Predicting the failure of disc surgery by a hypofunctional HPA axis: evidence from a prospective study on patients undergoing disc surgery.
Identifieur interne : 000715 ( PubMed/Corpus ); précédent : 000714; suivant : 000716Predicting the failure of disc surgery by a hypofunctional HPA axis: evidence from a prospective study on patients undergoing disc surgery.
Auteurs : Andrea Geiss ; Nicolas Rohleder ; Clemens Kirschbaum ; Klaus Steinbach ; Heinz W. Bauer ; Fernand AntonSource :
- Pain [ 0304-3959 ] ; 2005.
English descriptors
- KwdEn :
- Adult, Diskectomy (adverse effects), Female, Humans, Hydrocortisone (blood), Hypothalamo-Hypophyseal System (physiology), Interleukin-6 (blood), Intervertebral Disc Displacement (blood), Intervertebral Disc Displacement (surgery), Male, Middle Aged, Pain Measurement (methods), Pain Threshold (physiology), Pain, Postoperative (blood), Pituitary-Adrenal System (physiology), Predictive Value of Tests, Prospective Studies, Treatment Failure.
- MESH :
- chemical , blood : Hydrocortisone, Interleukin-6.
- adverse effects : Diskectomy.
- blood : Intervertebral Disc Displacement, Pain, Postoperative.
- methods : Pain Measurement.
- physiology : Hypothalamo-Hypophyseal System, Pain Threshold, Pituitary-Adrenal System.
- surgery : Intervertebral Disc Displacement.
- Adult, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Treatment Failure.
Abstract
Patients with postoperative ongoing sciatic pain have been shown to exhibit reduced cortisol levels along with enhanced IL-6 levels. The aim of the present study was to clarify the relationship between a reduced cortisol secretion and enhanced cytokine levels by performing a prospective study on patients with disc herniation. Twenty-two patients were examined before and after their disc surgery. Twelve healthy, pain-free subjects matched for age, education and gender constituted the control group. The preoperative examinations included the assessment of the diurnal pattern of cortisol secretion and the feedback sensitivity of the hypothalamus-pituitary-adrenal (HPA) axis. Patients' subjective stress levels also were assessed during the preoperative examination. The diurnal pattern of cortisol secretion was again assessed during the postoperative examination. Furthermore, blood samples were collected to measure catecholamine, adrenocorticotropic hormone (ACTH)- and interleukin-6 (IL-6) levels before and after measuring the pressure pain thresholds (PPTs). An assessment of the sensitivity of circulating monocytes to the immunosuppressive effects of glucocorticoids was further included in the postoperative examinations. Failed back syndrome (FBS) patients (n=12) showed a reduced cortisol secretion in the morning hours and enhanced feedback sensitivity of the HPA axis. Furthermore, FBS patients displayed an increased in-vitro production of proinflammatory cytokines and a relative glucocorticoid resistance of pro-inflammatory cytokine producing monocytes as compared to non-FBS patients (n=10) and controls. After PPT measurement FBS patients exhibited an increased norepinephrine but decreased epinephrine response, together with lower ACTH levels and a four times higher plasma IL-6 response. These findings suggest that chronically stressed patients are at a higher risk for a poor surgical outcome as their reduced cortisol secretion promotes the postoperative ongoing synthesis of proinflammatory cytokines.
DOI: 10.1016/j.pain.2004.12.007
PubMed: 15733636
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Predicting the failure of disc surgery by a hypofunctional HPA axis: evidence from a prospective study on patients undergoing disc surgery.</title><author><name sortKey="Geiss, Andrea" sort="Geiss, Andrea" uniqKey="Geiss A" first="Andrea" last="Geiss">Andrea Geiss</name><affiliation><nlm:affiliation>Department of Psychobiology, University of Trier, D-54286 Trier, Germany. andrea.geiss@orthop.gu.se</nlm:affiliation></affiliation></author><author><name sortKey="Rohleder, Nicolas" sort="Rohleder, Nicolas" uniqKey="Rohleder N" first="Nicolas" last="Rohleder">Nicolas Rohleder</name></author><author><name sortKey="Kirschbaum, Clemens" sort="Kirschbaum, Clemens" uniqKey="Kirschbaum C" first="Clemens" last="Kirschbaum">Clemens Kirschbaum</name></author><author><name sortKey="Steinbach, Klaus" sort="Steinbach, Klaus" uniqKey="Steinbach K" first="Klaus" last="Steinbach">Klaus Steinbach</name></author><author><name sortKey="Bauer, Heinz W" sort="Bauer, Heinz W" uniqKey="Bauer H" first="Heinz W" last="Bauer">Heinz W. Bauer</name></author><author><name sortKey="Anton, Fernand" sort="Anton, Fernand" uniqKey="Anton F" first="Fernand" last="Anton">Fernand Anton</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2005">2005</date><idno type="RBID">pubmed:15733636</idno><idno type="pmid">15733636</idno><idno type="doi">10.1016/j.pain.2004.12.007</idno><idno type="wicri:Area/PubMed/Corpus">000715</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">000715</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Predicting the failure of disc surgery by a hypofunctional HPA axis: evidence from a prospective study on patients undergoing disc surgery.</title><author><name sortKey="Geiss, Andrea" sort="Geiss, Andrea" uniqKey="Geiss A" first="Andrea" last="Geiss">Andrea Geiss</name><affiliation><nlm:affiliation>Department of Psychobiology, University of Trier, D-54286 Trier, Germany. andrea.geiss@orthop.gu.se</nlm:affiliation></affiliation></author><author><name sortKey="Rohleder, Nicolas" sort="Rohleder, Nicolas" uniqKey="Rohleder N" first="Nicolas" last="Rohleder">Nicolas Rohleder</name></author><author><name sortKey="Kirschbaum, Clemens" sort="Kirschbaum, Clemens" uniqKey="Kirschbaum C" first="Clemens" last="Kirschbaum">Clemens Kirschbaum</name></author><author><name sortKey="Steinbach, Klaus" sort="Steinbach, Klaus" uniqKey="Steinbach K" first="Klaus" last="Steinbach">Klaus Steinbach</name></author><author><name sortKey="Bauer, Heinz W" sort="Bauer, Heinz W" uniqKey="Bauer H" first="Heinz W" last="Bauer">Heinz W. Bauer</name></author><author><name sortKey="Anton, Fernand" sort="Anton, Fernand" uniqKey="Anton F" first="Fernand" last="Anton">Fernand Anton</name></author></analytic><series><title level="j">Pain</title><idno type="ISSN">0304-3959</idno><imprint><date when="2005" type="published">2005</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Diskectomy (adverse effects)</term><term>Female</term><term>Humans</term><term>Hydrocortisone (blood)</term><term>Hypothalamo-Hypophyseal System (physiology)</term><term>Interleukin-6 (blood)</term><term>Intervertebral Disc Displacement (blood)</term><term>Intervertebral Disc Displacement (surgery)</term><term>Male</term><term>Middle Aged</term><term>Pain Measurement (methods)</term><term>Pain Threshold (physiology)</term><term>Pain, Postoperative (blood)</term><term>Pituitary-Adrenal System (physiology)</term><term>Predictive Value of Tests</term><term>Prospective Studies</term><term>Treatment Failure</term></keywords><keywords scheme="MESH" type="chemical" qualifier="blood" xml:lang="en"><term>Hydrocortisone</term><term>Interleukin-6</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Diskectomy</term></keywords><keywords scheme="MESH" qualifier="blood" xml:lang="en"><term>Intervertebral Disc Displacement</term><term>Pain, Postoperative</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Pain Measurement</term></keywords><keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>Hypothalamo-Hypophyseal System</term><term>Pain Threshold</term><term>Pituitary-Adrenal System</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Intervertebral Disc Displacement</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Predictive Value of Tests</term><term>Prospective Studies</term><term>Treatment Failure</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Patients with postoperative ongoing sciatic pain have been shown to exhibit reduced cortisol levels along with enhanced IL-6 levels. The aim of the present study was to clarify the relationship between a reduced cortisol secretion and enhanced cytokine levels by performing a prospective study on patients with disc herniation. Twenty-two patients were examined before and after their disc surgery. Twelve healthy, pain-free subjects matched for age, education and gender constituted the control group. The preoperative examinations included the assessment of the diurnal pattern of cortisol secretion and the feedback sensitivity of the hypothalamus-pituitary-adrenal (HPA) axis. Patients' subjective stress levels also were assessed during the preoperative examination. The diurnal pattern of cortisol secretion was again assessed during the postoperative examination. Furthermore, blood samples were collected to measure catecholamine, adrenocorticotropic hormone (ACTH)- and interleukin-6 (IL-6) levels before and after measuring the pressure pain thresholds (PPTs). An assessment of the sensitivity of circulating monocytes to the immunosuppressive effects of glucocorticoids was further included in the postoperative examinations. Failed back syndrome (FBS) patients (n=12) showed a reduced cortisol secretion in the morning hours and enhanced feedback sensitivity of the HPA axis. Furthermore, FBS patients displayed an increased in-vitro production of proinflammatory cytokines and a relative glucocorticoid resistance of pro-inflammatory cytokine producing monocytes as compared to non-FBS patients (n=10) and controls. After PPT measurement FBS patients exhibited an increased norepinephrine but decreased epinephrine response, together with lower ACTH levels and a four times higher plasma IL-6 response. These findings suggest that chronically stressed patients are at a higher risk for a poor surgical outcome as their reduced cortisol secretion promotes the postoperative ongoing synthesis of proinflammatory cytokines.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">15733636</PMID><DateCreated><Year>2005</Year><Month>02</Month><Day>28</Day></DateCreated><DateCompleted><Year>2005</Year><Month>05</Month><Day>16</Day></DateCompleted><DateRevised><Year>2013</Year><Month>11</Month><Day>21</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">0304-3959</ISSN><JournalIssue CitedMedium="Print"><Volume>114</Volume><Issue>1-2</Issue><PubDate><Year>2005</Year><Month>Mar</Month></PubDate></JournalIssue><Title>Pain</Title><ISOAbbreviation>Pain</ISOAbbreviation></Journal><ArticleTitle>Predicting the failure of disc surgery by a hypofunctional HPA axis: evidence from a prospective study on patients undergoing disc surgery.</ArticleTitle><Pagination><MedlinePgn>104-17</MedlinePgn></Pagination><Abstract><AbstractText>Patients with postoperative ongoing sciatic pain have been shown to exhibit reduced cortisol levels along with enhanced IL-6 levels. The aim of the present study was to clarify the relationship between a reduced cortisol secretion and enhanced cytokine levels by performing a prospective study on patients with disc herniation. Twenty-two patients were examined before and after their disc surgery. Twelve healthy, pain-free subjects matched for age, education and gender constituted the control group. The preoperative examinations included the assessment of the diurnal pattern of cortisol secretion and the feedback sensitivity of the hypothalamus-pituitary-adrenal (HPA) axis. Patients' subjective stress levels also were assessed during the preoperative examination. The diurnal pattern of cortisol secretion was again assessed during the postoperative examination. Furthermore, blood samples were collected to measure catecholamine, adrenocorticotropic hormone (ACTH)- and interleukin-6 (IL-6) levels before and after measuring the pressure pain thresholds (PPTs). An assessment of the sensitivity of circulating monocytes to the immunosuppressive effects of glucocorticoids was further included in the postoperative examinations. Failed back syndrome (FBS) patients (n=12) showed a reduced cortisol secretion in the morning hours and enhanced feedback sensitivity of the HPA axis. Furthermore, FBS patients displayed an increased in-vitro production of proinflammatory cytokines and a relative glucocorticoid resistance of pro-inflammatory cytokine producing monocytes as compared to non-FBS patients (n=10) and controls. After PPT measurement FBS patients exhibited an increased norepinephrine but decreased epinephrine response, together with lower ACTH levels and a four times higher plasma IL-6 response. These findings suggest that chronically stressed patients are at a higher risk for a poor surgical outcome as their reduced cortisol secretion promotes the postoperative ongoing synthesis of proinflammatory cytokines.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Geiss</LastName><ForeName>Andrea</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Psychobiology, University of Trier, D-54286 Trier, Germany. andrea.geiss@orthop.gu.se</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Rohleder</LastName><ForeName>Nicolas</ForeName><Initials>N</Initials></Author><Author ValidYN="Y"><LastName>Kirschbaum</LastName><ForeName>Clemens</ForeName><Initials>C</Initials></Author><Author ValidYN="Y"><LastName>Steinbach</LastName><ForeName>Klaus</ForeName><Initials>K</Initials></Author><Author ValidYN="Y"><LastName>Bauer</LastName><ForeName>Heinz W</ForeName><Initials>HW</Initials></Author><Author ValidYN="Y"><LastName>Anton</LastName><ForeName>Fernand</ForeName><Initials>F</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D003160">Comparative Study</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Pain</MedlineTA><NlmUniqueID>7508686</NlmUniqueID><ISSNLinking>0304-3959</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D015850">Interleukin-6</NameOfSubstance></Chemical><Chemical><RegistryNumber>WI4X0X7BPJ</RegistryNumber><NameOfSubstance UI="D006854">Hydrocortisone</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" 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