Multiple confounders influence the association between low-grade systemic inflammation and musculoskeletal pain. A call for a prudent interpretation of the literature

Our understanding of the multiple systems and their interactions that contribute to musculoskeletal pain has evolved considerably in recent years. There is a large interest in the role of the immune system in both acute and persistent musculoskeletal pain states [1,2]. Systemically elevated levels of proinflammatory cytokines and chemokines have been revealed in people with musculoskeletal pain. This low-grade inflammation has been demonstrated in various musculoskeletal conditions, such as low back pain [1], neck pain [2] and radicular pain [3].

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