The effect of a single spinal manipulation on cardiovascular autonomic activity and the relationship to pressure pain threshold: a randomized, cross-over, sham-controlled trial

Mathieu Picchiottino, Margaux Honoré, Charlotte Leboeuf-Yde, Olivier Gagey, François Cottin, David M Hallman, Mathieu Picchiottino, Margaux Honoré, Charlotte Leboeuf-Yde, Olivier Gagey, François Cottin, David M Hallman

Abstract

Background: The autonomic nervous system interacts with the pain system. Knowledge on the effects of high velocity low amplitude spinal manipulations (SM) on autonomic activity and experimentally induced pain is limited. In particular, the effects of SM on autonomic activity and pain beyond the immediate post intervention period as well as the relationship between these two outcomes are understudied. Thus, new research is needed to provide further insight on this issue.

Objectives: The aim was to assess the effect of a single SM (i.e. SM vs. sham) on cardiovascular autonomic activity. Also, we assessed the relationship between cardiovascular autonomic activity and level of pain threshold after the interventions.

Method: We conducted a randomized, cross-over, sham-controlled trial on healthy first-year chiropractic students comprising two experimental sessions separated by 48 h. During each session, subjects received, in a random order, either a thoracic SM or a sham manipulation. Cardiovascular autonomic activity was assessed using heart rate and systolic blood pressure variabilities. Pain sensitivity was assessed using pressure pain threshold. Measurements were performed at baseline and repeated three times (every 12 min) during the post intervention period. Participants and outcome assessors were blinded. The effect of the SM was tested with linear mixed models. The relationship between autonomic outcomes and pressure pain threshold was tested with bivariate correlations.

Results: Fifty-one participants were included, forty-one were finally analyzed. We found no statistically significant difference between SM and sham in cardiovascular autonomic activity post intervention. Similarly, we found no post-intervention relationship between cardiovascular autonomic activity and pressure pain threshold.

Conclusion: Our results suggest that a single SM of the thoracic spine has no specific effect on cardiovascular autonomic activity. Also, we found no relationship between cardiovascular autonomic activity and pressure pain threshold after the SM. Further experimental research should consider the use of several markers of autonomic activity and a more comprehensive pain assessment.

Trial registration: N° NCT03273868. Registered September 6, 2017.

Keywords: Autonomic nervous system; HVLA; Heart rate variability; High velocity low amplitude manipulation; Manipulation; Pressure pain threshold; Spinal manipulation.

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests. CLY is a senior advisor at the Journal but played no role in the review process.

© The Author(s). 2020.

Figures

Fig. 1
Fig. 1
(a) Experimental design (b) Session design
Fig. 2
Fig. 2
Participant flow diagram

References

    1. Hurwitz EL. Epidemiology: Spinal manipulation utilization. J Electromyogr Kinesiol. 2012;22(5):648–654. doi: 10.1016/j.jelekin.2012.01.006.
    1. Gross A, Langevin P, Burnie SJ, Bedard-Brochu MS, Empey B, Dugas E, Faber-Dobrescu M, Andres C, Graham N, Goldsmith CH, et al. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database Syst Rev. 2015;9:CD004249.
    1. Coulter ID, Crawford C, Hurwitz EL, Vernon H, Khorsan R, Suttorp Booth M, Herman PM. Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. Spine J. 2018;18(5):866–879. doi: 10.1016/j.spinee.2018.01.013.
    1. Rubinstein SM, de Zoete A, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ. 2019;364:l689. doi: 10.1136/bmj.l689.
    1. Branney J, Breen AC. Does inter-vertebral range of motion increase after spinal manipulation? A prospective cohort study. Chiropr Man Ther. 2014;22(1).
    1. Anderst WJ, Gale T, LeVasseur C, Raj S, Gongaware K, Schneider M. Intervertebral kinematics of the cervical spine before, during, and after high-velocity low-amplitude manipulation. Spine J. 2018;18(12):2333–2342. doi: 10.1016/j.spinee.2018.07.026.
    1. Nougarou F, Dugas C, Deslauriers C, Page I, Descarreaux M. Physiological responses to spinal manipulation therapy: investigation of the relationship between electromyographic responses and peak force. J Manip Physiol Ther. 2013;36(9):557–563. doi: 10.1016/j.jmpt.2013.08.006.
    1. Page I, Nougarou F, Dugas C, Descarreaux M. The effect of spinal manipulation impulse duration on spine neuromechanical responses. J Can Chiropr Assoc. 2014;58(2):141–148.
    1. Nougarou F, Pagé I, Loranger M, Dugas C, Descarreaux M. Neuromechanical response to spinal manipulation therapy: effects of a constant rate of force application. BMC Complement Altern Med. 2016;16(1).
    1. Millan M, Leboeuf-Yde C, Budgell B, Amorim M-A. The effect of spinal manipulative therapy on experimentally induced pain: a systematic literature review. Chiropr Man Therap. 2012;20(1):26. doi: 10.1186/2045-709X-20-26.
    1. Honore M, Leboeuf-Yde C, Gagey O. The regional effect of spinal manipulation on the pressure pain threshold in asymptomatic subjects: a systematic literature review. Chiropr Man Therap. 2018;26:11. doi: 10.1186/s12998-018-0181-3.
    1. Chu J, Allen DD, Pawlowsky S, Smoot B. Peripheral response to cervical or thoracic spinal manual therapy: an evidence-based review with meta analysis. J Man Manipulative Ther. 2014;22(4):220–229. doi: 10.1179/2042618613Y.0000000062.
    1. Kingston L, Claydon L, Tumilty S. The effects of spinal mobilizations on the sympathetic nervous system: a systematic review. Man Ther. 2014;19(4):281–287. doi: 10.1016/j.math.2014.04.004.
    1. Picchiottino M, Leboeuf-Yde C, Gagey O, Hallman DM. The acute effects of joint manipulative techniques on markers of autonomic nervous system activity: a systematic review and meta-analysis of randomized sham-controlled trials. Chiropr Man Therap. 2019;27(1):17. doi: 10.1186/s12998-019-0235-1.
    1. Jänig W: The integrative action of the autonomic nervous system : neurobiology of homeostasis. Cambridge, UK ; New York: Cambridge University Press; 2006.
    1. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task force of the European Society of Cardiology and the north American Society of Pacing and Electrophysiology. Circ. 1996;93(5):1043–65.
    1. Japundzic N, Grichois ML, Zitoun P, Laude D, Elghozi JL. Spectral analysis of blood pressure and heart rate in conscious rats: effects of autonomic blockers. J Auton Nerv Syst. 1990;30(2):91–100. doi: 10.1016/0165-1838(90)90132-3.
    1. Figner B, Murphy RO. Using skin conductance in judgment and decision making research. A handbook of process tracing methods for decision research: a critical review and user's guide. Psychology Pr: New York; 2011.
    1. Perry J, Green A, Singh S, Watson P. A preliminary investigation into the magnitude of effect of lumbar extension exercises and a segmental rotatory manipulation on sympathetic nervous system activity. Man Ther. 2011;16(2):190–195. doi: 10.1016/j.math.2010.10.008.
    1. Perry J, Green A, Singh S, Watson P. A randomised, independent groups study investigating the sympathetic nervous system responses to two manual therapy treatments in patients with LBP. Man Ther. 2015;20(6):861–867. doi: 10.1016/j.math.2015.04.011.
    1. Minarini G, Ford M, Esteves J. Immediate effect of T2, T5, T11 thoracic spine manipulation of asymptomatic patient on autonomic nervous system response: single-blind, parallel-arm controlled-group experiment. Int J Osteopath Med. 2018;30:12–17. doi: 10.1016/j.ijosm.2018.10.002.
    1. Benarroch EE. Pain-autonomic interactions: a selective review. Clin Auton Res. 2001;11(6):343–349. doi: 10.1007/BF02292765.
    1. Benarroch EE. Pain-autonomic interactions. Neurol Sci. 2006;27(Suppl 2):S130–S133. doi: 10.1007/s10072-006-0587-x.
    1. Benarroch EE. Periaqueductal gray: an interface for behavioral control. Neurol. 2012;78(3):210–217. doi: 10.1212/WNL.0b013e31823fcdee.
    1. Wright A. Hypoalgesia post-manipulative therapy: a review of a potential neurophysiological mechanism. Man Ther. 1995;1(1):11–16. doi: 10.1054/math.1995.0244.
    1. Vicenzino B, Collins D, Benson H, Wright A. An investigation of the interrelationship between manipulative therapy-induced hypoalgesia and sympathoexcitation. J Manip Physiol Ther. 1998;21(7):448–453.
    1. Sterling M, Jull G, Wright A. Cervical mobilisation: concurrent effects on pain, sympathetic nervous system activity and motor activity. Man Ther. 2001;6(2):72–81. doi: 10.1054/math.2000.0378.
    1. La Touche R, París-Alemany A, Mannheimer JS, Angulo-Díaz-Parreño S, Bishop MD, Lopéz-Valverde-Centeno A, von Piekartz H, Fernández-Carnero J. Does mobilization of the upper cervical spine affect pain sensitivity and autonomic nervous system function in patients with Cervico-craniofacial pain?: a randomized-controlled trial. Clin J Pain. 2013;29(3):205–215. doi: 10.1097/AJP.0b013e318250f3cd.
    1. FXd A, Scholl Schell M, Ferreira GE, MDV P, de Oliveira LR, Borges BG, Macagnan FE, RDM P, Silva MF. autonomic function and pressure pain threshold following thoracic mobilization in asymptomatic subjects: a randomized controlled trial. J Bodyw Mov Ther. 2017.
    1. Wager TD, Atlas LY. The neuroscience of placebo effects: connecting context, learning and health. Nat Rev Neurosci. 2015;16(7):403–418. doi: 10.1038/nrn3976.
    1. Honoré M, Picchiottino M, Wedderkopp N, Leboeuf-Yde C, Gagey O. What is the effect of spinal manipulation on the pressure pain threshold in young asymptomatic subjects? A randomized placebo-controlled trial, with a cross-over design. Chiropr Man Ther. 2019; 10.1186/s12998-020-0296-1.
    1. Dwan K, Li T, Altman DG, Elbourne D. CONSORT 2010 statement: extension to randomised crossover trials. BMJ. 2019;366:l4378. doi: 10.1136/bmj.l4378.
    1. Grieve GP. Contra-indications to spinal manipulation and allied treatments. Physiother. 1989;75(8):445–453. doi: 10.1016/S0031-9406(10)62623-5.
    1. Budgell B, Polus B. The effects of thoracic manipulation on heart rate variability: a controlled crossover trial. J Manip Physiol Ther. 2006;29(8):603–610. doi: 10.1016/j.jmpt.2006.08.011.
    1. Chaibi A, Saltyte Benth J, Bjorn Russell M. Validation of placebo in a manual therapy randomized controlled trial. Sci Rep. 2015;5:11774. doi: 10.1038/srep11774.
    1. Chesterton LS, Sim J, Wright CC, Foster NE. Interrater reliability of algometry in measuring pressure pain thresholds in healthy humans, using multiple raters. Clin J Pain. 2007;23(9):760–766. doi: 10.1097/AJP.0b013e318154b6ae.
    1. Lacourt TE, Houtveen JH, van Doornen LJP. Experimental pressure-pain assessments: test-retest reliability, convergence and dimensionality. Scand J Pain. 2012;3(1):31–37. doi: 10.1016/j.sjpain.2011.10.003.
    1. O'Neill S, Odegaard-Olsen O, Sovde B. The effect of spinal manipulation on deep experimental muscle pain in healthy volunteers. Chiropr Man Therap. 2015;23:25. doi: 10.1186/s12998-015-0069-4.
    1. ADINSTRUMENTS: Using the Lomb-Scargle Periodogram for HRV analysis. . Accessed 15 Mar 2019.
    1. Shaffer F, Ginsberg JP. An overview of heart rate variability metrics and norms. Front Public Health. 2017;5:258. doi: 10.3389/fpubh.2017.00258.
    1. Billman GE. The LF/HF ratio does not accurately measure cardiac sympatho-vagal balance. Front Physiol. 2013;4:26.
    1. Sandercock GR, Bromley PD, Brodie DA. The reliability of short-term measurements of heart rate variability. Int J Cardiol. 2005;103(3):238–247. doi: 10.1016/j.ijcard.2004.09.013.
    1. Sacha J, Pluta W. Alterations of an average heart rate change heart rate variability due to mathematical reasons. Int J Cardiol. 2008;128(3):444–447. doi: 10.1016/j.ijcard.2007.06.047.
    1. Sacha J, Barabach S, Statkiewicz-Barabach G, Sacha K, Muller A, Piskorski J, Barthel P, Schmidt G. How to strengthen or weaken the HRV dependence on heart rate--description of the method and its perspectives. Int J Cardiol. 2013;168(2):1660–1663. doi: 10.1016/j.ijcard.2013.03.038.
    1. Sacha J, Sobon J, Sacha K, Barabach S. Heart rate impact on the reproducibility of heart rate variability analysis. Int J Cardiol. 2013;168(4):4257–4259. doi: 10.1016/j.ijcard.2013.04.160.
    1. Younes M, Nowakowski K, Didier-Laurent B, Gombert M, Cottin F. Effect of spinal manipulative treatment on cardiovascular autonomic control in patients with acute low back pain. Chiropr Man Therap. 2017;25:33. doi: 10.1186/s12998-017-0167-6.
    1. Morgan CRWVaBL Understanding power and rules of thumb for determining sample sizes. Tutorials Quant Methods Psychol. 2007;3(2):43–50. doi: 10.20982/tqmp.03.2.p043.
    1. Mukaka MM. Statistics corner: a guide to appropriate use of correlation coefficient in medical research. Malawi Med J. 2012;24(3):69–71.
    1. Schober P, Boer C, Schwarte LA. Correlation coefficients: appropriate use and interpretation. Anesth Analg. 2018;126(5):1763–1768. doi: 10.1213/ANE.0000000000002864.
    1. Budgell B, Hirano F. Innocuous mechanical stimulation of the neck and alterations in heart-rate variability in healthy young adults. Auton Neurosci. 2001;91(1–2):96–99. doi: 10.1016/S1566-0702(01)00306-X.
    1. Roy RA, Boucher JP, Comtois AS. Heart rate variability modulation after manipulation in pain-free patients vs patients in pain. J Manip Physiol Ther. 2009;32(4):277–286. doi: 10.1016/j.jmpt.2009.03.003.
    1. Sampath KK, Botnmark E, Mani R, Cotter JD, Katare R, Munasinghe PE, Tumilty S. Neuroendocrine response following a thoracic spinal manipulation in healthy men. J Orthop Sports Phys Ther. 2017;47(9):617–627. doi: 10.2519/jospt.2017.7348.
    1. Lascurain-Aguirrebeña I, Newham DJ, Galindez-Ibarbengoetxea X, Casado-Zumeta X, Lertxundi A, Critchley DJ. Association between sympathoexcitatory changes and symptomatic improvement following cervical mobilisations in participants with neck pain. A double blind placebo controlled trial. Musculoskelet Sci Pract. 2019;42:90–97. doi: 10.1016/j.msksp.2019.05.001.
    1. Bruehl S, Chung OY. Interactions between the cardiovascular and pain regulatory systems: an updated review of mechanisms and possible alterations in chronic pain. Neurosci Biobehav Rev. 2004;28(4):395–414. doi: 10.1016/j.neubiorev.2004.06.004.
    1. Passatore M, Roatta S. Influence of sympathetic nervous system on sensorimotor function: whiplash associated disorders (WAD) as a model. Eur J Appl Physiol. 2006;98(5):423–449. doi: 10.1007/s00421-006-0312-8.
    1. Schlereth T, Birklein F. The sympathetic nervous system and pain. NeuroMolecular Med. 2008;10(3):141–147. doi: 10.1007/s12017-007-8018-6.
    1. Crockett A, Panickar A. Role of the sympathetic nervous system in pain. Anaesth Intensive Care Med. 2011;12(2):50–54. doi: 10.1016/j.mpaic.2010.10.023.
    1. Koenig J, Falvay D, Clamor A, Wagner J, Jarczok MN, Ellis RJ, Weber C, Thayer JF. Pneumogastric (Vagus) nerve activity indexed by heart rate variability in chronic pain patients compared to healthy controls: a systematic review and Meta-analysis. Pain Physician. 2016;19(1):E55–E78.
    1. Tracy LM, Ioannou L, Baker KS, Gibson SJ, Georgiou-Karistianis N, Giummarra MJ. Meta-analytic evidence for decreased heart rate variability in chronic pain implicating parasympathetic nervous system dysregulation. Pain. 2016;157(1):7–29. doi: 10.1097/j.pain.0000000000000360.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren