scholarly journals Changes in pain sensitivity and spinal stiffness in relation to responder status following spinal manipulative therapy in chronic low Back pain: a secondary explorative analysis of a randomized trial

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Casper Glissmann Nim ◽  
Gregory Neil Kawchuk ◽  
Berit Schiøttz-Christensen ◽  
Søren O’Neill
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Randomized Trial ◽  
Clinical Improvement ◽  
Spinal Manipulation ◽  
Pain Sensitivity ◽  
Spinal Manipulative Therapy ◽  
Low Back ◽  
Manipulative Therapy ◽  
Pressure Pain Thresholds

Abstract Background In a prior randomized trial, we demonstrated that participants receiving spinal manipulative therapy at a pain-sensitive segment instead of a stiff segment experienced increased mechanical pressure pain thresholds. We hypothesized that the targeted segment mediated this increase through a segment-dependent neurophysiological reflective pathway. Presently, it is not known if this decrease in pain sensitivity is associated with clinical improvement. Therefore, we performed an explorative analysis to examine if changes in experimental pain sensitivity (mechanical and thermal) and lumbar stiffness were further dependent on clinical improvement in disability and patient-reported low back pain. Methods This study is a secondary explorative analysis of data from the randomized trial that compared 132 participants with chronic low back pain who received lumbar spinal manipulative therapy applied at either i) the stiffest segment or ii) the segment having the lowest pain threshold (i.e., the most pain-sensitive segment). We collected data at baseline, after the fourth session of spinal manipulation, and at 14-days follow-up. Participants were dichotomized into responders/non-responders using different clinical variables (disability and patient-reported low back pain) with varying threshold values (0, 30, and 50% improvement). Mixed models were used to assess changes in experimental outcomes (stiffness and pain sensitivity). The fixed interaction terms were time, segment allocation, and responder status. Results We observed a significant increase in mechanical pressure pain thresholds for the group, which received spinal manipulative therapy at the most pain-sensitive segment independent of whether they improved clinically or not. Those who received spinal manipulation at the stiffest segment also demonstrated increased mechanical pain sensitivity, but only in the subgroup with clinical improvement. We did not observe any changes in lumbar stiffness. Conclusion Our results suggest the existence of two different mechanistic pathways associated with the spinal manipulation target. i) A decrease of mechanical pain sensitivity independent of clinical outcome (neurophysiological) and ii) a decrease as a reflection of the clinical outcome. Together, these observations may provide a novel framework that improves our understanding of why some respond to spinal manipulative therapy while others do not. Trial registration ClinicalTrials.gov identifier: NCT04086667 registered retrospectively September 11th 2019.

The relative effectiveness of combined spinal manipulative therapy and action potential therapy versus combined spinal manipulative therapy and placebo action potential therapy in the treatment of mechanical low back pain

2000 ◽  
Author(s):  
◽  
Micah Justin Atkinson
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Action Potential ◽  
Lower Back Pain ◽  
Spinal Manipulation ◽  
Spinal Manipulative Therapy ◽  
Current Therapy ◽  
Low Back ◽  
Manipulative Therapy ◽  
Lower Back

Lower back pain represents as a common disorder, with between 60% and 80% of the general population being affected (Kirkaldy-Willis 1992:2). This, apart from just the health aspects, has serious financial implications which are an ongoing concern to industry (Frymoyer 1991: 137). This study was designed to determine the effectiveness of combined spinal manipulation and "Action Potential" therapy versus spinal manipulative therapy and placebo "Action Potential" therapy in the treatment of mechanical lower back pain. It is currently accepted that spinal manipulation is of great benefit in the treatment of lower back pain (Di Fabio 1992), and it appears that "Action Potential Simulation" therapy, a new low-frequency electrical current therapy, would fit the criteria necessary to address the dysfunctional phase of low back pain as set out by the authors such as Kirkaldy- Willis (1988).

scholarly journals Spinal Manipulative Therapy–Specific Changes in Pain Sensitivity in Individuals With Low Back Pain (NCT01168999)

2014 ◽  
Vol 15 (2) ◽  
pp. 136-148 ◽  
Author(s):  
Joel E. Bialosky ◽  
Steven Z. George ◽  
Maggie E. Horn ◽  
Donald D. Price ◽  
Roland Staud ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Sensitivity ◽  
Spinal Manipulative Therapy ◽  
Low Back ◽  
Manipulative Therapy

scholarly journals The relative effectiveness of specific passive mobilization versus spinal manipulation in the treatment of mechanical low back pain

1988 ◽  
Author(s):  
◽  
Cornelius Myburgh
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Treatment Period ◽  
Spinal Manipulation ◽  
Relative Effectiveness ◽  
Spinal Manipulative Therapy ◽  
Low Back ◽  
Treatment Protocols ◽  
Manipulative Therapy ◽  
Passive Mobilization

The absence oftested theory has resulted in the continued variation of treatment protocols in the treatment of mechanical low back pain. This study was designed to determine the relative effectiveness of specific passive mobilization versus spinal manipulation in the treatment of uncomplicated mechanical low back pain. It was hypothesized that both spinal manipulative therapy and specific passive mobilization would be effective, but that manipulation would be significantly more effective in terms of objective and subjective findings, over the same two week treatment period

Comparison of general exercise, motor control exercise and spinal manipulative therapy for chronic low back pain: A randomized trial

Pain ◽  
2007 ◽  
Vol 131 (1) ◽  
pp. 31-37 ◽  
Author(s):  
Manuela L. Ferreira ◽  
Paulo H. Ferreira ◽  
Jane Latimer ◽  
Robert D. Herbert ◽  
Paul W. Hodges ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Motor Control ◽  
Back Pain ◽  
Randomized Trial ◽  
Chronic Low Back Pain ◽  
Spinal Manipulative Therapy ◽  
Low Back ◽  
Manipulative Therapy ◽  
General Exercise ◽  
Control Exercise

scholarly journals EFFICACY OF HIGH-VELOCITY LOW-AMPLITUDE SPINAL MANIPULATION FOR NON SPECIFIC LOW BACK PAIN

2014 ◽  
Vol 3 (1) ◽  
pp. 4-14
Author(s):  
Sadaf Shafqat
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
High Velocity ◽  
Spinal Manipulation ◽  
Spinal Manipulative Therapy ◽  
Systemic Review ◽  
Low Back ◽  
Manipulation Under Anesthesia ◽  
Manipulative Therapy ◽  
Low Amplitude

BACKGROUND Back pain is one of the most frequently seen health problems, affecting 9 out of 10 people in a population at some point during their lives. The lower back is the region most commonly affected. Low-back pain can be debilitating, and it is often challenging to treat Low Back Pain. OBJECTIVE The objective of this review is to evaluate the efficacy of High-Velocity Low-Amplitude (HVLA) Spinal Manipulative Therapy (SMT) for Non Specific Low Back Pain (NSLBP). STUDY DESIGN Systemic review METHODS Only articles that had adult (18 years and above) participants were included in this review and studies that classified the intervention as HVLA spinal manipulation were included. Studies that included spinal manipulation other than HVLA or studies of spinal manipulation under anesthesia were excluded. RESULTS Eight full text papers and three systemic reviews justifying the inclusion criteria are reviewed which revealed that high velocity low amplitude spinal manipulative therapy have significant effect in alleviating low back pain. CONCLUSION Spinal manipulation therapy is a distinctive approach that considerably decreases nonspecific low back pain however there is need of further clinical trials into this subject focusing solely on high velocity low amplitude spinal manipulation.

scholarly journals Spinal manipulation and exercise for low back pain in adolescents: study protocol for a randomized controlled trial

2014 ◽  
Vol 22 (1) ◽  
Author(s):  
Craig Schulz ◽  
Brent Leininger ◽  
Roni Evans ◽  
Darcy Vavrek ◽  
Dave Peterson ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Low Back Pain ◽  
Back Pain ◽  
Spinal Manipulation ◽  
Controlled Trial ◽  
Spinal Manipulative Therapy ◽  
Low Back ◽  
Manipulative Therapy ◽  
Randomized Controlled ◽  
Recurrent Low Back Pain

Abstract Background Low back pain is among the most common and costly chronic health care conditions. Recent research has highlighted the common occurrence of non-specific low back pain in adolescents, with prevalence estimates similar to adults. While multiple clinical trials have examined the effectiveness of commonly used therapies for the management of low back pain in adults, few trials have addressed the condition in adolescents. The purpose of this paper is to describe the methodology of a randomized clinical trial examining the effectiveness of exercise with and without spinal manipulative therapy for chronic or recurrent low back pain in adolescents. Methods/design This study is a randomized controlled trial comparing twelve weeks of exercise therapy combined with spinal manipulation to exercise therapy alone. Beginning in March 2010, a total of 184 participants, ages 12 to 18, with chronic or recurrent low back pain are enrolled across two sites. The primary outcome is self-reported low back pain intensity. Other outcomes include disability, quality of life, improvement, satisfaction, activity level, low back strength, endurance, and motion. Qualitative interviews are conducted to evaluate participants’ perceptions of treatment. Discussion This is the first randomized clinical trial assessing the effectiveness of combining spinal manipulative therapy with exercise for adolescents with low back pain. The results of this study will provide important evidence on the role of these conservative treatments for the management of low back pain in adolescents. Trial registration (ClinicalTrials.gov NCT01096628).

scholarly journals Effects of spinal manipulative therapy on inflammatory mediators in patients with non-specific low back pain: a non-randomized controlled clinical trial

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Julita A. Teodorczyk-Injeyan ◽  
John J. Triano ◽  
Robert Gringmuth ◽  
Christopher DeGraauw ◽  
Adrian Chow ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Inflammatory Mediators ◽  
Interleukin 1 ◽  
Spinal Manipulative Therapy ◽  
Controlled Clinical Trial ◽  
Low Back ◽  
Manipulative Therapy ◽  
Randomized Controlled ◽  
Link Type

Abstract Background The inflammatory profiles of patients with acute and chronic nonspecific low back pain (LBP) patients are distinct. Spinal manipulative therapy (SMT) has been shown to modulate the production of nociceptive chemokines differently in these patient cohorts. The present study further investigates the effect(s) of SMT on other inflammatory mediators in the same LBP patient cohorts. Methods Acute (n = 22) and chronic (n = 25) LBP patients with minimum pain scores of 3 on a 10-point numeric scale, and asymptomatic controls (n = 24) were recruited according to stringent exclusion criteria. Blood samples were obtained at baseline and after 2 weeks during which patients received 6 SMTs in the lumbar or lumbosacral region. The in vitro production of tumor necrosis factor (TNFα), interleukin-1 β (IL-1β), IL-6, IL-2, interferon ɣ (IFNɣ), IL-1 receptor antagonist (IL-1RA), TNF soluble receptor type 2 (sTNFR2) and IL-10 was determined by specific immunoassays. Parametric as well as non-parametric statistics (PAST 3.18 beta software) was used to determine significance of differences between and within study groups prior and post-SMT. Effect size (ES) estimates were obtained using Cohen’s d. Results Compared with asymptomatic controls, SMT-related change scores were significant (P = 0.03–0.01) in reducing the production levels of TNFα in both patient cohorts and those of IL-6, IFNɣ and sTNFR2 (P = 0.001–0.02) in patients with chronic LBP. Above-moderate to large ES (d > 0.6–1.4) was observed for these mediators. Compared with respective baselines, a significant post-SMT reduction (P = 0.01) of IL-6 production was detected only in patients with chronic LBP while a significant increase of IL-2 production (P = 0.001 vs. control, and P = 0.004 vs. chronic LBP group) and a large ES (d = 0.87) were observed in patients with acute LBP. Pain and disability scores declined significantly (P < 0.001) in all LBP patients, and were positively correlated (P = 0.03) with IFNɣ and IL-2 levels in the acute LBP cohort. Conclusion The short course of SMT treatments of non-specific LBP patients resulted in significant albeit limited and diverse alterations in the production of several of the mediators investigated in this study. This exploratory study highlights the potential of SMT to modulate the production of inflammatory components in acute and chronic non-specific LBP patients and suggests a need for further, randomized controlled clinical trials in this area. Trial registration This study was prospectively registered April 2012 with Clinical Trials.gov (#NCT01766141). https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0003ZIL&selectaction=Edit&uid=U0001V74&ts=2&cx=-axvqtg

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