Spinal manipulative therapy-specific changes in pain sensitivity in individuals with low back pain (NCT01168999).
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 articleSubject
Central sensitizationlow 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
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https://hdl.handle.net/10161/12761Published Version (Please cite this version)
10.1016/j.jpain.2013.10.005Publication 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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Show full item recordScholars@Duke
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
Maggie Elizabeth Horn
Assistant Professor in Orthopaedic Surgery
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