LAS VEGAS—Multiple inflammatory markers should simultaneously be tested to best detect unresolved inflammation in pain patients according to results from a study conducted by pain specialist Forest Tennant, MD, DrPH, of the Veract Intractable Pain Clinic in West Covina, California.

Pain and inflammation are inextricably linked, so biologic markers that indicate the presence of inflammation are critically needed. Currently, only erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) assays are generally recognized as clinical inflammatory markers. To determine additional inflammatory biomarkers, Dr. Tennant conducted a study of 39 patients with centralized, intractable pain who were in medical treatment and considered stabilized. All patients were receiving at least one opioid, plus an antidepressant or neuropathic agent. Patients were tested for ESR, CRP, alpha-1 antitrypsin (A1AT), myeloperoxidase (MPO), and soluble tumor necrosis factor alpha receptor type II (TNFR).

Results showed that 22 (56.4%) patients had an elevation of at least one of the five inflammatory markers. Elevated levels of MPO, TNFR, or AIAT were observed in 18 (46.1%), of these 9 did not have an elevated ESR or CRP. Fourteen (35.9%) of patients showed elevations of ESR and/or CRP and of these, 8 also had an elevated MPO, TNFR, or AIAT. 

Dr. Tennant noted that over half (56.4%) of the intractable pain patients who appeared medically stabilized and were tested showed elevated inflammatory markers.  This indicates that symptomatic analgesia is helpful but does not eliminate an inflammatory, likely progressive, disease state. Findings from this study suggest that multiple inflammatory markers should simultaneously be tested to best detect unresolved inflammation in pain patients.