scholarly journals Chiropractic Spinal Manipulation Prevents Secondary Hyperalgesia Induced by Topical Capsaicin in Healthy Individuals

2021 ◽  
Vol 2 ◽  
Author(s):  
Carlos Gevers-Montoro ◽  
Benjamin Provencher ◽  
Stéphane Northon ◽  
João Paulo Stedile-Lovatel ◽  
Arantxa Ortega de Mues ◽  
...  
Keyword(s):  
Back Pain ◽  
Central Sensitization ◽  
Spinal Manipulation ◽  
Brain Activity ◽  
Experimental Studies ◽  
Gamma Oscillations ◽  
Secondary Hyperalgesia ◽  
Vertebral Level ◽  
Pressure Pain Thresholds ◽  
Topical Capsaicin

Background and Aims: Spinal manipulation (SM) is currently recommended for the management of back pain. Experimental studies indicate that the hypoalgesic mechanisms of SM may rely on inhibition of segmental processes related to temporal summation of pain and, possibly, on central sensitization, although this remains unclear. The aim of this study was to determine whether experimental back pain, secondary hyperalgesia, and pain-related brain activity induced by capsaicin are decreased by segmental SM.Methods: Seventy-three healthy volunteers were randomly allocated to one of four experimental groups: SM at T5 vertebral level (segmental), SM at T9 vertebral level (heterosegmental), placebo intervention at T5 vertebral level, or no intervention. Topical capsaicin was applied to the area of T5 vertebra for 40 min. After 20 min, the interventions were administered. Pressure pain thresholds (PPTs) were assessed outside the area of capsaicin application at 0 and 40 min to examine secondary hyperalgesia. Capsaicin pain intensity and unpleasantness were reported every 4 min. Frontal high-gamma oscillations were also measured with electroencephalography.Results: Pain ratings and brain activity were not significantly different between groups over time (p > 0.5). However, PPTs were significantly decreased in the placebo and control groups (p < 0.01), indicative of secondary hyperalgesia, while no hyperalgesia was observed for groups receiving SM (p = 1.0). This effect was independent of expectations and greater than placebo for segmental (p < 0.01) but not heterosegmental SM (p = 1.0).Conclusions: These results indicate that segmental SM can prevent secondary hyperalgesia, independently of expectations. This has implications for the management of back pain, particularly when central sensitization is involved.

scholarly journals Segmental Chiropractic Spinal Manipulation Does not Reduce Pain Amplification and the Associated Pain-Related Brain Activity in a Capsaicin-Heat Pain Model

2021 ◽  
Vol 2 ◽  
Author(s):  
Benjamin Provencher ◽  
Stéphane Northon ◽  
Mathieu Piché
Keyword(s):  
Back Pain ◽  
Central Sensitization ◽  
Spinal Manipulation ◽  
Chronic Back Pain ◽  
Brain Activity ◽  
Heat Pain ◽  
Pain Model ◽  
Pain Hypersensitivity ◽  
Clinical Pain ◽  
Primary Hyperalgesia

Musculoskeletal injuries lead to sensitization of nociceptors and primary hyperalgesia (hypersensitivity to painful stimuli). This occurs with back injuries, which are associated with acute pain and increased pain sensitivity at the site of injury. In some cases, back pain persists and leads to central sensitization and chronic pain. Thus, reducing primary hyperalgesia to prevent central sensitization may limit the transition from acute to chronic back pain. It has been shown that spinal manipulation (SM) reduces experimental and clinical pain, but the effect of SM on primary hyperalgesia and hypersensitivity to painful stimuli remains unclear. The goal of the present study was to investigate the effect of SM on pain hypersensitivity using a capsaicin-heat pain model. Laser stimulation was used to evoke heat pain and the associated brain activity, which were measured to assess their modulation by SM. Eighty healthy participants were recruited and randomly assigned to one of the four experimental groups: inert cream and no intervention; capsaicin cream and no intervention; capsaicin cream and SM at T7; capsaicin cream and placebo. Inert or capsaicin cream (1%) was applied to the T9 area. SM or placebo were performed 25 min after cream application. A series of laser stimuli were delivered on the area of cream application (1) before cream application, (2) after cream application but before SM or placebo, and (3) after SM or placebo. Capsaicin cream induced a significant increase in laser pain (p < 0.001) and laser-evoked potential amplitude (p < 0.001). However, SM did not decrease the amplification of laser pain or laser-evoked potentials by capsaicin. These results indicate that segmental SM does not reduce pain hypersensitivity and the associated pain-related brain activity in a capsaicin-heat pain model.

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.

scholarly journals Comparing targeted thrust manipulation with general thrust manipulation in patients with low back pain. A general approach is as effective as a specific one. A randomised controlled trial

2019 ◽  
Vol 5 (1) ◽  
pp. e000514 ◽  
Author(s):  
Christopher J McCarthy ◽  
Louise Potter ◽  
Jackie A Oldham
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Repeated Measures ◽  
Spinal Manipulation ◽  
Analysis Of Covariance ◽  
Controlled Clinical Trial ◽  
Lumbar Region ◽  
Low Back ◽  
Pressure Pain Thresholds ◽  
Randomised Controlled

BackgroundSpinal manipulation is commonly used to treat back pain. The application of spinal manipulation has traditionally involved an element of targeting the technique to a level of the spine where the proposed movement dysfunction is sited. We evaluated the effects of a targeted manipulative thrust versus a thrust applied generally to the lumbar region.MethodsA randomised controlled clinical trial in patients with low back pain following CONSORT (Consolidated Standards of Reporting Trials) guidelines. Sixty subjects were randomly allocated to two groups: one group received a targeted manipulative thrust (n=29) and the other a general manipulation thrust (GT) (n=31) to the lumbar spine. Thrust was either localised to a clinician-defined symptomatic spinal level or an equal force was applied through the whole lumbosacral region. We measured pressure-pain thresholds (PPTs) using algometry and muscle activity (magnitude of stretch reflex) via surface electromyography. Numerical ratings of pain and Oswestry Disability Index scores were collected.ResultsRepeated measures of analysis of covariance revealed no between-group differences in self-reported pain or PPT for any of the muscles studied.SummaryA GT procedure—applied without any specific targeting—was as effective in reducing participants’ pain scores as targeted approaches.Trial registration numberISRCTN11994230.

Aplicabilidade clínica das técnicas de liberação manual diafragmática: uma revisão sistemática

2020 ◽  
Vol 18 (3) ◽  
pp. 111-116
Author(s):  
Dulce Marieli Danieli ◽  
Fabíola De Almeida Gomes ◽  
Bruna Eibel ◽  
William Dhein
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Gastroesophageal Reflux ◽  
Randomized Clinical Trials ◽  
Experimental Studies ◽  
Scar Tissue ◽  
Low Back ◽  
Musculoskeletal Manipulations ◽  
Clinical Applicability ◽  
Quasi Experimental

INTRODUÇÃO: O diafragma é o principal músculo respiratório e desempenha um papel importante na respiração e na regulação fisiológica. Uma terapia que visa melhorar essas condições referentes ao diafragma, é a técnica de liberação manual diafragmática. OBJETIVO: O objetivo deste estudo foi verificar a aplicabilidade clínica das técnicas manuais de liberação diafragmática e identificar as principais técnicas, populações investigadas, variáveis avaliadas e seus desfechos. MÉTODOS: Foram pesquisadas as seguintes bases de dados: PubMed, Scielo e Science Direct, com os descritores “Diaphragm [Mesh]” e “Musculoskeletal Manipulations [Mesh]” com seus correspondentes no mesmo idioma. Foram incluídos ensaios clínicos randomizados, não randomizados, estudos semi, quase-experimentais e estudos pilotos ou de caso, que abordaram técnicas de liberação manuais diafragmáticas.RESULTADOS: Há variadas técnicas de liberação diafragmática, sendo as mais mencionadas: normalização dos pilares do diafragma, alongamento e estiramento do diafragma, relaxamento dos pilares do diafragma. Além disso, as técnicas de liberação diafragmática vêm sendo associadas a protocolos de terapia manipulativa osteopática (TMO). As principais populações estudadas foram de pacientes saudáveis, com lombalgia, cervicalgia, osteoartrite, asmáticos, doença pulmonar obstrutiva crônica, constipados, cardiopatas e com refluxo gastroesofágico. Os principais desfechos avaliados são variáveis musculoesqueléticas (dor, flexibilidade, amplitude, espessura diafragmática), variáveis cardiorrespiratórias (pressão inspiratória/expiratória máxima (PImax e Pemax), mobilidade torácica, frequência cardíaca e respiratória), qualidade de vida e disfunções gastrointestinais/gastroesofágicas. CONCLUSÃO: A aplicabilidade clínica das técnicas de liberação diagramática está sendo investigada associado com outras técnicas osteopáticas, em protocolos de TMO em pacientes saudáveis, pneumopatas, cardiopatas, gestantes, em cicatriz pós-cirúrgica, constipados, com refluxo gastroesofágico, osteoartrite, cervicalgia e com lombalgia. Evidencia-se: diminuição ou eliminação das dores musculoesqueléticas, aumento da flexibilidade, ADM, Pimáx e Pemáx, aumento da mobilidade torácica, aumento da qualidade de vida, diminuição do inchaço e dor abdominal e sem efeito em cardiopatas.ABSTRACT. Clinical applicability of manual diaphragmatic release techniques: a systematic review.BACKGROUND: The diaphragm is the main respiratory muscle and plays an important role in breathing and physiological regulation. A therapy that aims to improve these conditions regarding the diaphragm, is the manual diaphragmatic release technique.OBJECTIVE: The aim of this study was to verify the clinical applicability of manual diaphragmatic release techniques and searching the main techniques, population, evaluated variables, and outcomes. METHODS: The following electronic databases were searched: PubMed, Scielo, and Science Direct, with the descriptors “Diaphragm [Mesh]” and “Musculoskeletal Manipulations [Mesh]” with their correspondents in the same language. There were included randomized clinical trial, non-randomized clinical trials, semi, and quasi-experimental studies, and pilot or case studies, which addressed manual diaphragmatic release techniques.RESULTS: There are various diaphragmatic release techniques, the most mentioned are: normalization of the diaphragm pillars, stretching of the diaphragm, relaxation of the diaphragm pillars, and protocols for osteopathic manipulative therapy (OMT) for the diaphragm. The main populations studied were healthy patients, with low back pain, asthmatics, chronic pulmonary obstructive disease, constipated, cardiac patients, and gastroesophageal reflux. The main outcomes assessed are musculoskeletal variables (pain, flexibility, range of motion, diaphragmatic thickness), cardiorespiratory variables (maximal inspiratory/expiratory pressure (MIP and MEP), chest mobility, heart, and respiratory rate), quality of life, and gastrointestinal/ gastroesophageal disorders.CONCLUSION: The clinical applicability of diagrammatic release techniques is being investigated in association with other osteopathic techniques, in protocols of OMT in healthy subjects, patients with lung diseases, heart disease, pregnant women, scar tissue, constipated, with gastroesophageal reflux, osteoarthritis, cervicalgia and with low back pain. There is evidence of reduction and elimination of musculoskeletal pain, increased MIP, increased chest mobility, an increase in health quality, a decrease of bloating and abdominal pain related to constipation, and a decrease of reflux symptoms.

scholarly journals The genetic influence of the brain-derived neurotrophic factor Val66Met polymorphism in chronic low back pain

2021 ◽  
Vol 61 (1) ◽  
Author(s):  
Angela Shiratsu Yamada ◽  
Flavia Tasmim Techera Antunes ◽  
Camila Ferraz ◽  
Alessandra Hubner de Souza ◽  
Daniel Simon
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Neurotrophic Factor ◽  
Central Sensitization ◽  
Low Back ◽  
Bdnf Gene ◽  
Val66met Polymorphism ◽  
Bdnf Val66met Polymorphism ◽  
The Brain

Abstract Background The Val66Met polymorphism of the brain-derived neurotrophic factor (BDNF) gene is a potential biomarker of vulnerability to pain. Thus, the present study aimed to investigate the association of this polymorphism with clinical and biopsychosocial factors in patients with chronic low back pain (CLBP). Methods A total of 107 individuals with CLBP answered questionnaires that were validated and adapted for the Brazilian population, including the Brief Inventory of Pain, the Central Sensitization Inventory, the Roland Morris Disability Questionnaire, the Tampa Scale for Kinesiophobia, the Pain Catastrophizing Scale, the Survey of Pain Attitude-Brief, and the Hospital Anxiety and Depression Scale. All of the subjects were genotyped for the BDNF Val66Met polymorphism. Results The sample showed moderate scores of disability, central sensitization, and kinesiophobia, in addition to mild anxiety, hopelessness, and ruminant thoughts. No significant association was observed between the Val66Met polymorphism and the variables analyzed. Besides, there was no relationship between the BDNF Val66Met polymorphism with CSI, catastrophization, or disabilities that were generated by CLBP. Conclusion The results showed that the Val66Met polymorphism of the BDNF gene was not associated with clinical and biopsychosocial characteristics of CLBP in the sample studied.

scholarly journals A mixed treatment comparison of selected osteopathic techniques used to treat acute nonspecific low back pain: a proof of concept and plan for further research

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
James W. Price
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Spinal Manipulation ◽  
Conventional Care ◽  
Mixed Treatment Comparison ◽  
Low Back ◽  
Acute Low Back Pain ◽  
Treatment Comparison ◽  
Randomized Controlled ◽  
Mixed Treatment

Abstract Context Back injuries have a high prevalence in the United States and can be costly for both patients and the healthcare system at large. While previous guidelines from the American College of Physicians for the management of acute nonspecific low back pain (ANLBP) have encouraged nonpharmacologic management, those treatment recommendations involved only superficial heat, massage, acupuncture, and spinal manipulation. Investigation about the efficacy of spinal manipulation in the management of ANLBP is warranted. Objectives To compare the results in previously-published literature documenting the outcomes of osteopathic manipulative treatment (OMT) techniques used to treat ANLBP. The secondary objective of this study was to demonstrate the utility of using Bayesian network meta-analysis (NMA) to perform a mixed treatment comparison (MTC) of a variety of osteopathic techniques. Methods A literature search for randomized controlled trials (RCTs) of ANLBP treatments was performed in April 2020 according to PRISMA guidelines by searching MEDLINE/PubMed, OVID, Cochrane Central, PEDro, and OSTMED.Dr databases; scanning the reference lists of articles; and using the Canadian Agency for Drugs and Technologies in Health grey literature checklist. Each database was searched from inception to April 1, 2020. The following search terms were used: acute low back pain, acute low back pain plus physical therapy, acute low back pain plus spinal manipulation, and acute low back pain plus osteopathic manipulation. The validity of eligible trials was assessed by the single author using an adapted National Institute for Health and Care Excellence methodology checklist for randomized, controlled trials and an extraction form based on that checklist. The outcome measure chosen for this NMA was the Visual Analogue Scale of pain. The NMA were performed using the GeMTC user interface for automated NMA utilizing a Bayesian hierarchical model of random effects. Results The literature search initially found 483 unduplicated records. After screening and full text assessment, five RCTs were eligible for the MTC, yielding a total of 430 participants. Results of the MTC model suggested that there was no statistically significant decrease in reported pain when exercise, high-velocity low-amplitude (HVLA), counterstrain, muscle energy technique, or a mix of techniques were added to conventional treatment to treat ANLBP. However, the rank probabilities assessment determined that HVLA and the OMT mixed treatment protocol plus conventional care were ranked superior to conventional care alone for improving ANLBP. Conclusions While this study failed to provide definitive evidence upon which clinical recommendations can be based, it does demonstrate the utility of performing NMA for MTCs of osteopathic modalities used to treat ANLBP. However, to take full advantage of this statistical technique, future studies should be designed with consideration for the methodological shortcomings found in past osteopathic research.

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