syndromes / Q000097:blood; D009473:Neuronal Plasticity; D010003:Osteoarthritis / Q000097:blood; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018781:Tension-Type Headache / Q000097:blood; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
chemical_list: D019208:Brain-Derived Neurotrophic Factor; C508609:IL10 protein, human; C508600:IL6 protein, human; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; C579455:BDNF protein, human