The effect of a single spinal manipulation on cardiovascular autonomic activity and the relationship to pressure pain threshold: a randomized, cross-over, sham-controlled trial

Abstract

Background: The autonomic nervous system interacts with the pain system. Knowledge on the effects of high velocity low amplitude spinal manipulations (SM) on autonomic activity and experimentally induced pain is limited. In particular, the effects of SM on autonomic activity and pain beyond the immediate post intervention period as well as the relationship between these two outcomes are understudied. Thus, new research is needed to provide further insight on this issue. Objectives: The aim was to assess the effect of a single SM (i.e. SM vs. sham) on cardiovascular autonomic activity. Also, we assessed the relationship between cardiovascular autonomic activity and level of pain threshold after the interventions. Method: We conducted a randomized, cross-over, sham-controlled trial on healthy first-year chiropractic students comprising two experimental sessions separated by 48 h. During each session, subjects received, in a random order, either a thoracic SM or a sham manipulation. Cardiovascular autonomic activity was assessed using heart rate and systolic blood pressure variabilities. Pain sensitivity was assessed using pressure pain threshold. Measurements were performed at baseline and repeated three times (every 12 min) during the post intervention period. Participants and outcome assessors were blinded. The effect of the SM was tested with linear mixed models. The relationship between autonomic outcomes and pressure pain threshold was tested with bivariate correlations. Results: Fifty-one participants were included, forty-one were finally analyzed. We found no statistically significant difference between SM and sham in cardiovascular autonomic activity post intervention. Similarly, we found no post-intervention relationship between cardiovascular autonomic activity and pressure pain threshold. Conclusion: Our results suggest that a single SM of the thoracic spine has no specific effect on cardiovascular autonomic activity. Also, we found no relationship between cardiovascular autonomic activity and pressure pain threshold after the SM. Further experimental research should consider the use of several markers of autonomic activity and a more comprehensive pain assessment.

The global summit on the efficacy and effectiveness of spinal manipulative therapy for the prevention and treatment of non-musculoskeletal disorders: a systematic review of the literature

“…However, two systematic reviews suggest that such effects, if they occur, are short-lasting and without clinical consequences [ 13 , 20 ]. Moreover, a recent randomized controlled trial which compared SMT to a successful sham control found no such effect [ 21 ]. Although essential to the understanding of physiological mechanisms of action of interventions, laboratory experiments alone have not provided a mechanistic understanding of these hypotheses nor provided evidence of clinical efficacy or effectiveness [ 22 ].…”

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

“…Thus, the present report deals only with information relevant to the pain perception study. For more details, please see Picchiottino et al, 2019 [12]. The study was approved by the ethics committee EA 4532 of the University Paris Sud UFR STAPS, Orsay, France (October, 2016), registered as a clinical trial at https://clinicaltrials.gov (Registration NCT03776708), and, as required by French law, insured by HDI global assurance (N°01012787-14,009).…”

“…The data collection also included autonomic nervous system variables [12], so the students were informed not to ingest food, caffeine, alcohol, or tobacco in the hour prior to the sessions, as well as not to perform intense physical activity the day of the experimentation.…”

Linear and non-linear analysis of heart rate variability in HIV-positive patients on two different antiretroviral therapy regimens

“…Autonomic nervous system it’s a part of the central nervous system, and can be divided in three parts: the enteric-, parasympathetic- and the sympathetic nervous system, [ 39 ] and ensures the perfect physiologic harmony translated in homeostasis by working antagonistically [ 40 ]. ANS can be studied by several non-invasive methods, such as heart rate variability (HRV), cardiovagal, adrenergic, and sudomotor tests [ 31 ] plasma catecholamines, Electrodermal activity, blood pressure changes [ 41 ] and two new protocols described by Ghiasi & Cols.…”