Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials

Background  

Osteopathic manipulative treatment (OMT) is a distinctive modality commonly used by osteopathic physicians to complement their conventional treatment of musculoskeletal disorders. Previous reviews and meta-analyses of spinal manipulation for low back pain have not specifically addressed OMT and generally have focused on spinal manipulation as an alternative to conventional treatment. The purpose of this study was to assess the efficacy of OMT as a complementary treatment for low back pain.     

Beliefs in the population about cracking sounds produced during spinal manipulation

Objectives

To examine beliefs about cracking sounds heard during high-velocity low-amplitude (HVLA) thrust spinal manipulation in individuals with and without personal experience of this technique.

The influence of expectation on spinal manipulation induced hypoalgesia: An experimental study in normal subjects

Background  

The mechanisms thorough which spinal manipulative therapy (SMT) exerts clinical effects are not established. A prior study has suggested a dorsal horn modulated effect; however, the role of subject expectation was not considered. The purpose of the current study was to determine the effect of subject expectation on hypoalgesia associated with SMT.     

Dorsoventral organization of sensory nerves in the lumbar spine as indicated by double labeling of dorsal root ganglion neurons

Background  

Referred pain due to lumbar disc disorders can be analyzed using the stereoscopic structure of the peripheral sensory nervous system. The rostrocaudal structure has been clarified. The dorsoventral structure of the lumbar spine would be useful for mapping areas of pain perception in spinal disorders.     

Effects of spinal manipulation versus therapeutic exercise on adults with chronic low back pain: a literature review

Background Context:

Chronic low back pain (CLBP) is a prevalent disorder that has a significant burden to society in terms of loss of work time and increased economic cost. Two common treatment choices of intervention for CLBP are spinal manipulation and prescribed exercise.

Purpose:

The purpose of this systematic review was to examine the effectiveness of spinal manipulation vs prescribed exercise for patients diagnosed with CLBP. Studies that compared head-to-head spinal manipulation to an exercise group were included in this review.

Methods:

A search of the current literature was conducted using a keyword process in CINAHL, Cochrane Register of Controlled Trials Database, Medline, and Embase. The search was conducted on, and included studies available up to August 29^th 2014. Studies were included based on PICOS criteria 1) individuals with CLBP defined as lasting 12 weeks or longer; 2) spinal manipulation performed by a health care practitioner; 3) prescribed exercise for the treatment of CLBP and monitored by a health care practitioner; 4) measurable clinical outcomes for reducing pain, disability or improving function; 5) randomized controlled trials. The quality of included articles was determined by the author using the criteria developed and used by the Physiotherapy Evidence Database (PEDro).

Results:

Three randomized controlled trials met the inclusion criteria of this systematic review and were included in this review. The outcomes used in these studies included Disability Indexes, Pain Scales and function improvement scales. The results included a mix of effects with one study finding spinal manipulation as more effective and another finding the exercises more so. The third study found both interventions offering equal effects in the long term.

Conclusion:

Based on the findings of this systematic review there is no conclusive evidence that clearly favours spinal manipulation or exercise as more effective in treatment of CLBP. More studies are needed to further explore which intervention is more effective.     

Hypoalgesia following epidural morphine: a controlled quantitative experimental study

The efficacy, duration, and spread of epidural morphine hypoalgesia were assessed by an experimentally induced pricking pain evoked by laser stimulation. Four mg of plain morphine was injected epidurally in 7 volunteers at the L2-L3 interspace. Thresholds to warmth and pain perception, and pain-evoked potentials were measured. In the first experiment, hypoalgesia was monitored each hour for 7 h at various dermatomes. Hypoalgesia was detected at S1 dermatome after 2 h, but 3 h elapsed before hypoalgesia could be detected at the L1, T12, T10, T8, and T6 dermatomes. No effect was found at C7. No conduction delay was found along the pain pathway during hypoalgesia. Hypoalgesia lasted more than 7 h at S1, whereas hypoalgesia could not be detected after 5 h at other dermatomes. In the second experiment, naloxone (0.8 mg i.v.) was injected 230 min after injection of epidural morphine, and the subsequent recording 10 min later showed that hypoalgesia had been partly reversed. The onset and duration of hypoalgesia are different for experimentally induced pain and clinical pain. Experimentally laser-induced pain has the advantage of being quantitative, and is, as such, useful to assess hypoalgesia, and to test the potency of narcotics.     

Pain in the lumbar, thoracic or cervical regions: do age and gender matter? A population-based study of 34,902 Danish twins 20–71 years of age

Background  

It is unclear to what extent spinal pain varies between genders and in relation to age. It was the purpose of this study to describe the self-reported prevalence of 1) pain ever and pain in the past year in each of the three spinal regions, 2) the duration of such pain over the past year, 3) pain radiating from these areas, and 4) pain in one, two or three areas. In addition, 5) to investigate if spinal pain reporting is affected by gender and 6) to see if it increases gradually with increasing age.     

Scoliosis treatment using a combination of manipulative and rehabilitative therapy: a retrospective case series

Background  

The combination of spinal manipulation and various physiotherapeutic procedures used to correct the curvatures associated with scoliosis have been largely unsuccessful. Typically, the goals of these procedures are often to relax, strengthen, or stretch musculotendinous and/or ligamentous structures. In this study, we investigate the possible benefits of combining spinal manipulation, positional traction, and neuromuscular reeducation in the treatment of idiopathic scoliosis.     

Spinal pain and nutrition in adolescents - an exploratory cross-sectional study

Background  

Spinal pain is an important health issue for adolescents resulting in functional limitations for many and increasing the risk of spinal pain in adulthood. Whilst human and animal studies suggest nutrition could influence spinal pain, this has not been investigated in adolescents. The objective of this exploratory cross sectional study was to evaluate associations between diet and adolescent spinal pain.     

Influence of surgical gloves on haptic perception thresholds

Background

Impairment of haptic perception by surgical gloves could reduce requirements on haptic systems for surgery. While grip forces and manipulation capabilities were not impaired in previous studies, no data is available for perception thresholds.

Methods

Absolute and differential thresholds (20 dB above threshold) of 24 subjects were measured for frequencies of 25 and 250 Hz with a Ψ‐method. Effects of wearing a surgical glove, moisture on the contact surface and subject's experience with gloves were incorporated in a full‐factorial experimental design.

Results

Absolute thresholds of 12.8 dB and ?29.6 dB (means for 25 and 250 Hz, respectively) and differential thresholds of ?12.6 dB and ?9.5 dB agree with previous studies. A relevant effect of the frequency on absolute thresholds was found. Comparisons of glove‐ and no‐glove‐conditions did not reveal a significant mean difference.

Conclusions

Wearing a single surgical glove does not affect absolute and differential haptic perception thresholds.     

Comparison of the effectiveness of three manual physical therapy techniques in a subgroup of patients with low back pain who satisfy a clinical prediction rule: Study protocol of a randomized clinical trial [NCT00257998]

Background  

Recently a clinical prediction rule (CPR) has been developed and validated that accurately identifies patients with low back pain (LBP) that are likely to benefit from a lumbo-pelvic thrust manipulation. The studies that developed and validated the rule used the identical manipulation procedure. However, recent evidence suggests that different manual therapy techniques may result similar outcomes. The purpose of this study is to investigate the effectiveness of three different manual therapy techniques in a subgroup of patient with low back pain that satisfy the CPR.     

Long-term experience with implanted intrathecal drug administration systems for failed back syndrome and chronic mechanical low back pain

Background  

Continuous intrathecal drug delivery has been shown in open studies to improve pain and quality of life in those with intractable back pain who have had spinal surgery. There is limited data on long term effects and and even less for patients with mechanical back pain without prior spinal surgery.     

Efficacy of manipulation for non-specific neck pain of recent onset: design of a randomised controlled trial

Background  

Manipulation is a common treatment for non-specific neck pain. Neck manipulation, unlike gentler forms of manual therapy such as mobilisation, is associated with a small risk of serious neurovascular injury and can result in stroke or death. It is thought however, that neck manipulation provides better results than mobilisation where clinically indicated. There is long standing and vigorous debate both within and between the professions that use neck manipulation as well as the wider scientific community as to whether neck manipulation potentially does more harm than good. The primary aim of this study is to determine whether neck manipulation provides more rapid resolution of an episode of neck pain than mobilisation.     

Clinical outcome of instrumented fusion for the treatment of failed back surgery syndrome: a case series of 100 patients

Object  

Failed back surgery syndrome is defined as persistent chronic low-back pain and/or leg pain lasting more than 1 year, despite of one or more surgical procedures. Instrumented spinal fusion has been offered by surgeons as a potential treatment to recover from pain and functional disability. Factors contributing to good outcome of instrumented spinal fusion have not been investigated extensively. This study evaluated the global perceived recovery and functional status of patients after instrumented fusion for the treatment of failed back surgery syndrome.     

Validation of a novel sham cervical manipulation procedure

Background context

No clinical trial of spinal manipulation for chronic neck pain (NP), for either single or multiple intervention session(s), has used an effective manual sham-manipulation control group.

Purpose

Validate a practical sham cervical high-velocity low-amplitude spinal manipulation.

Study design/setting

Randomized experimental validation study in an institutional clinical research laboratory.

Patient sample

Eligible subjects were males and females, 18 to 60 years of age with mechanical NP (as defined by the International Association for the Study of Pain Classification) of at least 3 months' duration. Subjects with arm pain, any pathologic cause of NP, or any contraindication to spinal manipulation were excluded.

Outcome measures

The primary outcome was the patient's self-report or registration of group allocation after treatment. Secondary outcomes were numerical rating scale-101 for NP, range of motion (ROM; by goniometer), and tenderness (by pressure algometry).

Methods

Eligible subjects were randomly allocated to one of two groups: real cervical manipulation (RM) or sham cervical manipulation (SM). All subjects were given two procedures in sequence, either RM+SM or SM+SM. Immediately after the two procedures, subjects were asked to register any pain experienced during the procedures and to identify their treatment group allocation. Force-time profiles were recorded during all procedures. Secondary clinical outcome measures were obtained at baseline, 5 and 15 minutes after the intervention, including ROM, self-report of pain, and local spinous process tenderness. Data for each variable were summarized and tested for normality in distribution. Summary statistics were obtained for each variable and statistically tested.

Results

Sixty-seven subjects were randomized. Data from 64 subjects (32 per group) were available for analysis. There were no significant differences between the groups at baseline. One adverse event occurred in the “real” group, which was a mild posttreatment pain reaction lasting less than 24 hours. In the RM group, 50% of subjects incorrectly registered their treatment allocation; in the sham group, 53% did so. For the SM group, none of the procedures resulted in cavitation, whereas in the RM group, 87% of procedures resulted in cavitation. There were no significant changes between groups on pain, tenderness, or ROM. Force-time profiles of the RM and SM procedures demonstrated fidelity with significant differences between components as intended.

Conclusions

The novel sham procedure has been shown to be effective in masking subjects to group allocation and to be clinically inert with respect to common outcomes in the immediate posttreatment stage. Further research on serial applications and for multiple operators is warranted.     

Cytokine inhibition and time-related influence of inflammatory stimuli on the hyperalgesia induced by the nucleus pulposus

Introduction  

The symptoms of lumbar disc herniation, such as low back pain and sciatica, have been associated with local release of cytokines following the inflammatory process induced by the contact of the nucleus pulposus (NP) with the spinal nerve.     

Does a dose-response relation exist between spinal pain and temporomandibular disorders?

Background  

The aim of this study was to test whether a reciprocal dose-response relation exists between frequency/severity of spinal pain and temporomandibular disorders (TMD).     

Use of spinal manipulation in a rheumatoid patient presenting with acute thoracic pain: a case report

Background:

There is limited research related to spinal manipulation of uncomplicated thoracic spine pain and even less when pain is associated with comorbid conditions such as rheumatoid arthritis. In the absence of trial evidence, clinical experience and appropriate selection of the type of intervention is important to informing the appropriate management of these cases.

Case presentation:

We present a case of a patient with long standing rheumatoid arthritis who presented with acute thoracic pain. The patient was diagnosed with costovertebral joint dysfunction and a myofascial strain of the surrounding musculature. The patient was unresponsive to treatment involving a generalized manipulative technique; however, improved following the administration of a specific applied manipulation with modified forces. The patient was deemed recovered and discharged with ergonomic and home care recommendations.

Discussion:

This case demonstrates a clinical situation where there is a paucity of research to guide management, thus clinicians must rely on experience and patient preferences in the selection of an appropriate and safe therapeutic intervention. The case highlights the need to contextualize the apparent contraindication of manipulation in patients with rheumatoid arthritis and calls for further research. Finally the paper advances evidence based decision making that balances the available research, clinical experience, as well as patient preferences.     

Design considerations in a clinical trial of a cognitive behavioural intervention for the management of low back pain in primary care: Back Skills Training Trial

Background  

Low back pain (LBP) is a major public health problem. Risk factors for the development and persistence of LBP include physical and psychological factors. However, most research activity has focused on physical solutions including manipulation, exercise training and activity promotion.     

Hypoalgesia following intrathecal morphine: a segmental dependent effect

The onset phase of hypoalgesia, following intrathecal morphine, was assessed by experimental argon laser-induced pain. A dose of 0.4 mg morphine was injected pre-operatively at the L3-L4 level into nine patients. The thresholds to laser-induced pain and pain-evoked brain potentials were monitored for 2 h at the S1, L1, and C7 dermatomes. Hypoalgesia was detected at the S1 and L1 dermatomes after 5 and 15 min, respectively. No hypoalgesic effect was found at C7. This indicates that hypoalgesia was caused predominantly by segmental spinal mechanisms during the onset phase, and not by a general widespread effect. No latency changes (conduction delay) of the brain potentials evoked from the hypoalgesic dermatomes were found. Cutaneous pain, induced experimentally by laser stimulation, has the advantage of being quantitative and is useful to assess the onset and the segmental spread of hypoalgesia.