Spinal Manipulative Therapy-Specific Changes in Pain Sensitivity in Individuals With Low Back Pain (NCT01168999)

被引:93
作者
Bialosky, Joel E. [1 ,2 ]
George, Steven Z. [1 ]
Horn, Maggie E. [2 ]
Price, Donald D. [3 ]
Staud, Roland [4 ]
Robinson, Michael E. [5 ]
机构
[1] Univ Florida, Dept Phys Therapy, Ctr Pain Res & Behav Hlth, Gainesville, FL 32610 USA
[2] Univ Florida, Dept Phys Therapy, Gainesville, FL 32610 USA
[3] Univ Florida, Div Neurosci, Gainesville, FL 32610 USA
[4] Univ Florida, Dept Med, Gainesville, FL 32610 USA
[5] Univ Florida, Ctr Pain Res & Behav Hlth, Dept Clin & Hlth Psychol, Gainesville, FL 32610 USA
关键词
Central sensitization; manual therapy; low back pain; placebo; spinal manipulation; CLINICAL-PREDICTION RULE; MANUAL PHYSICAL-THERAPY; FEAR-AVOIDANCE BELIEFS; 2ND PAIN; PATIENT SATISFACTION; TEMPORAL SUMMATION; DISABILITY QUESTIONNAIRE; CATASTROPHIZING SCALE; CERVICAL-SPINE; NECK PAIN;
D O I
10.1016/j.jpain.2013.10.005
中图分类号
R74 [神经病学与精神病学];
学科分类号
100204 [神经病学];
摘要
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 eta(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. (C) 2014 by the American Pain Society
引用
收藏
页码:136 / 148
页数:13
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