The Impact of Manual Therapy Techniques on Pain, Disability and Il-1b Levels in Patients With Chronic Cervical Pain

Abstract

Background: Chronic neck pain is a common musculoskeletal dysfunction, and Manual Therapy is one of the effective treatment modalities, but underlying mechanisms of action are unclear. The study's purpose was to investigate the short-term effect of mobilization-manipulations on patient's symptoms and to detect changes in the concentration of inflammatory biomarker interleukin-1b. Methods: Twenty-two patients aged 20-50 years with chronic neck pain, randomly assigned into two groups. The study group received nine sessions of a three-week Manual Therapy intervention. The control group received SHAM Manual Therapy of the same dosage. Pain and functionality measures conducted before and after the intervention via NPRS and NDI scales, respectively. Blood samples collected at baseline, after the first session and post-intervention, detecting IL-1β concentration, using the corresponding ELISA kit. Mixed ANOVA statistical analysis implemented for differences in the GROUP-TIME factors. Results: There was a significant statistical interaction between factors and significant main effects on pain, functionality, and IL-1β (p <.05). IL-1β was statistically significant reduced (p <.05) at second measurement for the study group, but not significantly reduced (p> .05) between second and final measurement. No statistical significance was found for the control group on any of the dependent variables across measures. Conclusion:Patients with chronic mechanical pain showed significant pain and functionality improvement after manual therapy application. The underlying mechanism of action seems to relate with a reduced IL-1b concentration of reinforcing future research at relevant pain biomarkers.

Effects of joint and nerve mobilisation on neuroimmune responses in animals and humans with neuromusculoskeletal conditions: a systematic review and meta-analysis

“…Information regarding allocation concealment, sample size calculation, and trial registration was unclear and potentially resulted in high levels of bias. 45,61,74,96 The interrater agreement for the RoB assessment was (nearly) perfect (kappa = 0.93 for the animal studies and kappa = 1.0 for the human studies).…”

“…Two of 3 studies did find a reduction in pain intensity after joint manipulation compared with control. 74,96 Another study did not find significant differences in pain intensity and pressure pain thresholds after joint manipulation compared with sham intervention. 46…”

“…Most studies 22,24,25,50,61,65,72,75–77,84,85,90,96 assessed the effects of joint mobilisation and nerve mobilisation on distinct biomarkers, providing a broad description of possible neuroimmune responses primarily in animal models of neuropathic pain and human spinal pain (Appendix D, available at http://links.lww.com/PR9/A104). Eleven 22,24,25,50,65,72,75–77,84,85 of the 13 animal studies identified significant changes in at least one neuroimmune response after joint and nerve mobilisations compared with the control intervention.…”

“…Ten 22,24,49,50,65,72,75,76,84,85 of the 13 animal studies and 3 74,90,96 of 5 human studies revealed that the neuroimmune responses were accompanied by several morphological, behavioural, and functional improvements. These improvements could imply tissue healing, functional recovery, and reduced pain intensity after joint and nerve mobilisations in animal neuropathic pain conditions.…”

“…Eighteen articles were included after full-text screening: 13 animal studies 22,24,25,49,50,65,68,72,[75][76][77]84,85 and 5 human studies. 45,61,74,90,96 Figure 1 presents the flowchart of the selection process. The overall agreement for study inclusion was almost perfect (kappa 5 0.95).…”