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.

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Citation

Published Version (Please cite this version)

10.1016/j.jpain.2013.10.005

Publication Info

Bialosky, Joel E, Steven Z George, Maggie E Horn, Donald D Price, Roland Staud and Michael E Robinson (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.

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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 Pain, and International Association for the Study of Pain. 

Dr. George’s research projects have been supported by the National Institutes of Health, Department of Defense, and Orthopaedic Academy of the American Physical Therapy Association.  Dr. George and his collaborators have authored over 300 peer-reviewed publications in leading medical, orthopaedic surgery, physical therapy, rehabilitation, and pain research journals.  He currently serves as Deputy Editor for Physical Therapy and is an Editorial Board Member for the Journal of Pain. Dr. George has also been involved with clinical practice guideline development for the Academy of Orthopaedic Physical Therapy and the American Psychological Association. 

Dr. George has been recognized with prestigious research awards from the American Physical Therapy Association, American Pain Society, and International Association for the Study of Pain. For example from the American Physical Therapy Association: he was named the  21st John H.P. Maley Lecturer, recognized as a Catherine Worthingham Fellow in 2017, and selected for the Marian Williams Award for Research in Physical Therapy in 2022.    

Horn

Maggie Elizabeth Horn

Assistant Professor in Orthopaedic Surgery

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