Chronic inflammation patterns in extensively treated patients suffering from arachnoiditis and chronic intractable pain

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Chronic inflammation patterns in extensively treated patients suffering from arachnoiditis and chronic intractable pain

Arachnoiditis is a pain disorder generated by the inflammation of the arachnoid, one of the membranes that surrounds and protects the nerves of the spinal cord. It is characterized by severe stinging, burning pain, and neurological problems. The investigators explained to use biomarkers to gain insight into and measure the residual (post-treatment) level of inflammation in two groups of intensively treated patients with severe chronic pain.

For this, three study groups were examined , and included: (i) patients (n=90) with chronic intractable pain (CIP), (ii) patients (n=26) with chronic pain and MRI-documented arachnoiditis (ARC) and (iii) normal subjects without a diagnosis of chronic pain (n=86). They determined and contrasted the serum concentrations of Alpha-1 Antitrypsin (A1AT), Myeloperoxidase (MPO) and soluble tumor necrosis factor receptor type 2 (sTNFR2) in each of the patient populations under investigation.

The patients treated for ARC or CIP had elevated serum levels of A1AT and MPO than normal untreated subjects without a diagnosis of chronic pain. The A1AT mean serum concentration of 167.9±41.9 mg/dL as compared to 148.9±35.2 mg/dL for normal subjects (p=0.023) was observed in the ARC patients. Patients with CIP had the highest mean serum A1AT level 183.6±39.2 mg/dL with P<0.0001 as distinguished from normal subjects or ARC patients respectively. The ARC patients had an MPO mean serum concentration of 344.6±227.9 ng/mL as compared to 188.2±107.5 ng/mL for normal subjects (P<0.0001). Patients with CIP had a similar mean serum MPO level of 352.3±164 ng/mL (P<0.0001) when compared to normal subjects or ARC patients. Also, a difference in the pattern of MPO expression in patients with ARC in that 34% had levels of MPO at normal or below and 31% had levels 2-fold or greater than normal was observed.

It was deduced that this data supports the concept that in centralized pain, sites of neuroinflammation elaborate MPO and other inflammatory factors which may not be entirely cleared from the system despite extensive and complex treatment regimens.


Postgraduate medicine

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Original title of article:

Patterns of chronic inflammation in extensively treated patients with arachnoiditis and chronic intractable pain


  John A. Bilello et al.

Postgraduate medicine
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