The effect of spinal manipulative therapy on pain relief and function in patients with chronic low back pain: an individual participant data meta-analysis

Zoete, Annemarie de; Rubinstein, Sidney M.; Boer, Michiel R. de; Ostelo, Raymond; Underwood, Martin; Hayden, Jill A.; Buffart, Laurien M.; Tulder, Maurits W. van; Brønfort, Gert; Foster, Nadine E; Maher, C. G.; Hartvigsen, Jan; Balthazard, Pierre; Cecchi, Francesca; Ferreira, ML; Gudavalli, MR; Haas, Mitchell; Hidalgo, Benjamin; Hondras, MA; Hsieh, CJ; Learman, Kenneth; McCarthy, Peter W.; Petersen, Tue Hvass; Rasmussen-Barr, Eva; Skillgate, Eva; Verma, Yogita; Vismara, Luca; Walker, Brianna; Xia, Ting; Zaproudina, Nina

doi:10.1016/j.physio.2021.03.006

Cited by 30 publications

(25 citation statements)

References 42 publications

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“…SM is the main intervention used by chiropractors for the management of back pain ( 10 , 11 ). Recent meta-analyses including individual participant data indicate that SM may be as effective as other recommended therapies for the management of chronic low back pain ( 12 , 13 ). However, current data does not allow the identification of patients that will benefit more or less from SM therapy ( 14 ), in part because the mechanisms of both low back pain and its relief by SM remain unclear.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…The data pooled from 47 randomized controlled trials indicated that SMT provides improvements in pain and disability that are similar to those of recommended therapies for the management of chronic LBP, including exercise (60). The analysis of individual participant data from 21 of these trials confirmed these findings while not being able to identify any individual characteristic that could act as a moderator of the benefits provided by SMT (103,104). Therefore, chronic LBP patients may benefit from SMT and exercise to a similar extent, although it is still not possible to determine which treatment approach will be more beneficial for which patients.…”

Section: Effectiveness Of Spinal Manipulative Therapy Compared To Usual Care For Low Back Painmentioning

confidence: 96%

“…A recent meta-analysis by Coulter et al found moderatequality evidence to suggest that SMT significantly reduces pain and disability in patients with chronic LBP compared to both exercise and physical therapy (97). A set of three meta-analyses investigated the effects of SMT in patients with chronic LBP by comparing SMT or mobilization to currently recommended therapies (mainly exercise), non-recommended or ineffective therapies (inactive controls), and a combination of interventions (60,103,104). The data pooled from 47 randomized controlled trials indicated that SMT provides improvements in pain and disability that are similar to those of recommended therapies for the management of chronic LBP, including exercise (60).…”

Section: Effectiveness Of Spinal Manipulative Therapy Compared To Usual Care For Low Back Painmentioning

confidence: 99%

Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain

et al. 2021

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Spine pain is a highly prevalent condition affecting over 11% of the world's population. It is the single leading cause of activity limitation and ranks fourth in years lost to disability globally, representing a significant personal, social, and economic burden. For the vast majority of patients with back and neck pain, a specific pathology cannot be identified as the cause for their pain, which is then labeled as non-specific. In a growing proportion of these cases, pain persists beyond 3 months and is referred to as chronic primary back or neck pain. To decrease the global burden of spine pain, current data suggest that a conservative approach may be preferable. One of the conservative management options available is spinal manipulative therapy (SMT), the main intervention used by chiropractors and other manual therapists. The aim of this narrative review is to highlight the most relevant and up-to-date evidence on the effectiveness (as it compares to other interventions in more pragmatic settings) and efficacy (as it compares to inactive controls under highly controlled conditions) of SMT for the management of neck pain and low back pain. Additionally, a perspective on the current recommendations on SMT for spine pain and the needs for future research will be provided. In summary, SMT may be as effective as other recommended therapies for the management of non-specific and chronic primary spine pain, including standard medical care or physical therapy. Currently, SMT is recommended in combination with exercise for neck pain as part of a multimodal approach. It may also be recommended as a frontline intervention for low back pain. Despite some remaining discrepancies, current clinical practice guidelines almost universally recommend the use of SMT for spine pain. Due to the low quality of evidence, the efficacy of SMT compared with a placebo or no treatment remains uncertain. Therefore, future research is needed to clarify the specific effects of SMT to further validate this intervention. In addition, factors that predict these effects remain to be determined to target patients who are more likely to obtain positive outcomes from SMT.

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“…Although spinal manipulative therapy has a small immediate effect on the functionality of patients with cLBP (24), there is no speci c patient characteristic that identi es patients more likely to bene t from this intervention (25). Recognising patients' perceptions about the causes of pain and reducing the LBP is essentially better to guide clinical practice and future research (26,27).…”

Section: Introductionmentioning

confidence: 99%

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.

FREITAS¹,

Corrêa

Bittencourt

et al. 2021

Preprint

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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.

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The effect of spinal manipulative therapy on pain relief and function in patients with chronic low back pain: an individual participant data meta-analysis

Cited by 30 publications

References 42 publications

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

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

Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain

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.

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