May Influence Inflammation Markers in the Blood
Low back pain is so prevalent in the US and around the world that the World Health Organization (WHO) lists it as the “single leading cause of disability worldwide and the condition for which the greatest number of people may benefit from rehabilitation.” As such, it is the target of much research. Understanding both the internal mechanisms of back pain as well as the resulting physical effects will help health care providers provide more effective treatments and preventative measures for patients.
Inflammation is commonly associated with back pain. In addition to obvious swelling of tissue, there are markers within the blood that can indicate various types of inflammation in the body. A small research study published in 2010 explored the effects of spinal manipulative therapy (SMT) on two specific Inflammatory markers: interleukin-6 (IL-6) and C-reactive protein (CRP). The American Cancer Society describes Interleukins as proteins that “act as chemical signals between white blood cells.” They help regulate the “growth and activity” of both immune system cells and blood cells and provide a signal for the immune system to activate. Researchers for this study selected IL-6 because it is the “main mediator of the acute phase inflammatory response.” C-reactive protein (CRP) is a protein generated by the liver. According to the Mayo Clinic, the CRP levels increase when there is inflammation in the body and can be an indicator of infection, a chronic inflammatory disease (such as rheumatoid arthritis) and can also be an indicator of heart disease risk.
Study participants consisted of a control group and a treatment group. The control group participants were pain free and would complete all evaluations and blood tests, but receive no treatment. The treatment group reported chronic low back pain that had lasted 3 months or longer. They completed the same evaluations and blood tests as well as 2 weeks of chiropractic treatment including 9 spinal manipulations. The evaluations were completed before, immediately after and then 2 weeks after the study.
When results were analyzed, there was a “large” difference for both IL-6 and CRP between the control and treatment groups at the pre-test. The treatment group values for IL-6 and CRP tended to move toward the values of the control group so that by the final evaluation, there was only a “medium” difference between treatment and control groups. Researchers suggest that these changes are an indication that even as few as 9 SMT are “capable” of having a noticeable impact on the inflammation processes in the body. The treatment group also reported considerable improvement during the two weeks of treatment. Researchers state “it is plausible to consider that the inflammation processes were being reversed but that complete healing was not achieved following 2 weeks of treatment.” They called for additional studies with larger participant groups and longer time frame to delve more into the connection between inflammatory processes and SMT.
A decade later another study was published that investigated not only the effects of SMT on IL-6 and CRP, but other inflammatory markers in the blood as well as variations between acute and chronic low back pain. Participants included a control group that had no reported pain, an acute pain group and a chronic pain group. Blood samples were taken at baseline. The study groups then received 6 manipulations over the course of two weeks and returned for blood work 48 hours after the last SMT. The control group returned 2 weeks after baseline for their final blood samples to be taken and verification that they had not experienced back pain in the interim.
Analysis of results showed that pain and function scores were similar between acute and chronic groups at baseline and both groups showed significant improvement after the 2 weeks of SMT. Again, post treatment levels of IL-6 were significantly reduced for chronic group compared to their baseline.
Levels of IL-2, which the American Cancer Society says specifically helps immune cells grow and divide more quickly, actually increased in the Acute low back pain group to the point they “became significantly higher compared to those in asymptomatic controls and to patients with chronic LBP.” They note that some studies report IL-2 “to exert an analgesic effect” on pain and this could explain some of the pain reduction of manual therapies. While they also suggest more, larger studies, they conclude that the effects observed in this study “indicate the potential of this intervention to impact the inflammatory process in LBP patients.”
While the positive effects of chiropractic care have long been documented, these studies and others like them, add to the scientific knowledge base regarding how SMT effects the body. As the data grows, techniques, treatments and recommendations are further refined to enhance the benefit to the patient. Doctors of chiropractic receive a minimum of 7 years of higher-level education and are trained to provide safe, effective, drug-free pain management. They are able to provide information on nutrition, exercise and other wellness topics to augment the treatment they administer to provide the patient with the best possible outcomes. When needed, they can refer to and coordinate care with other health care providers to ensure the patient gets the best, most efficient care. To find a doctor of chiropractic near you, click here
Roy RA, Boucher JP, Comtois AS. Inflammatory response following a short-term course of chiropractic treatment in subjects with and without chronic low back pain. J Chiropr Med. 2010 Sep;9(3):107-14. doi: 10.1016/j.jcm.2010.06.002. PMID: 22027032; PMCID: PMC3188345.
Teodorczyk-Injeyan JA, Triano JJ, Gringmuth R, DeGraauw C, Chow A, Injeyan HS. Effects of spinal manipulative therapy on inflammatory mediators in patients with non-specific low back pain: a non-randomized controlled clinical trial. Chiropr Man Therap. 2021 Jan 8;29(1):3. doi: 10.1186/s12998-020-00357-y. PMID: 33413508; PMCID: PMC7792327.
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World Health Organization. News Room Fact Sheets-Low Back Pain. June 19, 2023 https://www.who.int/news-room/fact-sheets/detail/low-back-pain accessed 10/9/2023.
American Cancer Society medical and editorial content team. Cytokines and Their Side Effects. December 27, 2019 https://www.cancer.org/cancer/managing-cancer/treatment-types/immunotherapy/cytokines.html accessed 10/9/2023.
Mayo Clinic C-reactive protein test. https://www.mayoclinic.org/tests-procedures/c-reactive-protein-test/about/pac-20385228 accessed 10/9/2023.