Manipulation-induced hypoalgesia in musculoskeletal pain populations: a systematic critical review and meta-analysis

Aspinall, Sasha L.; Leboeuf‐Yde, Charlotte; Etherington, Sarah J.; Walker, Bruce F.

doi:10.1186/s12998-018-0226-7

Cited by 31 publications

(52 citation statements)

References 44 publications

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“…These results are strengthened by similar findings in the literature but on study subjects with musculoskeletal problems. Thus a recent systematic review concluded that there was no effect of SM on the pressure pain threshold in people with musculoskeletal problems [18] A recent subsequent study, using the same sham as us with verification of blinding afterwards, also failed to identify an effect of SM on PPT in people with musculoskeletal problems [19].…”

Section: Comparison With Literaturementioning

confidence: 90%

“…Sample size calculation was performed using a repeated measures approach. We found that we would need 43 subjects in each group to show at least a difference of 15% of change between groups ('supposed' percentage of clinical significance [18]), with the mean pressure pain threshold of 500 kg/cm2 at baseline. However, as this minimum clinical difference of the PPT is not clearly defined [18], the basis for this power calculation was purely speculative.…”

Section: Statistical Analysis Preliminary Analysesmentioning

confidence: 99%

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What is the effect of spinal manipulation on the pressure pain threshold in young, asymptomatic subjects? A randomized placebo-controlled trial, with a cross-over design

et al. 2020

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Background: Spinal manipulation (SM) has been shown to have an effect on the pressure pain threshold (PPT) in asymptomatic subjects, but SM has never been compared in studies on this topic to a validated sham procedure. We investigated the effect of SM on the PPT when measured i) in the area of intervention and ii) in an area remote from the intervention. In addition, we measured the size and duration of the effect. Method: In a randomized cross-over trial, 50 asymptomatic chiropractic students had their PPT measured at baseline, immediately after and every 12 min after intervention, over a period of 45 min, comparing values after SM and a previously validated sham. The trial was conducted during two sessions, separated by 48 h. PPT was measured both regionally and remotely from the 'treated' thoracic segment. Blinding of study subjects was tested with a post-intervention questionnaire. We used mixed linear regression with the baseline value and time as covariates. If a significant difference were found between groups, then an effect size would be calculated using Cohen's d or Hedge's h coefficient. Statistical significance was set at p < 0.05. Results: Study subjects had been successfully blinded. No statistically significant differences were found between SM and sham estimates, at any time or anatomical location. Conclusion: When compared to a valid sham procedure and with successfully blinded subjects, there is no regional or remote effect of spinal manipulation of the thoracic spine on the pressure pain threshold in a young pain-free population.

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Section: Comparison With Literaturementioning

confidence: 90%

Section: Statistical Analysis Preliminary Analysesmentioning

confidence: 99%

What is the effect of spinal manipulation on the pressure pain threshold in young, asymptomatic subjects? A randomized placebo-controlled trial, with a cross-over design

et al. 2020

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“…Pain sensitivity. The literature concerning the hypoalgesic effect of SMT is conflicting [15][16][17] . This may be the result of differences in study populations as they often are heterogeneous, and includes asymptomatics participants 17 as well as participants with musculoskeletal conditions often found in the general public or primary care 16 .…”

Section: Patient Reported Low Back Pain Intensity Whether the Reductmentioning

confidence: 99%

The effect on clinical outcomes when targeting spinal manipulation at stiffness or pain sensitivity: a randomized trial

Nim

Kawchuk

Schiøttz‐Christensen

et al. 2020

Sci Rep

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The mechanisms underlying pain relief following spinal manipulative therapy (SMT) are not understood fully although biomechanical and neurophysiological processes have been proposed. As such, we designed this randomized trial to elucidate the contributions of biomechanical and neurophysiological processes. A total of 132 participants with low back pain were randomly assigned to receive SMT at either the lumbar segment measured as the stiffest or the segment measured as having the lowest pain threshold. The primary outcome was patient reported low back pain intensity following treatment. Secondary outcomes were biomechanical stiffness and neurophysiological pressure pain threshold. All outcomes were measured at baseline, after the fourth and final session and at 2-weeks follow-up. Data were analyzed using linear mixed models, and demonstrated that the SMT application site did not influence patient reported low back pain intensity or stiffness. However, a large and significant difference in pressure pain threshold was observed between groups. This study provides support that SMT impacts neurophysiological parameters through a segment-dependent neurological reflex pathway, although this do not seem to be a proxy for improvement. This study was limited by the assumption that the applied treatment was sufficient to impact the primary outcome. Treatment of low back pain. Low back pain (LBP) is now the number one cause for years lived disability worldwide 1. In most cases, a specific pathoanatomical cause of LBP cannot be identified 2. Without a specific therapeutic target, a predictably large and diverse spectrum of interventions are available to clinicians that range from joint mobilization to spinal fusion surgery 3. Given these almost endless possibilities, clinical guidelines rate education and exercise as first line therapy for low back pain often in combination with manual therapy 3. Although, these guideline recommendations are generally clear and unambiguous, it is challenging for clinicians to implement them in practice (e.g. which exercises to recommend, how often, and which patients to offer manual therapy etc.). Spinal manipulative therapy. Spinal manipulative therapy (SMT) is a manual therapy recommended as a second line intervention for LBP in most clinical guidelines 4. However, like other conservative treatments, there is little evidence or consensus regarding the specifics of SMT application such as which patients are likely to respond, which type of SMT should be used, and which dose/frequency of SMT is optimal. While the specific SMT technique does not seem to be important 5-7 , there are at least two theoretical rationales for where to apply SMT: at the site of greatest biomechanical dysfunction or the site of greatest pain sensitivity. As the goal of SMT is to restore normal function to segments with biomechanical dysfunctions 8 , it may be surprising to some that the evidence for identifying such dysfunction is sparse. A narrative review reported that clinicians use a variety of different ways to ...

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“…Recent systematic reviews have observed that there might be differences in manipulation-induced hypoalgesia based on where the SMT is applied [29,50]. Since studies often show no change in PPT after lumbar SMT in clinical populations [29], it may be that the question of whether a participant's pain trajectory acts as a modifier of manipulation-induced hypoalgesia is irrelevant in this population (at least regarding PPT). This topic may be worth pursuing in other regions of the spine.…”

Section: Explanation and Comparisonsmentioning

confidence: 99%

“…It has also been suggested that changes in QST outcomes after manual therapy interventions, such as spinal manipulative therapy (SMT) and mobilisation, may help explain the positive clinical outcomes for musculoskeletal pain seen in some patients [28]. Short-term increases in PPT and attenuation of TS have been observed following SMT and mobilisation in people with musculoskeletal pain [29,30]. Since there are differences in pain processing and QST outcomes between asymptomatic and chronic LBP patients, and potentially between different LBP trajectories, it is also possible that changes in QST measures after an intervention may differ between LBP trajectories.…”

Section: Introductionmentioning

confidence: 99%

Pressure pain threshold and temporal summation in adults with episodic and persistent low back pain trajectories: a secondary analysis at baseline and after lumbar manipulation or sham

et al. 2020

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Background: People with chronic low back pain (LBP) typically have increased pain sensitivity compared to healthy controls, however its unknown if pain sensitivity differs based on LBP trajectory at baseline or after manual therapy interventions. We aimed to compare baseline pressure pain threshold (PPT) and temporal summation (TS) between people without LBP, with episodic LBP, and with persistent LBP, and to compare changes over time in PPT and TS after a lumbar spinal manipulation or sham manipulation in those with LBP. Methods: Participants were aged 18-59, with or without LBP. Those with LBP were categorised as having either episodic or persistent LBP. PPT and TS were tested at baseline. LBP participants then received a lumbar spinal manipulation or sham, after which PPT and TS were re-tested three times over 30 min. Generalised linear mixed models were used to analyse data. Results: One hundred participants (49 female) were included and analysed. There were 20 non-LBP participants (mean age 31 yrs), 23 episodic LBP (mean age 35 yrs), and 57 persistent LBP (mean age 37 yrs). There were no significant differences in PPT or TS between groups at baseline. There was a non-significant pattern of lower PPT (higher sensitivity) from the non-LBP group to the persistent LBP group at baseline, and high variability. Changes in PPT and TS after the interventions did not differ between the two LBP groups. Discussion: We found no differences between people with no LBP, episodic LBP, or persistent LBP in baseline PPT or TS. Changes in PPT and TS following a lumbar manual therapy intervention do not appear to differ between LBP trajectories. Trial registration: The trial was prospectively registered with ANZCTR (ACTRN12617001094369).

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Manipulation-induced hypoalgesia in musculoskeletal pain populations: a systematic critical review and meta-analysis

Cited by 31 publications

References 44 publications

What is the effect of spinal manipulation on the pressure pain threshold in young, asymptomatic subjects? A randomized placebo-controlled trial, with a cross-over design

What is the effect of spinal manipulation on the pressure pain threshold in young, asymptomatic subjects? A randomized placebo-controlled trial, with a cross-over design

The effect on clinical outcomes when targeting spinal manipulation at stiffness or pain sensitivity: a randomized trial

Pressure pain threshold and temporal summation in adults with episodic and persistent low back pain trajectories: a secondary analysis at baseline and after lumbar manipulation or sham

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