Background: Low back pain (LBP) is one of the greatest contributors to disability adjusted life years (DALYs) in the world. Inflammation results in proliferation of cytokines that activate inflammatory pathways which can result in non-specific LBP. The purpose of this systematic review was to analyze current literature on the association between inflammatory biomarkers, location, clinincal presentation and outcome of treatment in patients with non-specific LBP.
Methods: A search was conducted in PubMed, Embase and Cochrane databases. MeSH terms and keywords were used to identify studies that measured the association between inflammatory biomarkers and non-specific LBP. Two reviewers independently screened titles, abstracts and full text, and extracted data. Methodological risk of bias assessment was conducted via the Newcastle Ottowa quality assessment scale for cohort studies and Cochrane collaboration risk of bias tool for randomised controlled trials. Mean and standard errors were calculated to compensate for the great number of prospective studies. For this meta-analysis STATA software (Release 16, StataCorp LLC, TX) was used for the analysis. The GRADE approach was used to assess the quality of the evidence
Results: The literature search is illustrated in the PRISMA flow diagram. Twenty-two studies met the selection criteria for the purposes of the present review, which included xxx RCT and xxx observational studies. Different inflammatory biomarkers in different locations will be analysed. To calculate the association of mean pain/disability score with the measurements of biomarkers, we include the measurements of inflammatory biomarker as a predictor in a meta-regression. This meta-regression proportion of between-study variance will be explained with Knapp-Hartung modification.
Conclusions: We conducted this review as an inflammatory substrate in patients with LBP could be a potential target for anti-inflammatory therapy, specifically non-steroidal anti-inflammatory drugs (NSAIDs) or transforaminal epidural corticosteroids. We address many questions in particular: (1) the inflammatory biomarkers in patients with LBP; (2) the difference of inflammatory biomarkers in different locations; (3) the association between the level of inflammatory activity and clinical symptoms.