Neurophysiological mechanisms of chiropractic spinal manipulation for spine pain

Abstract

Spine pain of musculoskeletal origin can affect the cervical, thoracic, or lumbar regions. Its duration may range from an acute episode of a few days or weeks to chronicity over several years (Borghouts et al., 1998;Urits et al., 2019). Low back pain (LBP) is the leading contributor to disability, followed closely by neck pain (NP;James et al., 2018;Urits et al., 2019). Together, back pain and NP are responsible for more than 10% of the total years lived with disability worldwide (James et al., 2018). Spine pain can originate from myofascial tissues, facet joints, intervertebral discs, spinal ligaments and other less common causes (Urits et al., 2019;Vlaeyen et al., 2018). However, it remains challenging to identify the source of pain in individual cases

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

“…Altogether, the findings from the present and previous studies suggest that centrally mediated neurophysiological mechanisms independent of primary hyperalgesia may produce the immediate pain reduction by SM, which may add to anti-inflammatory and other effects later on, in line with the current literature ( 23 – 26 , 77 – 80 ). However, this should be confirmed with clinical populations since the effects of SM may be different on primary hyperalgesia associated with clinical pain.…”

“…This does not exclude that cerebral processes non-specific to SM may also modulate nociceptive activity. Accordingly, future studies should include all appropriate controls to examine the effects of SM on pain perception and pain-related processes with well-supported hypothesis-driven experimental designs and a mechanistic approach, as proposed previously ( 80 , 88 ).…”

“…Accordingly, experimental pain models are validated in preclinical research on biomarkers, which may be measured in clinical studies, thereby narrowing the gap between basic and clinical findings ( 38 ). Recently, three reviews on the mechanisms of SM ( 80 , 90 ) or manual therapy ( 91 ) stated the need for more well-designed mechanistic studies. The present study adds to previous basic studies to guide investigators on which measures should be used in mechanistic clinical trials and which mechanisms may underlie the clinical effects of SM in these clinical trials.…”

Force Distribution Within Spinal Tissues During Posterior to Anterior Spinal Manipulative Therapy: A Secondary Analysis

“…It involves the application of a high velocity, low amplitude force to a targeted region of the spine (Triano, 2001;Herzog, 2010). These applied forces mechanically load the spine and surrounding structures, capable of triggering neuromechanical responses which are considered to be related to physiological and clinical effects (Lima et al, 2020;Gevers-Montoro et al, 2021). Forces applied during SMT have been the focus of several studies, primarily to investigate how the input parameters of SMT (e.g., force-time characteristics, application site, etc.)…”

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.

“…Likewise, patients with cLBP experience short-term improvement in function after a spinal manipulative therapy compared with non-recommended interventions or sham manipulation (10). The effect of spinal manipulative therapy has contradictory ndings compared to sham manipulation or placebo intervention (12). Spinal manipulative therapy demonstrated a similar reduction in pain but superior improvement in function compared to sham manipulation (10).…”