Spinal Manipulative Therapy Has an Immediate Effect on Thermal Pain Sensitivity in People With Low Back Pain: A Randomized Controlled Trial
ABSTRACT Current evidence suggests that spinal manipulative therapy (SMT) is effective in the treatment of people with low back pain (LBP); however, the corresponding mechanisms are unknown. Hypoalgesia is associated with SMT and is suggestive of specific mechanisms.
The primary purpose of this study was to assess the immediate effects of SMT on thermal pain perception in people with LBP. A secondary purpose was to determine whether the resulting hypoalgesia was a local effect and whether psychological influences were associated with changes in pain perception.
This study was a randomized controlled trial.
A sample of convenience was recruited from community and outpatient clinics.
Thirty-six people (10 men, 26 women) currently experiencing LBP participated in the study. The average age of the participants was 32.39 (SD=12.63) years, and the average duration of LBP was 221.79 (SD=365.37) weeks.
Baseline demographic and psychological measurements were obtained, followed by quantitative sensory testing to assess temporal summation and Adelta fiber-mediated pain perception. Next, participants were randomly assigned to ride a stationary bicycle, perform low back extension exercises, or receive SMT. Finally, the same quantitative sensory testing protocol was reassessed to determine the immediate effects of each intervention on thermal pain sensitivity.
Hypoalgesia to Adelta fiber-mediated pain perception was not observed. Group-dependent hypoalgesia of temporal summation specific to the lumbar innervated region was observed. Pair-wise comparisons indicated significant hypoalgesia in participants who received SMT, but not in those who rode a stationary bicycle or performed low back extension exercises. Psychological factors did not significantly correlate with changes in temporal summation in participants who received SMT.
Only immediate effects of SMT were measured, so the authors are unable to comment on whether the inhibition of temporal summation is a lasting effect. Furthermore, the authors are unable to comment on the relationship between their findings and changes in clinical pain.
Inhibition of Adelta fiber-mediated pain perception was similar for all groups. However, inhibition of temporal summation was observed only in participants receiving SMT, suggesting a modulation of dorsal horn excitability that was observed primarily in the lumbar innervated area.
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ABSTRACT: Spinal manipulation (SMT) is commonly used for treating individuals experiencing musculoskeletal pain. The mechanisms of SMT remain unclear; however, pain sensitivity testing may provide insight into these mechanisms. The purpose of this systematic review is to examine the literature on the hypoalgesic effects of SMT on pain sensitivity measures and to quantify these effects using meta-analysis. We performed a systematic search of articles using CINAHL, MEDLINE, PsycINFO, and SPORTDiscus from each databases' inception until May 2011. We examined methodological quality of each study and generated pooled effect size estimates using meta-analysis software. Of 997 articles identified, 20 met inclusion criteria for this review. Pain sensitivity testing used in these studies included chemical, electrical, mechanical, and thermal stimuli applied to various anatomical locations. Meta-analysis was appropriate for studies examining the immediate effect of SMT on mechanical pressure pain threshold (PPT). SMT demonstrated a favorable effect over other interventions on increasing PPT. Subgroup analysis showed a significant effect of SMT on increasing PPT at the remote sites of stimulus application supporting a potential central nervous system mechanism. Future studies of SMT related hypoalgesia should include multiple experimental stimuli and test at multiple anatomical sites.Journal of electromyography and kinesiology: official journal of the International Society of Electrophysiological Kinesiology 01/2012; 22(5):752-67. DOI:10.1016/j.jelekin.2011.12.013 · 1.73 Impact Factor
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ABSTRACT: Two commonly utilised manual therapy techniques; McKenzie's lumbar extension exercises (EE); and segmental rotational grade V manipulation were investigated to determine their magnitude of neurophysiological effect. Proxy measures of sympathetic nervous system (SNS) activity (skin conductance) were utilised to ascertaining neurophysiological response. This study determined the neurological effects of these two treatment techniques in addition to establishing the Biopac System as a reliable measure of neurophysiological changes. A quasi-experimental, independent group's design was utilised, with random allocation of 50 normal, healthy participants into a manipulation or an EE group. Neurophysiological measurements of skin conductance were taken in the lower limbs before, during and after the administration of the techniques. Results were converted into percentage change calculations for the intervention and the post-intervention periods. Both treatments increased SNS activity during the intervention period, 63% for the manipulation group (p = 0.0005) and 42% for EE group (p = 0.0005) with the manipulative technique having significantly greater effect (p = 0.012). Further analysis of the manipulation group found no difference between the 'opening' and the 'closing' side of the technique (p = 0.76). Biopac System is a reliable method for measuring SNS activity with minimum measurement variability. Preliminary evidence now exists supporting the neurophysiological effects of two lumbar techniques.Manual therapy 04/2011; 16(2):190-5. DOI:10.1016/j.math.2010.10.008 · 1.76 Impact Factor
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ABSTRACT: Im Jahr 2010 hat die Bundesärztekammer (BÄK) zusammen mit der Kassenärztlichen Bundesvereinigung (KBV) und der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) eine VersorgungsLeitlinie Kreuzschmerz herausgegeben. Im vorliegenden Beitrag werden die Inhalte dieser Leitlinie gezielt und umfassend dargestellt sowie mit neueren Studienergebnissen in Beziehung gesetzt. Daraus lassen sich für den Manualmediziner relevante Standards der Diagnostik und Therapie des akuten Kreuzschmerzes ableiten.Manuelle Medizin 03/2013; 51(1). DOI:10.1007/s00337-012-0967-7