Low-grade inflammation may moderate the effect of behavioral treatment for chronic pain in adults

Julie Lasselin, Mike K Kemani, Marie Kanstrup, Gunnar L Olsson, John Axelsson, Anna Andreasson, Mats Lekander, Rikard K Wicksell, Julie Lasselin, Mike K Kemani, Marie Kanstrup, Gunnar L Olsson, John Axelsson, Anna Andreasson, Mats Lekander, Rikard K Wicksell

Abstract

The purpose of the present pilot study was to explore the moderating role of basal inflammation on the effects of behavioral pain treatment in 41 patients with long-standing pain. Baseline pro-inflammatory status moderated behavioral treatment outcomes: higher pre-treatment levels of Tumor Necrosis Factor (TNF)-α and Interleukin (IL)-6 were related to less improvement in pain intensity, psychological inflexibility and in mental health-related quality of life. The treatment outcomes improved in the subgroup that had low levels of pro-inflammatory cytokines at baseline, while the subjects with higher pro-inflammatory status did not. Altogether, results indicate that low-grade inflammation may influence the behavioral treatment outcomes and provide a possible explanation of the heterogeneity in treatment response.

Keywords: Chronic low-grade inflammation; Chronic pain; Cognitive behavioral therapy (CBT); Cytokines; Psychological inflexibility; Treatment responders.

Conflict of interest statement

Compliance with ethical standardsConflict of interestJulie Lasselin, Mike K. Kemani, Marie Kanstrup, Gunnar L. Olsson, John Axelsson, Anna Andreasson, Mats Lekander and Rikard K. Wicksell declare that they have no conflict of interest. Mike K. Kemani was in part financially supported by research grants from the Department of Psychology at the Karolinska University Hospital, Stockholm. Financial support was provided through the regional agreement on medical training and clinical research (ALF) between Stockholm City Council and Karolinska Institutet (RW). Financial support was also provided by Stockholm Stress Center (ML).Human and animal rights and Informed consentAll procedures performed in studies involving human participants were in accordance with the ethical strandards of the institutional and/or national research committee and with the 1964 Helsinki delcaration and its later amendments or comparable ethical standards. Informed consent was obtained from all patients for being included in the study.

Figures

Fig. 1
Fig. 1
Flow diagram of subjects included in the study
Fig. 2
Fig. 2
Association between combined concentration of IL-6 and TNF-α before treatment and the change in pain-related variables after treatment. Linear regression analyses, adjusted for age, gender, the change in number of used medicines and the relative change in HADS scores. Changes in pain-related variables were calculated as [= (post-treatment − pre-treatment)/pre-treatment)]. The combined concentration of IL-6 and TNF-α was extracted using principal component analysis
Fig. 3
Fig. 3
Effect of behavioral treatment in subjects with higher versus lower inflammatory status on psychological inflexibility and mental-health related quality of life. Higher inflammatory status: composite score IL-6/TNF-α/IL-8 in the highest tertile, n = 14; lower inflammatory status: composite score IL-6/TNF-α/IL-8 in the lowest tertile, n = 14. *p < .05; ***p < .001

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