Investigation of High-Sensitivity C-reactive Protein and Erythrocyte Sedimentation Rate in Low Back Pain Patients

  • Park, Chan-Hong (Department of Anesthesiology and Pain Medicine, Daegu Wooridul Hospital) ;
  • Lee, Sang-Ho (Department of Neurosurgery, Wooridul Hospital)
  • Received : 2009.11.12
  • Accepted : 2010.01.11
  • Published : 2010.06.01


Background: Chronic low back pain can be a manifestation of lumbar degenerative disease, herniation of intervertebral discs, arthritis, or lumbar stenosis. When nerve roots are compromised, low back pain, with or without lower extremity involvement, may occur. Local inflammatory processes play an important role in patients with acute lumbosciatic pain. The purpose of this study was to assess the value of erythrocyte sedimentation rate (ESR) and high sensitivity C-reactive protein (hsCRP) measurements in patients with chronic low back pain or radiculopathy. Methods: ESR and hsCRP were measured in 273 blood samples from male and female subjects with low back pain and/or radiculopathy due to herniated lumbar disc, spinal stenosis, facet syndrome, and other diseases. The hsCRP and ESR were measured prior to lumbar epidural steroid injection. Results: The mean ESR was 18.8 mm/h and mean hsCRP was 1.1 mg/L. ESR had a correlation with age. Conclusions: A significant systemic inflammatory reaction did not appear to arise in patients with chronic low back pain.



Supported by : Wooridul Institute


  1. Howe JF, Loeser JD, Calvin WH. Mechanosensitivity of dorsal root ganglia and chronically injured axons: a physiological basis for the radicular pain of nerve root compression. Pain 1977; 3: 25-41.
  2. Saal JS, Franson RC, Dobrow R, Saal JA, White AH, Goldthwaite N. High levels of inflammatory phospholipase A2 activity in lumbar disc herniations. Spine 1990; 15: 674-8.
  3. Gronblad M, Virri J, Tolonen J, Seitsalo S, Kaapa E, Kankare J, et al. A controlled immunohistochemical study of inflammatory cells in disc herniation tissue. Spine 1994; 19: 2744-51.
  4. Refshauge KM, Maher CG. Low back pain investigations and prognosis: a review. Br J Sports Med 2006; 40: 494-8.
  5. Kang JD, Georgescu HI, McIntyre-Larkin L, Stefanovic-Racic M, Donaldson WF 3rd, Evans CH. Herniated lumbar intervertebral discs spontaneously produce matrix metalloproteinases, nitric oxide, interleukin-6, and prostaglandin E2. Spine 1996; 21: 271-7.
  6. Nygaard OP, Mellgren SI, Osterud B. The inflammatory properties of contained and noncontained lumbar disc herniation. Spine 1997; 22: 2484-8.
  7. Gebhardt K, Brenner H, Stürmer T, Raum E, Richter W, Schiltenwolf M, et al. The course of high-sensitive Creactive protein in correlation with pain and clinical function in patients with acute lumbosciatic pain and chronic low back pain - a 6 months prospective longitudinal study. Eur J Pain 2006; 10: 711-9.
  8. Sturmer T, Raum E, Buchner M, Gebhardt K, Schiltenwolf M, Richter W, et al. Pain and high sensitivity C reactive protein in patients with chronic low back pain and acute sciatic pain. Ann Rheum Dis 2005; 64: 921-5.
  9. Le Gars L, Borderie D, Kaplan G, Berenbaum F. Systemic inflammatory response with plasma C-reactive protein elevation in disk-related lumbosciatic syndrome. Joint Bone Spine 2000; 67: 452-5.
  10. Pepys MB, Baltz ML. Acute phase proteins with special reference to C-reactive protein and related proteins (pentaxins) and serum amyloid a protein. Adv Immunol 1983; 34: 141-212.
  11. Sugimori K, Kawaguchi Y, Morita M, Kitajima I, Kimura T. High-sensitivity analysis of serum C-reactive protein in young patients with lumbar disc herniation. J Bone Joint Surg Br 2003; 85: 1151-4.
  12. Ackerman WE 3rd, Zhang JM. Serum hs-CRP as a useful marker for predicting the efficacy of lumbar epidural steroid injections on pain relief in patients with lumbar disc herniations. J Ky Med Assoc 2006; 104: 295-9.
  13. Osei-Bimpong A, Meek JH, Lewis SM. ESR or CRP? A comparison of their clinical utility. Hematology 2007; 12: 353-7.
  14. Griffiths RA, Good WR, Watson NP, O'Donnell HF, Fell PJ, Shakespeare JM. Normal erythrocyte sedimentation rate in the elderly. Br Med J 1984; 289: 724-5.

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