背景:慢性下腰痛(CLBP)是一种普遍且使人衰弱的疾病,导致患者和政府医疗保健系统面临重大挑战。非药物干预作为缓解慢性下腰痛和改善患者预后的潜在策略越来越受到关注。本系统评价的目的是全面评估CLBP患者非药物干预后血液炎症生物标志物的变化。从而试图了解非药物干预与CLBP炎性生物标志物变化之间的复杂相互作用.
方法:彻底搜索(从1月1日起,2002年10月5日,2022)PubMed,Medline(WebofScience平台),和Cochrane图书馆(Wiley在线图书馆平台)进行了,对纳入标准和排除标准进行了细化,以选择研究.使用Cochrane的RoB2或Downs和Black清单的改编版对研究质量进行了严格的评估。数据综合包括各种非药物干预后炎症生物标志物的改变,包括锻炼,穴位按摩,神经情感技术,和其他方式。
结果:本系统综述包括13项主要研究,8项随机对照试验,一项准随机试验,和四个前后研究。所研究的干预措施包括骨科手法治疗(一项研究),脊柱操纵疗法(SMT)(三项研究),锻炼(两项研究),瑜伽(两项研究)和穴位按摩(两项研究),神经情绪技术(一项研究),基于正念的(一项研究)和神经疗法研究(一项研究)。四项研究报告了与对照组相比,炎症生物标志物的一些变化。骨病手法治疗(OMT)后肿瘤坏死因子-α(TNF-α)降低,神经情绪技术(NET),还有瑜伽.NET后白细胞介素(IL)-1,IL-6,IL-10和C反应蛋白(CRP)降低,穴位按压后IL-4升高。另外五项研究通过干预前后的比较发现了炎症生物标志物的变化,表明干预后改善结果。治疗后IL-10增加;TNF-α减少,IL-1β,IL-8,干扰素-γ,运动后干扰素-γ诱导蛋白10-γ诱导蛋白10;运动后IL-6和SMT降低;SMT后CRP和趋化因子配体3降低。
结论:结果表明,由于对CLBP的非药物干预不同,炎症生物标志物的调节,通常导致减少的促炎标志物,如TNF-α和IL-6以及增加的抗炎标志物,如IL-4,从而揭示了不同的非药物干预对炎症过程的抑制。然而,数量有限的评估类似干预措施和类似生物标志物的高质量研究限制了本综述的结论.
BACKGROUND: Chronic low back pain (CLBP) is a prevalent and debilitating condition, leading to significant challenges to both patients and the governmental healthcare system. Non-pharmacologic interventions have received increasing attention as potential strategies to alleviate chronic low back pain and improve patient outcomes. The aim of this systematic
review was to comprehensively assess the changes in blood inflammatory biomarkers after non-pharmacologic interventions for CLBP patients, thus trying to understand the complex interactions between non-pharmacologic interventions and inflammatory biomarker changes in CLBP.
METHODS: A thorough search (from January 1st, 2002 to October 5th, 2022) of PubMed, Medline (platform Web of Science), and the Cochrane Library (platform Wiley Online Library) were conducted, and inclusion criteria as well as exclusion criteria were refined to selection of the studies. Rigorous assessments of study quality were performed using RoB 2 from Cochrane or an adaptation of the Downs and Black checklist. Data synthesis includes alterations in inflammatory biomarkers after various non-pharmacologic interventions, including exercise, acupressure, neuro-emotional technique, and other modalities.
RESULTS: Thirteen primary studies were included in this systematic
review, eight randomized controlled trials, one quasi-randomized trial, and four before-after studies. The interventions studied consisted of osteopathic manual treatment (one study), spinal manipulative therapy (SMT) (three studies), exercise (two studies), yoga (two studies) and acupressure (two studies), neuro-emotional technique (one study), mindfulness-based (one study) and balneotherapy study (one study). Four studies reported some changes in the inflammatory biomarkers compared to the control group. Decreased tumor necrosis factor-alpha (TNF-α) after osteopathic manual treatment (OMT), neuro-emotional technique (NET), and yoga. Decreased interleukin (IL)-1, IL-6, IL-10, and c-reactive protein (CRP) after NET, and increased IL-4 after acupressure. Another five studies found changes in inflammatory biomarkers through pre- and post-intervention comparisons, indicating improvement outcomes after intervention. Increased IL-10 after balneotherapy; decreased TNF-α, IL-1β, IL-8, Interferon-gamma, interferon-γ-induced protein 10-γ-induced protein 10 after exercise; decreased IL-6 after exercise and SMT; decreased CRP and chemokine ligand 3 after SMT.
CONCLUSIONS: Results suggest a moderation of inflammatory biomarkers due to different non-pharmacologic interventions for CLBP, generally resulting in decreased pro-inflammatory markers such as TNF-α and IL-6 as well as increased anti-inflammatory markers such as IL-4, thus revealing the inhibition of inflammatory processes by different non-pharmacologic interventions. However, a limited number of high-quality studies evaluating similar interventions and similar biomarkers limits the conclusion of this
review.