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Spinal manipulative therapy-specific changes in pain sensitivity in individuals with low back pain (NCT01168999).

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Date
2014-02
Authors
Bialosky, Joel E
George, Steven Z
Horn, Maggie E
Price, Donald D
Staud, Roland
Robinson, Michael E
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Abstract
UNLABELLED: Spinal manipulative therapy (SMT) is effective for some individuals experiencing low back pain; however, the mechanisms are not established regarding the role of placebo. SMT is associated with changes in pain sensitivity, suggesting related altered central nervous system response or processing of afferent nociceptive input. Placebo is also associated with changes in pain sensitivity, and the efficacy of SMT for changes in pain sensitivity beyond placebo has not been adequately considered. We randomly assigned 110 participants with low back pain to receive SMT, placebo SMT, placebo SMT with the instructional set "The manual therapy technique you will receive has been shown to significantly reduce low back pain in some people," or no intervention. Participants receiving the SMT and placebo SMT received their assigned intervention 6 times over 2 weeks. Pain sensitivity was assessed prior to and immediately following the assigned intervention during the first session. Clinical outcomes were assessed at baseline and following 2 weeks of participation in the study. Immediate attenuation of suprathreshold heat response was greatest following SMT (P = .05, partial η(2) = .07). Group-dependent differences were not observed for changes in pain intensity and disability at 2 weeks. Participant satisfaction was greatest following the enhanced placebo SMT. This study was registered at www.clinicaltrials.gov under the identifier NCT01168999. PERSPECTIVE: The results of this study indicate attenuation of pain sensitivity is greater in response to SMT than the expectation of receiving an SMT. These findings suggest a potential mechanism of SMT related to lessening of central sensitization and may indicate a preclinical effect beyond the expectations of receiving SMT.
Type
Journal article
Subject
Central sensitization
low back pain
manual therapy
placebo
spinal manipulation
Adult
Central Nervous System Sensitization
Disability Evaluation
Female
Hot Temperature
Humans
Low Back Pain
Male
Musculoskeletal Manipulations
Pain Measurement
Pain Threshold
Patient Satisfaction
Surveys and Questionnaires
Time Factors
Treatment Outcome
Permalink
https://hdl.handle.net/10161/12761
Published Version (Please cite this version)
10.1016/j.jpain.2013.10.005
Publication Info
Bialosky, Joel E; George, Steven Z; Horn, Maggie E; Price, Donald D; Staud, Roland; & Robinson, Michael E (2014). Spinal manipulative therapy-specific changes in pain sensitivity in individuals with low back pain (NCT01168999). J Pain, 15(2). pp. 136-148. 10.1016/j.jpain.2013.10.005. Retrieved from https://hdl.handle.net/10161/12761.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

George

Steven Zachary George

Laszlo Ormandy Distinguished Professor of Orthopaedic Surgery
Dr. George’s primary interest is research involving biopsychosocial models for the prevention and treatment of chronic musculoskeletal pain disorders.  His long term goals are to 1) improve accuracy for predicting who is going to develop chronic pain; and 2) identify non-pharmacological treatment options that limit the development of chronic pain conditions.  Dr. George is an active member of the American Physical Therapy Association, United States Association of the Study of
Horn

Maggie Elizabeth Horn

Assistant Professor in Orthopaedic Surgery
Alphabetical list of authors with Scholars@Duke profiles.
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