Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942009000300004
Brazilian Journal of Anesthesiology
Scientific Article

Citocinas pró-inflamatórias em pacientes com dor neuropática submetidos a tratamento com Tramadol

Proinflammatory cytokines in patients with neuropathic pain treated with Tramadol

Durval Campos Kraychete; Rioko Kimiko Sakata; Adriana Machado Issy; Olívia Bacellar; Rogério Santos Jesus; Edgar M Carvalho

http://dx.doi.org/10.1590/S0034-70942009000300004 Braz J Anesthesiol, vol.59, n3, p.297-303, 2009
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Resumo

JUSTIFICATIVA E OBJETIVOS: As citocinas pró-inflamatórias têm função importante na fisiopatologia das síndromes dolorosas neuropáticas. O objetivo desse estudo foi avaliar os níveis plasmáticos de citocinas pró-inflamatórias antes e após o tratamento com tramadol em pacientes com hérnia discal e síndrome do túnel do carpo e compará-los com indivíduos normais. MÉTODO: Investigou-se 38 pacientes com dor neuropática por hérnia discal ou síndrome do túnel do carpo. Todos os pacientes foram tratados com tramadol de liberação controlada (100 mg em 12h) durante 10 dias. Realizaram-se coletas de sangue venoso (5 mL), no período matutino, antes do tratamento e no 11º dia e as amostras foram armazenadas até análise (-70ºC). Foram utilizados testes enzimáticos ELISA para dosagem de citocinas plasmáticas (TNF-±, IL-1, IL-6) e receptores sTNF-R1, (R & D Systems). Realizou-se dosagem de citocinas em soro de 10 voluntários sadios. RESULTADOS: A concentração de TNF-± antes (5,8 ± 2,8 pg.mL-1) foi significativamente maior que após o tramadol (4,8 ± 2,1 pg.mL-1; p = 0,04, Teste Mann-Whitney). Não houve diferença significativa de IL-1², IL-6 e sTNF-R1 antes e após o tratamento. As concentrações plasmáticas de TNF-± (sadios: 1,4 ± 0,5; pacientes com dor: 5,8 ± 2,8 pg.mL-1; p = 0.01) e IL-6 (sadios: 1,2 ± 0,8; pacientes com dor: 3,5 ± 2,6 pg.mL-1; p = 0,01) foram significativamente maiores nos pacientes com dor neuropática que nos voluntários, Teste de Mann-Whitney. CONCLUSÕES: Nos pacientes com hérnia discal e síndrome do túnel do carpo as concentrações plasmáticas de TNF-± e IL-6 foram maiores que em voluntários sadios, não havendo diferença das concentrações de sTNF-R e IL-1². Houve redução da concentração plasmática de TNF-± após tratamento com tramadol (100 mg em 12h), mas não de IL-6, sTNF-R e IL-1².

Palavras-chave

ANALGÉSICO, CITOCINAS, CITOCINAS, CITOCINAS, CITOCINAS, DOR, neuropática, DOR, neuropática

Abstract

BACKGROUND AND METHODS: Proinflammatory cytokines play an important role in the pathophysiology of neuropathic pain syndromes. The objective of this study was to evaluate plasma levels of proinflammatory cytokines before and after treatment with tramadol in patients with herniated intervertebral disks and carpal tunnel syndrome, and to compare them with normal individuals. METHODS: Thirty-eight patients with neuropathic pain secondary to herniated intervertebral disks or carpal tunnel syndrome participated in this study. All patients were treated with controlled release tramadol (100 mg every 12 hours) for 10 days. Venous blood (5 mL) was collected in the morning, before treatment and on the 11th day, and stored (-70° C) until analysis. ELISA was used to determine the plasma levels of cytokines (TNF-±, IL-1, IL-6) and receptors sTNF-R1 (R & D Systems). Plasma levels of cytokines of 10 healthy volunteers were also determined. RESULTS: The concentration of TNF-± before (5.8 ± 2.8 pg.mL-¹) was significantly higher than after treatment with tramadol (4.8 ± 2.1 pg.mL-1; p = 0.04, Mann-Whitney test). The levels of IL-1², IL-6, and sTNF-R1 before and after treatment with tramadol showed no significant differences. Plasma levels of TNF-± (healthy individuals: 1.4 ± 0.5; pain patients: 5.8 ± 2.8 pg.mL-1; p = 0.01) and IL-6 (healthy individuals: 1.2 ± 0.8; pain patients: 3.5 ± 2.6 pg.mL-1; p = 0.01) were significantly higher in patients with neuropathic pain, Mann-Whitney Test. CONCLUSIONS: In patients with herniated intervertebral disks and carpal tunnel syndrome, plasma levels of TNF-± and IL-6 were higher than in healthy volunteers, while differences in the concentrations of sTNF-R and IL-1² were not observed. Plasma levels of TNF-±, but not of IL-6, sTNF-R, and IL-1², decreased after treatment with tramadol (100 mg every 12 hours).

Keywords

ANALGESIC, CYTOKINES, CYTOKINES, CYTOKINES, CYTOKINES, PAIN, neuropathic, PAIN, neuropathic

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