scholarly journals Immediate Effects of Spinal Manipulation on Painful Sensitivity and Postural Stability in Patients with Chronic Nonspecific Low Back Pain: Study Protocol for A Controlled Randomised Clinical Trial.

2021 ◽  
Author(s):  
JOAO PAULO FREITAS ◽  
Leticia Amaral Corrêa ◽  
Juliana Valentim Bittencourt ◽  
Karine Marcondes Armstrongd ◽  
Leandro Alberto Calazans Nogueira
Keyword(s):  
Clinical Trial ◽  
Low Back Pain ◽  
Back Pain ◽  
Postural Stability ◽  
Spinal Manipulation ◽  
Pain Threshold ◽  
Pressure Pain Threshold ◽  
Low Back ◽  
Pressure Pain ◽  
Lumbar Spinal

Abstract Background: Low back pain is one of the main public health concerns. Chronic low back pain (cLBP)reduces functional capacity and affects postural stability.Although health professionals widely use spinal manipulation, its immediate effect on painful sensitivity and postural stability is lacking. This study aims to verify the immediate effects of lumbar spinal manipulation on the pressure pain threshold and postural stability in individuals with cLBP. Methods: A two-arm, placebo-controlled clinical trial with parallel groups and examiner-blinded will be conducted with 80 participants with cLBPfrom an outpatient physical therapy department,randomly allocated at a 1:1 distribution. The experimental group will receive a lumbar spinal manipulation technique, and the placebo group will receive a simulated lumbar spinal manipulation. Both groups will receive one session of treatment and will be evaluated before and immediately after the intervention.The primary outcomes will be the pressure pain threshold and postural stability. Pain intensity and patient´s expectation will be assessed as a secondary outcome. The pressure pain threshold will be assessed using a pressure algometer in 6 different anatomical regions. The evaluation of postural stability will be performed in a baropodometry exam by displacing the centre of pressure. The pain intensity will be measuredusing the Numeric Pain Rating Scale. A Likert scale will be used for the patient´s expectationabout the treatment. A two-way analysis of variance will compare the effect of the interventions between groups. Discussion:This study will provide insights regarding the immediate effects of spinal manipulation in patients with cLBPagainst a simulated spinal manipulation using objective outcomes and considering patients’ expectations regarding the treatment.Trial registration: Brazilian Registry of Clinical Trials:RBR-3ksq2c; registered on 13 July 2020.

scholarly journals Immediate Effects of Region-Specific and Non–Region-Specific Spinal Manipulative Therapy in Patients With Chronic Low Back Pain: A Randomized Controlled Trial

2013 ◽  
Vol 93 (6) ◽  
pp. 748-756 ◽  
Author(s):  
Ronaldo Fernando de Oliveira ◽  
Richard Eloin Liebano ◽  
Lucíola da Cunha Menezes Costa ◽  
Lívia Leticia Rissato ◽  
Leonardo Oliveira Pena Costa
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Intensity ◽  
Spinal Manipulation ◽  
Pain Threshold ◽  
Controlled Trial ◽  
Pressure Pain Threshold ◽  
Low Back ◽  
Pressure Pain ◽  
Upper Thoracic

Background Manual therapists typically advocate the need for a detailed clinical examination to decide which vertebral level should be manipulated in patients with low back pain. However, it is unclear whether spinal manipulation needs to be specific to a vertebral level. Objective The purpose of this study was to analyze the immediate effects of a single, region-specific spinal manipulation defined during the clinical examination versus a single non–region-specific spinal manipulation (applied on an upper thoracic vertebra) in patients with chronic nonspecific low back pain for the outcome measures of pain intensity and pressure pain threshold at the time of the assessment. Design This was a 2-arm, prospectively registered, randomized controlled trial with a blinded assessor. Setting The study was conducted in an outpatient physical therapy clinic in Brazil. Patients The study participants were 148 patients with chronic nonspecific low back pain (with pain duration of at least 12 weeks). Randomization The randomization schedule was generated by an independent statistician and was concealed by using consecutively numbered, sealed, opaque envelopes. Interventions A single high-velocity manipulation was administered to the upper thoracic region of the participants allocated to the non–region-specific manipulation group and to the painful lumbar levels of the participants allocated to the region-specific manipulation group. Measurements Pain intensity was measured by a 0 to 10 numeric pain rating scale. Pressure pain threshold was measured using a pressure algometer. Limitations It was not possible to blind the therapist and participants. Results A total of 148 patients participated in the study (74 in each group). There was no loss to follow-up. Both groups improved in terms of immediate decrease of pain intensity; however, no between-group differences were observed. The between-group difference for pain intensity and pressure pain threshold were 0.50 points (95% confidence interval=−0.10 to 1.10) and −1.78 points (95% confidence interval=−6.40 to 2.82), respectively. No adverse reactions were observed. Conclusion The immediate changes in pain intensity and pressure pain threshold after a single high-velocity manipulation do not differ by region-specific versus non–region-specific manipulation techniques in patients with chronic low back pain.

scholarly journals Spinal manipulation and modulation of pain sensitivity in persistent low back pain: a secondary cluster analysis of a randomized trial

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Casper Glissmann Nim ◽  
Kenneth Arnold Weber ◽  
Gregory Neill Kawchuk ◽  
Søren O’Neill
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Spinal Manipulation ◽  
Pain Sensitivity ◽  
Pain Threshold ◽  
Pressure Pain Threshold ◽  
Low Back ◽  
Pressure Pain ◽  
Pain Hypersensitivity ◽  
Patient Reported

Abstract Background Pain hypersensitivity can be assessed using Quantitative Sensory Testing (QST) and is associated with persistent low back pain. Spinal manipulation appears to modify pain hypersensitivity, and this could function as one mechanism leading to clinical improvements. In the current study, we applied a comprehensive QST battery to assess pain sensitivity in a cohort of low back pain patients before and after spinal manipulation to improve our understanding of the association between QST and clinical improvements. This study addresses two questions: Are clinical improvements following spinal manipulation in low back pain patients contingent on pain hypersensitivity, and does pain sensitivity change following spinal manipulation? Methods We performed a secondary analysis of data from a randomized clinical trial. One hundred and thirty-two participants with persistent LBP were treated with spinal manipulation four times over two weeks. Patient-reported outcomes and QST were assessed at baseline, after the fourth spinal manipulation session, and 14-days later. The clinical outcomes were changes in low back pain intensity and disability. Using latent profile analysis, we categorized the participants into clusters depending on their baseline QST scores. We used linear mixed models to examine the association between clusters and changes in patient-reported outcomes and QST. Results Two clusters emerged: a Sensitized and a Not sensitized. The former had significantly lower regional pressure and thermal pain thresholds, remote pressure pain tolerance, and lower inhibitory conditioned pain modulation than the Not sensitized group. However, we only found between-cluster differences for regional pressure pain threshold following spinal manipulation. Thus, the clusters were not associated with patient-reported pain and disability changes or the remaining QST outcomes. Conclusions We report that the baseline QST profile was not associated with clinical improvements following spinal manipulation. We did observe a substantial change for regional pressure pain threshold, which suggests that any effect of spinal manipulation on pain sensitivity is most likely to be observed as changes in regional, mechanical pain threshold. However, the mechanism that invokes clinical improvement and pain sensitivity changes appear distinct. Due to methodological caveats, we advise caution when interpreting the results. Trial registration Clinical.Trial.gov identifier: NCT04086667, registered 11 September 2019 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04086667

Changes in Pressure Pain Threshold in Patients With Chronic Nonspecific Low Back Pain

Spine ◽  
2013 ◽  
Vol 38 (24) ◽  
pp. 2098-2107 ◽  
Author(s):  
Marta Imamura ◽  
Janini Chen ◽  
Suely Reiko Matsubayashi ◽  
Rosa A. Targino ◽  
Fábio Marcon Alfieri ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Threshold ◽  
Pressure Pain Threshold ◽  
Low Back ◽  
Pressure Pain

scholarly journals The effects of rice grain and Thai herbal hot pack on pain and back extensibility in persons with low back pain

2021 ◽  
Vol 60 (1) ◽  
Author(s):  
P Manoy ◽  
◽  
S Kumfu ◽  
A Srithawong ◽  
◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Threshold ◽  
Pressure Pain Threshold ◽  
Rice Grain ◽  
Low Back ◽  
Pressure Pain ◽  
Pain Disability Index ◽  
Pain Disability ◽  
Hot Pack

Objectives Low back pain (LBP) is the most prevalent musculoskeletal condition. Superficial heat has been utilized for decades to alleviate the symptoms; however, there has been no study of the effect of rice grain and Thai herbal hot packs using a microwave method in persons with low back pain. The purpose of this study was to compare pain scale scores and back extensibility with rice grain and Thai herbal hot packs with standard hot packs in individuals with LBP. Methods Forty participants with LBP were stratified using a random sampling method into two groups: a rice grain and Thai herbal hot pack group (n=20) and a standard hot pack group (n=20). Twenty-minute duration treatments were given. Each patient was followed-up 6 times (3 times per week for 2 weeks). Pressure pain threshold (PPT) and back extensibility were measured using a visual analogue scale (VAS) and the Thai Oswestry low back pain disability index. Results VAS scores and the Thai Oswestry low back pain disability index in both groups were reduced significantly (p < 0.05). PPT and back extensibility were significantly increased after rice grain and Thai herbal hot pack and hot pack treatment (p < 0.05). After treatments, PPT with rice grain and Thai herbal hot pack was significantly higher than the standard hot pack group. (p < 0.05). Conclusions Rice grain and Thai herbal hot pack may be considered as an alternative method for relieving pain and improving pressure pain threshold and back extensibility in persons with LBP. Chiang Mai Medical Journal 2021;60(1):75-86. doi 10.12982/CMUMEDJ.2021.07

scholarly journals The Direct Effect of Magnetic Tape® on Pain and Lower-Extremity Blood Flow in Subjects with Low-Back Pain: A Randomized Clinical Trial

Sensors ◽  
2021 ◽  
Vol 21 (19) ◽  
pp. 6517
Author(s):  
Francisco Selva-Sarzo ◽  
Samuel Fernández-Carnero ◽  
Rob Sillevis ◽  
Héctor Hernández-Garcés ◽  
Josep-Carles Benitez-Martinez ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Blood Flow ◽  
Low Back Pain ◽  
Back Pain ◽  
Magnetic Tape ◽  
Pain Threshold ◽  
Pressure Pain Threshold ◽  
Resistance Index ◽  
Low Back ◽  
Kinesio Tape

Low-back pain has a high impact on the world population, and solutions are in demand. The behavior of specific physiological processes has been modified using magnetic fields, whether for pain relief, bone consolidation, or improvement of vascularization. The use of tape with magnetic properties could help in these cases. A double-blind randomized clinical trial was designed to use Magnetic Tape® versus placebo Kinesio tape. Blood flow variables were evaluated using pulsed power Doppler ultrasound. Resistance index, pulsatility index, systolic velocity, and diastolic velocity were measured. The pressure pain threshold was measured using algometry in 22 subjects. The results reveal significant differences between the groups for the pulsation index variable (8.06 [5.16, 20.16] in Magnetic Tape® versus 5.50 [4.56, 6.64] in Kinesio tape) and lower (0.98 [0.92, 1.02] for Magnetic Tape® versus 0.99 [0.95, 1.01] for Kinesio tape) in the resistance index variable. The pressure pain threshold variable presented significant differences at multiple levels. The application of Magnetic Tape® causes immediate effects on blood flow and pain and could be a technique of choice for pain modulation. Further studies would be necessary.

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