Placebo response to manual therapy: Something out of nothing?

Department of Physical Therapy, University of Florida, Gainesville, FL, USA.
The Journal of manual & manipulative therapy 02/2011; 19(1):11-9. DOI: 10.1179/2042618610Y.0000000001
Source: PubMed


The mechanisms through which manual therapy inhibits musculoskeletal pain are likely multifaceted and related to the interaction between the intervention, the patient, the practitioner, and the environment. Placebo is traditionally considered an inert intervention; however, the pain research literature suggests that placebo is an active hypoalgesic agent. Placebo response likely plays a role in all interventions for pain and we suggest that the same is true for the treatment effects associated with manual therapy. The magnitude of a placebo response may be influenced by negative mood, expectation, and conditioning. We suggest that manual therapists conceptualize placebo not only as a comparative intervention, but also as a potential active mechanism to partially account for treatment effects associated with manual therapy. We are not suggesting manual therapists include known sham or ineffective interventions in their clinical practice, but take steps to maximize placebo responses to reduce pain.

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    • "Historical views that placebo responses represent fake, passive, and undesirable results; require deception; and should be minimized and avoided in clinical practice continue today among healthcare providers. Further, the placebo response has been described as a single mechanism through which an intervention may induce a positive therapeutic outcome [9]. Harboring such views may bias manual therapy practitioners away from valuable clinical evidence that may influence their clinical decision making. "
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    ABSTRACT: Over the decades, research into placebo responses has shed light onto several endogenous (i.e. produced from within) mechanisms underlying modulation of pain perception initiated after the administration of inert substances (i.e. placebos). Chiropractors and manual therapists should embrace analgesic-placebo-research in an attempt to maximize clinical benefit. Historical views that placebo responses are fake, passive, undesirable, and require deception and therefore should be minimized and avoided in clinical practice are outdated. Further, statements that contend the placebo response represents a single mechanism are overly simplistic. This commentary will discuss research that shows that there are several active biological processes underlying modulation of pain perception involved in placebo analgesia and its counterpart nocebo hyperalgesia. We contend that it is highly likely that, to some extent, all of these biological processes are engaged, in varying degrees, following all interventions and represent endogenous pain modulating processes. Failure, of chiropractors and manual therapists, to embrace a more contemporary view of analgesic-placebo-research serves as a barrier to transferring knowledge into clinical practice and represents a missed opportunity to improve the delivery of current treatments.
    Chiropractic and Manual Therapies 02/2014; 22(1):6. DOI:10.1186/2045-709X-22-6
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    • "Through these mechanisms, the thoracic manipulation may induce ventral periaqueductal gray (vPAG) in the brain, which activates endogenous opioid peptides resulting in pain reduction in different areas22,23,24,25). Regarding the reduction in pain at rest between baseline ratings and the 24-hour follow-up for the control group, this may have been the results of overall relaxation and psychological change due to physical contact by a clinician26, 27). "
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    ABSTRACT: [Purpose] To investigate effects of thoracic manipulation versus mobilization on chronic neck pain. [Methods] Thirty-nine chronic neck pain subjects were randomly assigned to single level thoracic manipulation, single level thoracic mobilization, or a control group. The cervical range of motion (CROM) and pain ratings (using a visual analog scale: VAS) were measured before, immediately after and at a 24-hour follow-up. [Results] Thoracic manipulation significantly decreased VAS pain ratings and increased CROM in all directions in immediate and 24-hour follow-ups. The thoracic mobilization group significantly increased in CROM in most directions at immediate follow-up and right and left rotational directions at the 24-hour follow-up. Comparisons between groups revealed the CROM for the manipulation group to increase significantly more than for control subjects in most directions at immediate follow-up and flexion, left lateral flexion and left rotation at the 24-hour follow-up. The CROM for the thoracic mobilization group significantly increased in comparison to the control group in flexion at immediate follow-up and in flexion and left rotation at the 24-hour follow-up. [Conclusion] The study demonstrated reductions in VAS pain ratings and increases in CROM at immediate and 24-hour follow-ups from both single level thoracic spine manipulation and thoracic mobilization in chronic neck pain.
    Journal of Physical Therapy Science 07/2013; 25(7):865-871. DOI:10.1589/jpts.25.865 · 0.39 Impact Factor
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    The Journal of manual & manipulative therapy 05/2011; 19(2):120-1. DOI:10.1179/106698111X12998437860794
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