2.50
Hdl Handle:
http://hdl.handle.net/10755/157988
Type:
Presentation
Title:
The Lumbar Spine Surgical Experience: A Psychoneuroimmunology Perspective
Abstract:
The Lumbar Spine Surgical Experience: A Psychoneuroimmunology Perspective
Conference Sponsor:Western Institute of Nursing
Conference Year:2005
Author:Starkweather, Angela, PhD, RN, ACNP, CCRN, CNRN
P.I. Institution Name:Washington State University Intercollegiate College of Nursing
Title:Assistant Professor
Contact Address:2917 West Fort George Wright Drive, RM 369, Spokane, WA, 99224, USA
Contact Telephone:509-324-7279
Purpose/Aims: Pain due to lumbar spondylosis is a major health problem and the role of psychological factors in this form of pain is well known. Proinflammatory cytokines localized in the chondrocytes of disc tissue have been implicated in the degenerative process of lumbar spondylosis and disc herniation. Local proinflammatory cytokine production in herniated disc tissue parallels the production of peripheral cytokines in response to stress activation due to pain and injury. The purpose of this study was to investigate the effects of perceived pain, stress, anxiety and mood disturbance on proinflammatory cytokine production, both peripheral and local (in disc tissue), among patients undergoing lumbar spine surgery. Correlations between proinflammatory cytokine production, the degree of neurological deficit and quality of life were also evaluated. The design incorporated the preoperative administration of an anti-depressant medication which inhibits proinflammatory cytokine production, to determine its effects on these same variables. Rationale/Background/Conceptual Framework: Bidirectional communication between the neurologic and immune systems which occur within the context of the psychological being is the basis of psychoneuroimmunology (PNI). The framework of PNI suggests a complex interactive network among pain, psychological factors, and immune effector molecules known as cytokines. Studies within the field of PNI provide compelling evidence that one's emotions and level of psychological stress influence immune function, including the release of proinflammatory cytokines. These same cytokines appear to be implicated not only in disc degeneration but also in the mediation and perception of low back and sciatic pain. The aims of this study, therefore, will fill a major gap in this area by exploring pain from not only the immune perspective but also from the perspective of one's level of psychological stress and mood disturbance and the cumulative effects on quality of life. Methods: Men and women diagnosed with lumbar herniated disc (N=70) or lumbar spondylosis (N=35) were enrolled. A double-blind, randomized, clinical trial was used in which amitriptyline or placebo was administered to patients with a lumbar herniated disc for six days prior to surgery. Data assessments took place over five time points. Evaluation of biochemical and psychological events extended throughout a two-month perioperative period surrounding surgical repair of a herniated lumbar disc and lumbar fusion. Results: Increased pain perception, stress and tension/anxiety were significantly related to elevated proinflammatory cytokines production (IL-6, TNF-a), both peripherally and locally, throughout the perioperative course. Amitriptyline therapy significantly decreased these variables, which resulted in better pain control. However, quality of life indices remained the same between groups at the two-month postoperative interval. Implications: The results of this study further the understanding of immune regulation on low back pain and sciatica. Importantly, the use of a PNI framework provided insight into the modulatory role of psychological factors on pain-immune mechanisms in this complex pain situation. The direct application of these results may guide treatments toward inhibiting proinflammatory cytokine production as a means of alleviating the biochemical events involved in sciatica and low back pain from which thousands of people suffer.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleThe Lumbar Spine Surgical Experience: A Psychoneuroimmunology Perspectiveen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157988-
dc.description.abstract<table><tr><td colspan="2" class="item-title">The Lumbar Spine Surgical Experience: A Psychoneuroimmunology Perspective</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2005</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Starkweather, Angela, PhD, RN, ACNP, CCRN, CNRN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Washington State University Intercollegiate College of Nursing</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Professor</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">2917 West Fort George Wright Drive, RM 369, Spokane, WA, 99224, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">509-324-7279</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">astarkweather@wsu.edu</td></tr><tr><td colspan="2" class="item-abstract">Purpose/Aims: Pain due to lumbar spondylosis is a major health problem and the role of psychological factors in this form of pain is well known. Proinflammatory cytokines localized in the chondrocytes of disc tissue have been implicated in the degenerative process of lumbar spondylosis and disc herniation. Local proinflammatory cytokine production in herniated disc tissue parallels the production of peripheral cytokines in response to stress activation due to pain and injury. The purpose of this study was to investigate the effects of perceived pain, stress, anxiety and mood disturbance on proinflammatory cytokine production, both peripheral and local (in disc tissue), among patients undergoing lumbar spine surgery. Correlations between proinflammatory cytokine production, the degree of neurological deficit and quality of life were also evaluated. The design incorporated the preoperative administration of an anti-depressant medication which inhibits proinflammatory cytokine production, to determine its effects on these same variables. Rationale/Background/Conceptual Framework: Bidirectional communication between the neurologic and immune systems which occur within the context of the psychological being is the basis of psychoneuroimmunology (PNI). The framework of PNI suggests a complex interactive network among pain, psychological factors, and immune effector molecules known as cytokines. Studies within the field of PNI provide compelling evidence that one's emotions and level of psychological stress influence immune function, including the release of proinflammatory cytokines. These same cytokines appear to be implicated not only in disc degeneration but also in the mediation and perception of low back and sciatic pain. The aims of this study, therefore, will fill a major gap in this area by exploring pain from not only the immune perspective but also from the perspective of one's level of psychological stress and mood disturbance and the cumulative effects on quality of life. Methods: Men and women diagnosed with lumbar herniated disc (N=70) or lumbar spondylosis (N=35) were enrolled. A double-blind, randomized, clinical trial was used in which amitriptyline or placebo was administered to patients with a lumbar herniated disc for six days prior to surgery. Data assessments took place over five time points. Evaluation of biochemical and psychological events extended throughout a two-month perioperative period surrounding surgical repair of a herniated lumbar disc and lumbar fusion. Results: Increased pain perception, stress and tension/anxiety were significantly related to elevated proinflammatory cytokines production (IL-6, TNF-a), both peripherally and locally, throughout the perioperative course. Amitriptyline therapy significantly decreased these variables, which resulted in better pain control. However, quality of life indices remained the same between groups at the two-month postoperative interval. Implications: The results of this study further the understanding of immune regulation on low back pain and sciatica. Importantly, the use of a PNI framework provided insight into the modulatory role of psychological factors on pain-immune mechanisms in this complex pain situation. The direct application of these results may guide treatments toward inhibiting proinflammatory cytokine production as a means of alleviating the biochemical events involved in sciatica and low back pain from which thousands of people suffer.</td></tr></table>en_GB
dc.date.available2011-10-26T20:23:57Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:23:57Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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