Low Back Pain Treatment – Inflammation, IL-6 and the new FAR infrared treatment connection.

I recently posted an article regarding drug-based Rheumatoid Arthritis treatment targeting the IL-6 protein.

I was interested in the potential implications of a study by Wong et Al (1), showing that as well as pain relief, post knee surgery patients treated with FAR infrared exhibited reduced levels of the proinflammatory IL-6 protein.  I raised the question whether the new FAR infrared modalities be an effective treatment aid for Rheumatoid Arthritis.

FAR infrared and IL 6 protein

http://www.ncbi.nlm.nih.gov/pubmed/22339105

“This study demonstrated that the FIR can lower the NRS of pain and thus reduce the discomfort experienced by the patient. Findings indicated that effective application of FIR decreased the serum level of Interleukin-6 (IL-6) and Endothelin ET-1, which represent the subjective indicator of pain.”

Working so heavily with low back pain and IDD Therapy spinal decompression treatment, this got me thinking about inflammation, IL-6 and low back pain.  What are the potential applications of new infrared modalities as a cost-effective tool to ease inflammation and reduce low back pain … without the need for steroid injections and anti-inflammatory medication?

With regards to Low Back Pain, we observe on many occasions that patients using Thermedic infrared pads report pain relief beyond what might be expected from a standard conductive heating aid.  I have written at various times that the humble “heat pad” offers more profound benefits than we might think, see evidence.

Looking at some of the research into IL-6 and back pain, Heffner et al (2) show that higher levels of IL 6 are associated with chronic low back pain (CLBP) and sleep disturbance:

“Individuals with CLBP had more sleep disturbance than controls. Circulating IL-6 levels were similar for the 2 groups; however, in adults with CLBP, poorer sleep quality was associated with higher IL-6 levels, and both sleep and IL-6 related to pain reports.”

Burke et al show that there are high levels of proinflammatory IL-6 in the nucleus pulposus of painful intervertebral discs:

“We have compared the levels of production of interleukin-6 (IL-6), interleukin-8 (IL-8) and prostaglandin E2 (PGE2) in disc tissue from patients undergoing discectomy for sciatica (63) with that from patients undergoing fusion for discogenic low back pain (20) using an enzyme-linked immunoabsorbent assay. There was a statistically significant difference between levels of production of IL-6 and IL-8 in the sciatica and low back pain groups (p < 0.006 and p < 0.003, respectively). The high levels of proinflammatory mediator found in disc tissue from patients undergoing fusion suggest that production of proinflammatory mediators within the nucleus pulposus may be a major factor in the genesis of a painful lumbar disc.”

Kraychete et al (4) show that:

“…  patients with chronic low back pain due to disc herniation presented higher levels of TNF-alpha and IL-6, but not of IL-1 or sTNF-R.”

Thus whilst looking at the Wong et al study showing reduced levels of IL-6 for knee pain post surgery using infrared,  we can also see that elevated levels of IL-6 are associated with CLBP.

Could Wong et al help us to explain more fully the observed benefits of FAR infrared for relieving low back pain?

TherMedic is a new technology which uses a mains powered carbon-fabric element which emits FAR infrared.   It replaces lamps.  Worn against the body TherMedic provides a localised constant infrared heat/energy source.  Evidence shows both thermal and non-thermal effects from the resonant energy for pain reduction for a variety of conditions.

Most of the evidence comes from Asia where the technology is developed and being applied to many medical conditions.  We expect that European academic interest will develop as awareness of the new technology and its applications spreads.

PW140-Lower-Back-Thermography-heat-only   l220103-heat-pad_jpg   l220103-temp-control_jpg

Regular users of Thermedic for low back pain report “not being able to live without their TherMedic” infrared pad.  Patients with sciatica report that their pain has disappeared which is surprsing for something viewed as a simple heat pad and used on the lower back.

PW140-TherMedic-Lower-Back-PackShotRather than simple pain relief from heat and increased blood flow which “feels nice”, might Thermedic infrared have a deeper effect by helping to reduce levels of inflammation-causing IL-6 in LBP?

There is clearly a lot to explore, but as you look into the new FAR infrared fabric application for low back pain relief, you will see that there is a lot more than meets the eye.

Convention has it that heat should not be applied when there is inflammation.

Having heard from people suffering with inflammation but reporting relief when using TherMedic Infrared, could the new infrared turn some of that conventional thinking about heat and inflammation on its head?

Author: Stephen Small
Director www.steadfastclinics.co.uk  www.thermedic.co.uk  www.iddtherapy.co.uk

1) Wong CHLin LCLee HHLiu CF. The analgesic effect of thermal therapy after total knee arthroplasty.  J Altern Complement Med. 2012 Feb;18(2):175-9. doi: 10.1089/acm.2010.0815.  http://www.ncbi.nlm.nih.gov/pubmed/22339105

2) Heffner KLFrance CRTrost ZNg HMPigeon WR Chronic low back pain, sleep disturbance, and interleukin-6. Clin J Pain. 2011 Jan;27(1):35-41. http://www.ncbi.nlm.nih.gov/pubmed/21188850

3) Burke JGWatson RWMcCormack DDowling FEWalsh MGFitzpatrick JMIntervertebral discs which cause low back pain secrete high levels of proinflammatory mediators. J Bone Joint Surg Br. 2002 Mar;84(2):196-201. http://www.ncbi.nlm.nih.gov/pubmed/11924650
4)  Kraychete DCSakata RKIssy AMBacellar OSantos-Jesus RCarvalho EMSerum cytokine levels in patients with chronic low back pain due to herniated disc: analytical cross-sectional study. Sao Paulo Med J. 2010;128(5):259-   62. http://www.ncbi.nlm.nih.gov/pubmed/21181064

Rheumatoid Arthritis Treatment – A link between drug treatments, new FAR infrared and targeting the IL-6 protein.

Last month a news article in The Daily Express, a UK newspaper, appeared referencing a new drug treatment for Rheumatoid Arthritis (RA).  The drug targets the IL-6 protein which is responsible for inflammation.

This stimulated my memory banks for a different study for knee pain which I vaguely remembered made reference to an IL protein … hang on, it’s the IL-6 protein!

Have I just discovered a link to a potential treatment for RA?

Here is the extract from the article and a link, but read on.

Sarilumab

http://www.express.co.uk/news/health/444653/New-breakthrough-jab-to-ease-arthritis-agony-and-slow-disease

Whilst preparing a summary of evidence for new FAR infrared (FIR) elements, I came across a study showing the effects of the FIR treatment on patients who had undergone knee surgery (total knee arthroplasty).  As well as significant pain reduction, reference is also made to IL-6 reduction:

FAR infrared and IL 6 protein

http://www.ncbi.nlm.nih.gov/pubmed/22339105

“This study demonstrated that the FIR can lower the NRS of pain and thus reduce the discomfort experienced by the patient. Findings indicated that effective application of FIR decreased the serum level of Interleukin-6 (IL-6) and Endothelin ET-1, which represent the subjective indicator of pain.”

FAR Infrared TherapyNow, anecdotally we hear countless testimonials from people with arthritis (not specifically RA) reporting significant pain relief from using TherMedic infrared ProWraps, as well as other conditions including low back pain, Frozen Shoulder and more.

Some of these effects may be down to the thermal effects of sustained vasodilation but other studies detail non-thermal effects which may explain other significant properties and benefits of TherMedic FIR for pain relief, see evidence summary.

For some people living with Rheumatoid Arthritis, medication does not always work and can include side-effects.

l220100-heat-pad_jpgThe above paper looking at the application of FIR for knee arthroplasty and reduction of IL-6 protein is not a large double-blind randomised controlled trial.

HOWEVER, in the context of this and other scientific evidence surrounding the re-emergence of FAR infrared, as well as the growing anecdotal evidence, there is surely a case for more detailed investigation into the potential applications of the new localised carbon-fabric infrared modality, TherMedic for the relief of pain caused by Rheumatoid Arthritis.

This question may well be being addressed in Asia where the new carbon fabric infrared element was developed, but to the scientific community in the UK, the new technology is still unknown.  That is changing.

NOTES:

Endothelins are proteins that constrict blood vessels and raise blood pressure. They are normally kept in balance by other mechanisms, but when they are over-expressed, they contribute to high blood pressure (hypertension) and heart disease

Interleukin-6 (IL-6) is an interleukin that acts as both a pro-inflammatory and anti-inflammatory cytokine. Expression of IL-6 is enhanced at the site of inflammation, and blockade of IL-6 and IL-6 signalling is effective at prevention and treatment in models of inflammatory diseases (including arthritis and colitis).  Overall IL-6 is important – indeed, critical under certain conditions – to the development of persistent inflammation.

(C. Gabay Interleukin-6 and chronic inflammation  Arthritis Research & Therapy 2006, 8(Suppl 2):S3 http://arthritis-research.com/content/8/S2/S3

Author: Stephen Small
Director www.steadfastclinics.co.uk

I first came across infrared whilst using it with IDD Therapy spinal decompression.  Initially I saw it as a simple heat modality but it quickly became apparent that there was a lot more to TherMedic than meets the eye.  Steadfast Clinics distribute Thermedic in the UK.