Immediate effects of spinal manipulation on thermal pain sensitivity: an experimental study

Steven Z George, Mark D Bishop, Joel E Bialosky, Giorgio Zeppieri Jr, Michael E Robinson, Steven Z George, Mark D Bishop, Joel E Bialosky, Giorgio Zeppieri Jr, Michael E Robinson

Abstract

Background: The underlying causes of spinal manipulation hypoalgesia are largely unknown. The beneficial clinical effects were originally theorized to be due to biomechanical changes, but recent research has suggested spinal manipulation may have a direct neurophysiological effect on pain perception through dorsal horn inhibition. This study added to this literature by investigating whether spinal manipulation hypoalgesia was: a) local to anatomical areas innervated by the lumbar spine; b) correlated with psychological variables; c) greater than hypoalgesia from physical activity; and d) different for A-delta and C-fiber mediated pain perception.

Methods: Asymptomatic subjects (n = 60) completed baseline psychological questionnaires and underwent thermal quantitative sensory testing for A-delta and C-fiber mediated pain perception. Subjects were then randomized to ride a stationary bicycle, perform lumbar extension exercise, or receive spinal manipulation. Quantitative sensory testing was repeated 5 minutes after the intervention period. Data were analyzed with repeated measures ANOVA and post-hoc testing was performed with Bonferroni correction, as appropriate.

Results: Subjects in the three intervention groups did not differ on baseline characteristics. Hypoalgesia from spinal manipulation was observed in lumbar innervated areas, but not control (cervical innervated) areas. Hypoalgesic response was not strongly correlated with psychological variables. Spinal manipulation hypoalgesia for A-delta fiber mediated pain perception did not differ from stationary bicycle and lumbar extension (p > 0.05). Spinal manipulation hypoalgesia for C-fiber mediated pain perception was greater than stationary bicycle riding (p = 0.040), but not for lumbar extension (p = 0.105).

Conclusion: Local dorsal horn mediated inhibition of C-fiber input is a potential hypoalgesic mechanism of spinal manipulation for asymptomatic subjects, but further study is required to replicate this finding in subjects with low back pain.

Figures

Figure 1
Figure 1
Spinal manipulation technique utilized in this study(5;47;54–56). (Reprinted with permission of the American Physical Therapy Association from Cibulka MT. The treatment of the sacroiliac joint component to low back pain: a case report. Phys Ther. 1992;72:917–922.)
Figure 2
Figure 2
Temporal summation hypoalgesia for stationary bicycle, lumbar extension, and spinal manipulation. Figure 2 Key • Positive numbers indicate hypoalgesia • Error bars are 1 standard error • * – indicates statistically significant (p < 0.05) difference in intervention for pain sensitivity in lower extremity area.

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