Spinal Manipulation For Chronic Pain

Today's post from sciencedaily.com (see link below) looks at spinal manipulative therapy (SMT) as a means of reducing chronic pain in the back. central spinal sensitization is also a factor in peripheral neuropathic problems and SMT may also be able to play a role in lessening neuropathic pain too. The post is generally aimed at low back pain sufferers but it's an interesting read for all those living with chronic pain.

Spinal manipulative therapy reduces central pain sensitization 
Date:
February 25, 2014
Source:
American Pain Society

The lessening of pain sensitivity achieved with spinal manipulation therapy (SMT) occurs as a result of the treatment and not as much from a placebo effect caused by the expectation of receiving SMT. Chronic low back pain is associated with altered pain processing, suggesting a mechanism related to central sensitization of pain. Central sensitization is considered a factor in the progression of acute pain to chronic pain and in the maintenance of chronic pain.

The lessening of pain sensitivity achieved with spinal manipulation therapy (SMT) occurs as a result of the treatment and not as much from a placebo effect caused by the expectation of receiving SMT, according to a study published in The Journal of Pain.

Spinal manipulative therapy has been shown to reduce the severity of low back pain in some patients. Improved understanding of its pain-relieving mechanisms could enhance clinical effectiveness.

Chronic low back pain is associated with altered pain processing, suggesting a mechanism related to central sensitization of pain. Central sensitization is considered a factor in the progression of acute pain to chronic pain and in the maintenance of chronic pain.

Researchers from the University of Florida investigated whether lessening of pain sensitivity attributed to SMT is specific to the procedure itself or occurs as a placebo effect from treatment expectation. Studies have shown that placebo is associated with robust analgesia produced by anticipation of pain relief.

Subjects for the study had low back pain and were recruited from the University of Florida campus. Participants underwent baseline pressure and thermal pain testing and were randomly assigned to SMT, placebo SMT, enhanced placebo SMT (same as placebo SMT except subjects were informed they would get SMT or a placebo intervention) or no intervention. The 110 study subjects had repeat mechanical and thermal pain sensitivity testing to measure immediate, within session, change in pain sensitivity.

Results showed that significantly more participants receiving the enhanced placebo SMT indicated good to excellent outcomes than those receiving standard placebo SMT or no treatment. A significant difference was not found between subjects receiving SMT and the enhanced placebo.

The authors concluded their findings reveal a mechanism of SMT unrelated to the expectation of receiving SMT, but from modulation of dorsal horn excitability and lessening of central sensitization. This suggests potential for SMT to be a clinically beneficial intervention.

Story Source:

The above story is based on materials provided by American Pain Society. Note: Materials may be edited for content and length.

Journal Reference:
Joel E. Bialosky, Steven Z. George, Maggie E. Horn, Donald D. Price, Roland Staud, Michael E. Robinson. Spinal Manipulative Therapy–Specific Changes in Pain Sensitivity in Individuals With Low Back Pain (NCT01168999). The Journal of Pain, 2014; 15 (2): 136 DOI: 10.1016/j.jpain.2013.10.005
 
http://www.sciencedaily.com/releases/2014/02/140225122220.htm