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It was found that in patients with attenuated tuberculous spondylitis and post-tuberculous vertebral osteochondrosis there was a sharp increase in platelet aggregability and a decrease in their disaggregability at the peak of the pain syndrome. With the therapy followed by relief of the pain syndrome, a rise in the platelet aggregability was significantly less noticeable, without significant changes in their disaggregability.

Demographic, clinical and psychological characteristics of 92 patients with low back pain were correlated with prolactin and cortisol levels in cerebrospinal fluid (CSF). Somatization and depression scores correlated statistically significantly with the CSF serum ratio of prolactin both in men and in the total group. An increased CSF/serum ratio of cortisol was slightly associated with somatization scores in the total group. Multiple stepwise regression, furthermore, revealed that somatization, anxiety and one of the pain indices contributed to the variance in the CSF prolactin level, which was mostly dependent on the respective serum level. Sex and electromyographic findings (EMG) accounted for 12 and 7%, respectively, of the variance in the afternoon cortisol levels. Women reported more somatization and depression feelings than did men. Most of the data support our earlier assumption that male and female pain patients have different coping mechanisms. In spite of the common underlying endocrine responses to distress in men and women, gender differences in psychological response appear to modify endocrine responses to the experience of low back pain.

The circulating levels of sialic acid (N-acetylneuraminic acid) and glycosaminoglycans (GAGs) were measured in 69 patients with spinal disorders of orthopaedic interest (ankylosing spondylitis 17, osteofluorosis 6, idiopathic backache 10, osteoarthrosis 16, osteoporosis 20). The serum GAG levels showed no statistically significant change from control values in the five disorders investigated in the present study. Although osteoporosis and osteoarthrosis showed a decrease in serum sialic acid (SA) levels, the mean ratio (SA/GAG) demonstrated no change from control values. Idiopathic backache showed no difference in any of the parameters studied when compared with control values. Ankylosing spondylitis and osteofluorosis had a remarkable similarity in their clinical and radiological features, but a divergent mean value of ratio was noted. The mean ratio of both the conditions also showed a statistically significant difference from the control value. This suggests that the SA/GAG ratio can be used as a diagnostic test in ankylosing spondylitis.

The relationship between chronic pain and depression has become enmeshed in the literature. In an attempt to unravel the relationship between chronic pain and depression, the authors studied a uniform group of 80 chronic back pain patients with and without depression using the dexamethasone suppression test (DST). The DST examines the hypothalamic response to an exogenously administered steroid (dexamethasone) challenge. In normal subjects and patients without major depression, the dexamethasone suppresses the release of cortisol from the adrenal glands. In 40% of patients with major depression, there is an early escape of cortisol from dexamethasone suppression. We found that 40% of patients with a DSM-III major depression (dysphoric mood, appetite and sleep changes, loss of energy and interest, decreased concentration, suicidal ideation, and feelings of self-reproach) were non-suppressors and none of the patients without major depression showed this abnormality. These findings suggest that the concept of chronic pain as a variant of depression might be an oversimplification.

The search for diabetes in a patient with crural neuralgia is well established practice. The prevalence of diabetes in the general population is not known, and studies attempting to demonstrate a relationship between diabetes and radiculopathies have been inconclusive. In the present study, fasting and postprandial blood glucose determinations, as well as 14 other parameters, were analyzed in 88 patients with classical sciatica, 27 with crural neuralgia, and 42 with only back pain. Multidimensional statistical analysis revealed that patients with crural neuralgia were older than those with classical sciatica or only back pain, and that there were no differences in blood glucose regulation. The concept that diabetes is found more frequently in patients with crural neuralgia should be revised, since age appears to be the only factor responsible for changes in glucose regulation.

The concept of chronic pain has become enmeshed with depression. In an attempt to unravel this complex relationship, the authors studied a uniform group of 42 patients with chronic pain, i.e., patients who had chronic low back pain with defined organic pathology, in relation to the dexamethasone suppression test (DST). The results were analyzed in relation to the presence or absence of major depression and cortisol suppression. Forty-one percent of the patients with major depression had abnormal cortisol responses to dexamethasone administration; all patients without major depression had normal responses. These results suggest that chronic pain patients differ from patients with major depression and a positive DST.

Blood fibrinolytic activity was measured in 18 subjects with severe chronic back pain and 18 age and sex matched controls. The patients showed evidence of defective fibrinolysis--namely, significant prolongation of the euglobulin clot-lysis time, reduction in fibrin-plate lysis-area and plasminogen levels, and increase in levels of the fibrinolytic inhibitors, alpha 2 antiplasmin and alpha 2 macroglobulin. This defect could be associated with fibrin deposition and scar formation and be responsible for the development and/or perpetuation of chronic inflammation and scarring at sites of damage in the spine. Enhancement of fibrinolytic activity may offer a new approach to the management of these back problems, and a double-blind controlled trial is in progress.

The authors present the results of determinations of beta-endorphin-like immunoreactivity in the plasma carried out before and after pinpoint receptor stimulation (prs) that is acupuncture in patients with long-standing pain. No significant differences were observed in this immunoreactivity after prs, and the clinical analgesic effect was independent of the level of this immunoreactivity and its changes during these procedures. On the other hand, a positive correlation was demonstrated between plasma beta-endorphin concentration and the neuroticism index as evaluated by Eysenck's personality inventory. The reliability of this observation requires, however, confirmation in a greater material.

Using the monoclonal antibody to the keratan sulfate(KS), we modified the assay system for detecting of serum KS levels (Thonar, et al. Arthritis Rheum. 28:1367-1376, 1985). This method is based on the enzyme-linked immunosorbent assay (ELISA). The dogfish KS was most effective and sensitive, in this system. KS levels were measured in 45 patients with no complaints of arthralgia, no history of arthritis and no remarkable change in the laboratory data, including erythrocyte sedimentation rates, rheumatoid factor, uric acid and C-reactive protein. Age related changes were apparent in serum levels of KS. Age related catabolism in normal articular cartilage and serum KS levels will aid to estimate the turnover of articular proteoglycan.

The reported study was carried out in 26 patients hospitalized for protracted acute lumbosciatic pain syndrome lasting from 3 weeks to 3 months. In all patients the concentration of haemoglobin A1c was assessed in the erythrocytes by the colorimetric method of Thoma and Kutter. The control group comprised 14 healthy subjects in the same age group. The obtained results were subjected to statistical analysis which demonstrated an evident increase in the mean concentration of haemoglobin A1c in the erythrocytes in cases of lumbosciatic pain syndrome of protracted course.

A fibrinolytic defect is common in chronic back pain syndromes. Its role in the chronicity of these conditions is not fully understood. To elucidate the possible mechanisms, 11 patients with acute low back pain were studied over 12 months and compared with controls. The patients showed prolongation of the euglobulin lysis time throughout the study; the fibrin plate lysis area was initially normal but became abnormal within 2 weeks. In five patients, the symptoms resolved and the initial fibrinolytic defect improved. In contrast, the fibrinolytic defect remained in six patients with persistent pain. These results suggest that the fibrinolytic defect is secondary to mechanical damage but, if persistent, may become a secondary pathogenic factor associated with the chronicity of some back pain problems.

The use of laboratory screening tests for the detection of heavy drinking in outpatients implies among other things knowledge about their relation to the degree of alcohol consumption. In this study of 95 patients with chronic low back pain, serum gamma-glutamyltransferase demonstrated the best correlation with the mean daily amount of alcohol consumed (r = 0.74). Adding other serological tests, such as high density lipoprotein cholesterol, aminotransferases and linoleic acid content in lecithin, did not improve this correlation, although these tests also correlated well with the alcohol intake.

When single oral doses of oxprenolol were given to three healthy subjects on three separate occasions under standardised conditions the plasma concentration-time curves for each subject were closely similar. In two of the subjects, however, a mild illness led to a dramatic, temporary increase in the peak plasma concentration and area under the plasma concentration-time curve (AUC). This effect of inflammatory disease was confirmed by comparing a group of patients with an erythrocyte sedimentation rate (ESR) of over 20 mm in the first hour with a group whose ESR was below this value. The mean peak plasma concentration and AUC were significantly higher in the group with a raised ESR. This may be related to altered concentrations of one of the acute-phase proteins. Thus it is concluded that plasma oxprenolol concentrations are raised in inflammatory disease, but further work is needed to determine the mechanism of this increase.

Fibrinolytic activity was studied in 34 patients who had chronic low-back pain of defined types (spondylosis, post-laminectomy and postmyelography-proven arachnoiditis, postlaminectomy and postmyelography-possible arachnoiditis, chronic prolapsed intervertebral disc (PID), spinal stenosis, and nonspecific low-back pain). Fibrinolysis was significantly impaired in the back pain patients as a whole compared with matched controls. Similar changes were observed in all the different back pain syndromes. In the smaller subgroups, these did not reach significance but were significant in spondylosis, proven arachnoiditis, and nonspecific back pain. It is suggested that the abnormal persistence of a defect in fibrinolytic activity, leading to fibrin deposition and chronic inflammation, may be an important factor in the chronicity of many back pain syndromes.

Chronic pain has been considered as a variant of depression or as a masked depression. In an attempt to unravel the complex relationship between chronic pain and depression, we administered the TRH stimulation test to a uniform group of chronic pain patients classified into those with and without major depression using DSM-III criteria. Eighteen percent showed blunting of TSH response to TRH. There was no significant difference between the two groups.