TNF and Low back pain: We have also previously shown that individuals with poorer recovery after an acute episode of LBP have higher depressive symptoms and a unique pro-inflammatory profile (including elevation of TNFα) during the early-acute phase (8, 63, 66) As inflammation and specific psychological features can fuel each other in a bidirectional manner (105, 106), we suspect that a disturbance to either, as might occur with the onset of LBP, could setup a negative cycle between the two that mediates LBP persistence.