Disturbance of pro-inflammatory cytokines in post-traumatic psychopathology. 
Post-traumatic psychopathology (PTP) is important to the orthopaedic surgeon as it may complicate the recovery from musculoskeletal injury.  PTP is associated with a disturbance of the hypothalamic-pituitary-adrenal axis, and may lead to impaired healing.  We have investigated the relationship between PTP and pro-inflammatory markers of the metabolic response to trauma.  A prospective cohort study of 82 patients with musculoskeletal injuries, correlating development of psychopathology (measured by general health questionnaire) and pro-inflammatory markers (CRP, IL-6, sIL-6r, TNF-alpha) two and six months after their injury.  Psychological disturbance was found in 39% of patients at two months and 18% at six months.  This disturbance was associated with significantly increased levels of IL-6 at two months and of sIL-6r and TNF-alpha at six months.  CRP levels were not related to the development of PTP.  The relationship between PTP and disturbances of pro-inflammatory markers needs further exploration, but may explain in part the impaired functional recovery when musculoskeletal trauma is complicated by psychological disturbance.