Spinal manipulation and beta-endorphin: a controlled study of the effect of a spinal manipulation on plasma beta-endorphin levels in normal males

The role of spinal manipulation in the relief of pain is becoming clearer and more demonstrable as time passes. One approach to this study is the effect of manipulation on the neurochemical mechanisms of antinociception. Chief among these is beta-endorphin, which has been found to produce a wide range of beneficial effects, especially analgesia. The intent of our study was to demonstrate the effect of spinal manipulation on plasma beta-endorphin levels. Three groups of male subjects were randomly created: the experimental, sham and control groups. All three groups were screened for symptomatology, present use of medications and the present use of innocuous stimulants, such as nicotine and caffeine. A standard protocol involving a 20-min pretest resting period, an intervention and a 40-min test period ensued. The experimental group received a manipulation in the region of the cervical spine; the placebo group received a sham maneuver with no dynamic thrust; the control group received no intervention. Samples were taken by venipuncture at -20, -5, +5, +10 and +30 min. The data were analyzed by repeated measures analysis of variance and by Scheffe's post-hoc multiple comparison tests. Plasma beta-endorphin levels were assessed by radioimmune assay technique (according to the method described by Harber and Sutton in 1984). The results of our study demonstrated a small, but statistically significant, increase in serum beta-endorphin levels in the experimental group at the 5-min postintervention point. The levels in the placebo and control groups demonstrated a steady decrease that was distinct from the response in the experimental group.(ABSTRACT TRUNCATED AT 250 WORDS)     

The effect of spinal manipulation on pain and prostaglandin levels in women with primary dysmenorrhea.

OBJECTIVE: The primary objectives of this study were to compare the effect of spinal manipulation vs. sham manipulation on a) circulating plasma levels of the prostaglandin F2a metabolite, 15-keto-13,14-dihydroprostaglandin (KDPGF2a), b) perceived abdominal and back pain and c) perceived menstrual distress in women with primary dysmenorrhea. DESIGN: This randomized clinical pilot study investigated the outcome measures before and after either a spinal manipulation treatment (SMT) or a sham manipulation. SETTING: All subjects were treated at the National College Chiropractic clinic, a private chiropractic clinic in the suburban Chicago area. PARTICIPANTS: Forty-five women with a history of primary dysmenorrhea were recruited from the local community. The volunteers ranged in age from 20-49 (mean age = 30.3 yr), and were entered into the study between April 1990 and January 1991. Twenty-four were randomly assigned to the spinal manipulation group and 21 were assigned to the sham group. INTERVENTIONS: Subjects treated with spinal manipulation were placed in a side-lying position with the bottom leg straight and the top leg flexed at the knee and hip. They received a high-velocity, short lever, low-amplitude thrust to all clinically relevant vertebral levels within T10 and L5-S1 and the sacroiliac joints. In the sham manipulation, subjects were placed in a side-lying position with both hips and knees flexed. Their manipulation consisted of a similar thrust administered to the midline base of the sacrum. OUTCOME MEASURES: Perceived abdominal and back pain were measured with a visual analog scale, and menstrual distress was measured with the Menstrual Distress Questionnaire. Both were administered 15 min before and 60 min after treatment. Blood samples were collected by venipuncture for the determination of plasma levels of KDPGF2a at the same times. The plasma was then assayed for KDPGF2a by radioimmunoassay. RESULTS: Analysis of covariance and paired Student's t tests were used for the statistical evaluation. Immediately after treatment, the perception of pain and the level of menstrual distress were significantly reduced by SMT. This reduction was associated with a significant reduction in plasma levels of KDGPF2a in the SMT group. A significant and similar reduction in plasma KDPGF2a also occurred in the sham group, indicating that a placebo effect was associated with a single sham intervention. CONCLUSIONS: This randomized pilot study suggests that SMT may be an effective and safe nonpharmacological alternative for relieving the pain and distress of primary dysmenorrhea. However, the large change in KDPGF2a observed in both treatment groups clearly indicates that further studies with more subjects, studied over a longer time frame, are needed to resolve the question of a placebo effect.     

A single-blind placebo-controlled investigation into the analgesic effects of interferential currents on experimentally induced ischaemic pain in healthy subjects

The aim of this single-blind placebo-controlled study was to examine the analgesic effects of interferential currents (IFC) on experimentally induced ischaemic pain. Ischaemic pain was induced using the submaximal effort tourniquet technique (SETT) and pain intensity was recorded using a visual analogue scale at 1-min intervals was used as the primary outcome measure. Following baseline recordings 30 healthy volunteers received either active IFC, sham IFC, or no treatment (10 subjects per group). Data were analysed by calculating the mean change in pain intensity at each 1-min interval by subtracting data during treatment from the baseline data. IFC was administered throughout the duration of the ischaemic pain test via four electrodes (quadripolar application) on the forearm. Active IFC delivered electrical currents at a 'strong but comfortable' intensity. A 'dummy' stimulator that delivered no current was used as sham IFC. Subjects in the no treatment control group were informed that the IFC device was not switched on. There were significant effects for Groups (P=0.04) which were attributed to a significant reduction in pain intensity for the IFC group when compared with sham and no-treatment control (P< or =0.05). There were no significant effects for Time (P=0.69) or Group-Time interaction (P=0.45). In conclusion, IFC produced significantly greater analgesia than sham and no-treatment control groups under the present experimental conditions.     

Pressure pain threshold evaluation of the effect of spinal manipulation in the treatment of chronic neck pain: a pilot study

Nine subjects with chronic mechanical neck pain syndromes were evaluated for pressure pain threshold (PPT) over standardized tender points in the paraspinal area surrounding a manipulable spinal lesion. The subjects were then allocated randomly to an intervention consisting of either an oscillatory mobilization of the cervical spine (n = 4), which was designated as the control procedure, or a rotational manipulation of the cervical spine (n = 5). An assessor-blinded re-evaluation of the pressure pain threshold levels was conducted after 5 min. In the group receiving a manipulation the mean increases in pressure pain threshold ranged from 40-56% with an average of 45%. In the control group no change in any of the pressure pain thresholds was found. These results were analyzed using ANOVA and were found to be statistically significant (p less than 0.0001). This study confirms that manipulation can increase local paraspinal pain threshold levels. The use of the pressure pain threshold meter allows for the determination of such a beneficial effect in the deeper tissues.     

The effect of therapeutic touch on pain and anxiety in burn patients

The purpose of this single-blinded randomized clinical trial was to determine whether therapeutic touch (TT) versus sham TT could produce greater pain relief as an adjunct to narcotic analgesia, a greater reduction in anxiety, and alterations in plasma T-lymphocyte concentrations among burn patients. Therapeutic touch is an intervention in which human energies are therapeutically manipulated, a practice conceptually supported by Rogers' (1970) theory of unitary human beings. Data were collected at a university burn centre in the south-eastern United States. The subjects were 99 men and women between the ages of 15 and 68 hospitalized for severe burns, and they received either TT or sham TT once a day for 5 days. Baseline data were collected on day 1, data were collected before and after treatment on day 3, and post-intervention data were collected on day 6. Instruments included the McGill Pain Questionnaire, Visual Analogue Scales for Pain, Anxiety and Satisfaction with Therapy, and an Effectiveness of Therapy Form. Blood was drawn on days 1 and 6 for lymphocyte subset analysis. Medication usage for pain in mean morphine equivalents, and mean doses per day of sleep, anxiety and antidepressant medications were recorded. Subjects who received TT reported significantly greater reduction in pain on the McGill Pain Questionnaire Pain Rating Index and Number of Words Chosen and greater reduction in anxiety on the Visual Analogue Scale for Anxiety than did those who received sham TT. Lymphocyte subset analyses on blood from 11 subjects showed a decreasing total CD8+lymphocyte concentration for the TT group. There was no statistically significant difference between groups on medication usage.     

Effect of transcutaneous electrical nerve stimulation on human blood beta-endorphin levels

We randomly assigned 42 subjects for treatment with transcutaneous electrical nerve stimulation (TENS) to one of three groups: conventional TENS--80 Hz; low frequency TENS--2 Hz; and a control group--TENS without batteries. Pain threshold measurements and blood beta-endorphin levels were obtained at regular intervals before, during, and for 17 hours after TENS application. We found no significant difference in blood beta-endorphin levels between the groups before, during, or immediately after TENS application. The differences in pain threshold and beta-endorphin levels appeared to be a function of the patient-selection process and not the application of TENS. The results indicated that TENS, with the stimulation characteristics used in this study, did not significantly change the measured plasma levels of beta-endorphin. The blind administration of naloxone hydrochloride, an opiate antagonist, did not significantly alter the perceived experimental pain of these subjects. We could find no evidence that TENS altered experimental pain threshold or plasma beta-endorphin levels.     

The role of prior pain experience and expectancy in psychologically and physically induced pain

Cognitive theories regarding symptom formation suggest that environmental factors such as warnings of impending pain and earlier experiences with pain can lead to a cognitive schema in which pain is selectively monitored. This study evaluated the role of prior experience with pain in the development of expectancy induced somatoform pain. Subjects from two experimental groups were connected to a sham stimulator and told to expect a headache. One of these groups, the physical stimulation first group, was exposed to pain induction by ice water and by pressure prior to the sham stimulation. A second group, the sham stimulation first group, received the sham stimulation followed by the cold water and pressure pain induction techniques. Subjects in the physical stimulation first group showed significant increases in their pain reports as settings on the sham stimulator were increased. Significant increases were not noted in the sham stimulation first group. The two groups did not differ in the number of subjects reporting pain or the mean maximal pain reported during the sham stimulation. Duration of cold water tolerance and the time until the analgesic threshold level for cold water were significantly shorter in subjects who had the sham stimulation first. This study suggests that prior pain can influence the reactivity to external suggestion for pain but does not increase the frequency of pain reports. It does suggest that the selective monitoring induced during the sham stimulation may influence later pain behaviours as was seen during the cold water tolerance testing.     

Situational and psychophysiological factors in psychologically induced pain

To investigate pain that occurs in the absence of painful stimulation, normal subjects were connected to a sham stimulator and were told that a headache could occur as a result of the electrical current they would receive. Half of the subjects who received this suggestion reported pain. The frequency and intensity of pain reports in a group which was given prior pain experience as a reference point in reporting pain and in a group which was exposed to a manipulation designed to reduce intentional deception were not significantly different from the pain reports of a group not exposed to these manipulations. The frequency of pain reports in subjects not connected to the sham stimulator but still asked to report pain was 25% which was significantly less than the frequency for subjects who were told there would be stimulation to the head. Pain ratings increased as the settings of the sham stimulator were increased. Subjects who reported pain had significantly fewer electrodermal responses to tones signaling them to prepare for a reaction time task. The results suggest that pain can be produced in the absence of peripheral stimulation. The pain does not appear to be due to intentional deception or the lack of a standard for comparison, but is strongly influenced by environmental cues. Psychophysiologically, pain responders were less attentive to signal stimuli.     

Effects of myofascial release in erector spinae myoelectric activity and lumbar spine kinematics in non-specific chronic low back pain: Randomized controlled trial

BackgroundFlexion-relaxation response of the lumbar erector spinae has been previously studied after different interventions such as exercise programs or spinal manipulation, in subjects with chronic low back pain. The objective of the study was to investigate the effects of an isolated myofascial release protocol on erector spinae myoelectric activity and lumbar spine kinematics in chronic low back pain.MethodsThirty-six participants, with nonspecific chronic low back pain, were randomized to myofascial release group (n = 18) receiving four sessions of myofascial treatment, each lasting 40 min, and to control group (n = 18) receiving a sham myofascial release. Electromyographic and kinematic variables as well as pain and disability questionnaires were analyzed.FindingsThere was a bilateral reduction of the flexion relaxation ratio in individuals receiving myofascial release and who did not show myoelectric silence at baseline (right difference M = 0.34, 95% CI [0.16, 0.33], p ≤ .05 and left difference M = 0.45, 95% CI [0.16, 0.73], p ≤ .05). There was also a significant reduction in pain in the myofascial release group (difference M = −9.1, 95% CI [−16.3, −1.8], p ≤ .05) and disability (difference M = −5.6, 95% CI [−9.1, −2.1], p ≤ .05), compared with control group. No significant differences between groups were found for the kinematic variables.InterpretationThe myofascial release protocol contributed to the normalization of the flexion- relaxation response in individuals who did not show myoelectric silence before the intervention, and also showed a significant reduction in pain and disability compared with the sham group.     

Ice and pulsed electromagnetic field to reduce pain and swelling after distal radius fractures.

OBJECTIVE: To examine the relative effectiveness of ice therapy and/or pulsed electromagnetic field in reducing pain and swelling after the immobilization period following a distal radius fracture. METHODS: A total of 83 subjects were randomly allocated to receive 30 minutes of either ice plus pulsed electromagnetic field (group A); ice plus sham pulsed electromagnetic field (group B); pulsed electromagnetic field alone (group C), or sham pulsed electromagnetic field treatment for 5 consecutive days (group D). All subjects received a standard home exercise programme. A visual analogue scale was used for recording pain; volumetric displacement for measuring the swelling of the forearm; and a hand-held goniometer for measuring the range of wrist motions before treatment on days 1, 3 and 5. RESULTS: At day 5, a significantly greater cumulative reduction in the visual analogue scores as well as ulnar deviation range of motion was found in group A than the other 3 groups. For volumetric measurement and pronation, participants in group A performed better than subjects in group D but not those in group B. CONCLUSION: The addition of pulsed electromagnetic field to ice therapy produces better overall treatment outcomes than ice alone, or pulsed electromagnetic field alone in pain reduction and range of joint motion in ulnar deviation and flexion for a distal radius fracture after an immobilization period of 6 weeks.     

Immediate effects of the audible pop from a thoracic spine thrust manipulation on the autonomic nervous system and pain: a secondary analysis of a randomized clinical trial

Purpose

This study investigated the immediate effects of audible joint sounds following a supine T3-T4 spinal thrust manipulation on the autonomic nervous system activity using a fully automated pupillometry system in patients with chronic neck pain. An additional aim was to determine if audible sounds as perceived by the therapist were associated with the reduction of pain following manipulation.

Methods

One hundred subjects with chronic neck pain completed the study protocol. The Mann-Whitney U test was used to compare the change scores of the 3 measuring points between the one-pop and multiple-pop groups. Subjects were randomized into either a manipulation or a mobilization group. A method of automated pupillometry was used in this study to capture pupil responsiveness.

Results

The analysis showed that there was no significant difference between the 2 groups (P > .05). The Kruskal-Wallis test was used to compare the median change scores between the mobilization, no-pop, and pop groups. The analysis showed that there was no statistically significant difference in the amount of change in pupil diameter between the 3 groups (P > .05).The Mann-Whitney U test demonstrated that the no-pop group (P = .031) and the multiple-pop group (P = .014) had a significant reduction of pain; however, it did not reach the minimal clinically significant level of 13 mm on the visual analog scale.

Conclusions

The results of this study provided evidence that the presence of joint sounds does not influence the overall activity of the autonomic nervous system following a thrust manipulation or contribute to the reduction of pain in patients with chronic neck pain.     

Modulation of shock-elicited pain by acupuncture and suggestion.

An experimental investigation of acupuncture's analgesic potency, separated from suggestion effects, is described, in which judgments of shock-elicited pain of the forearm were recorded along two separate scales: intensity and aversiveness. Data from experimental subjects, who received electrical acupunctural stimulation through surface electrodes located over acupuncture points and were given explicit counter-suggestions of sensitization, were compared to those obtained from control subjects, who received such stimulation over incorrect loci and were given explicit suggestions of analgesia. No alterations in the perception of pain intensity, either by acupunctural stimulation or suggestion, could be detected at any time during the experiment, but stimulation of the correct points produced a significant analgesic reduction in aversiveness which was specific to the arm so stimulated, overcame the counter-suggestion of sensitization, and persisted after stimulation was discontinued. No significant reductions were recorded from control subjects. These findings are interpreted in light of other experimental acupuncture research, and of the demonstrated mode of action of analgesics of proven efficacy.     

Relaxation training as a treatment for chronic pain caused by ulcerative colitis

Relaxation training was found to be highly successful in ameliorating pain in a population that has not been studied before—individuals with ulcerative colitis. Twenty subjects with chronic pain due to ulcerative colitis received 6 weekly training sessions of 75 min duration in the technique of progressive relaxation, and another 20 subjects with the same condition constituted an attention control group. There were no significant differences between experimental and control subjects before treatment but, immediately after treatment and also at the 6-week follow-up, experimental and control subjects differed significantly on 6 of 7 measures. By comparison with control subjects, experimental subjects: (1) used significantly fewer words on the McGill Pain Questionnaire to describe their pain (P < 0.001); (2) rated their pain, on a scale of 1–10, as less intense (P < 0.02); (3) said that their pain was less frequent (P < 0.04); (4) rated their pain relief, on a scale of 1–10, as greater (P < 0.001); (5) reported, on the Zung Pain and Distress Scale, less distress due to pain (P < 0.001). After treatment but not before there were significantly fewer experimental than control subjects taking anti-inflammatory drugs (P < 0.03).     

Hydrotherapy in labor

Maternal anxiety and pain prolong labor and contribute to fetal distress. Hydrotherapy during labor may promote relaxation and decrease pain without the risks caused by other treatments. In this pilot study the psychophysiological effects of hydrotherapy on maternal anxiety and pain during labor were examined. Using a randomized, pretest-posttest control group design with repeated measures, 18 term parturients were assigned to a control or an experimental group. Experimental subjects were placed in a tub of 37 degrees C water for 1 hr during early labor. The Wilcoxon two-sample test revealed statistically significant effects. At 15 min bathers' anxiety and pain scores were decreased compared to nonbathers. At 60 min bathers' pain scores were decreased compared to nonbathers. After 15 min of immersion, bathers had a significantly greater increase in plasma volume than nonbathers. No significant differences were found in urine catecholamines or maternal-fetal complications. The small sample limits conclusions, but the findings offer preliminary support for the therapeutic effects of bathing in labor for acute, short-term anxiety and pain reduction.     

Manual acupuncture for analgesia during electromyography: a pilot study

OBJECTIVES: To evaluate the analgesic effect of acupuncture for needle electromyography and to validate a sham acupuncture needle. DESIGN: Randomized, double-blinded, controlled study. SETTING: University-based electrodiagnostics laboratory. PARTICIPANTS: Fifty-one subjects referred for electrodiagnostic evaluation. INTERVENTIONS: Before the electromyography examination, either real acupuncture needles or telescopic sham needles were applied. MAIN OUTCOME MEASURES: Visual analog scale of pain and unpleasantness after 3 muscles were examined with electromyography. Pretest pain was subtracted to give a measurement of pain attributable to the electromyography. Subjects were asked which needle they thought they had received. RESULTS: Twenty-six subjects were randomized to the treatment group and 25 to the sham group. Pain in the treatment group (-.96) was less than in the control group (9.68), but it was not statistically significant (P=.13). Post hoc analysis, excluding 5 subjects known to have been treated by the novice acupuncturist, showed a significant difference of 14.4mm (P=.02). The proportion of subjects who thought they received real needles in the acupuncture group (69%) did not differ from the proportion in the control group (48%) (P=.13). CONCLUSIONS: Acupuncture may represent an effective form of analgesia for electromyography. This is the first study to suggest independently the telescopic sham acupuncture needle as an effective control.     

规范化疼痛评估及同伴教育在癌痛患者中的应用

目的探讨规范化疼痛评估及同伴教育对癌痛患者自我效能感、生活质量和疼痛控制效果的影响。方法采用便利抽样法,选取河南省肿瘤医院于2019年1月—2020年1月收治的癌症住院患者162例作为研究对象,以患者病房尾号单双数为依据分为观察组(n=82)和对照组(n=80)。对照组患者接受常规健康教育及传统疼痛评估,观察组接受规范化疼痛评估及同伴教育,比较两组患者干预前后的自我效能感、生活质量、疼痛控制效果。结果干预前,两组患者的自我效能感、生活质量各维度得分及总分比较,差异无统计学意义(P>0.05)。干预后,两组癌痛患者自我效能感、生活质量各维度得分及总分均高于干预前,差异有统计学意义(P<0.01);观察组癌痛患者自我效能感、生活质量各维度得分及总分高于对照组,差异有统计学意义(P<0.01)。观察组癌痛患者总体疼痛控制效果优于对照组,差异有统计学意义(Z=-3.721,P<0.01)。结论规范化疼痛评估及同伴教育应用于癌痛患者疼痛管理中可有效提高疼痛控制效果和自我效能感,改善生活质量。     

Imagery-induced relaxation in children's postoperative pain relief: a randomized pilot study

This study aimed to test the efficacy of imagery and relaxation in hospitalized children's postoperative pain relief. Sixty children aged 8-12 years who had undergone appendectomy or upper/lower limb surgery and had been randomly assigned to the experimental group (n(1) = 30) listened to an imagery trip CD, whereas those in the control group (n(2) = 30) received standard care. An investigator-developed questionnaire was used, and the intensity of pain was assessed using a visual analogue scale: before (Phase 1), immediately after (Phase 2), and 1 hour after (Phase 3) intervention or standard care. The children in the experimental group reported having significantly less pain (p < .001) than the control children based on a comparison of VAS pain scores in Phases 1 and 2. There were no significant differences in nurse-assessed pain scores. The type and time of operation were related to pain intensity in children. The nurses underestimated the pain of pediatric patients. The imagery trip CD can be used to reduce children's postoperative pain in a hospital setting, although its effect is short-lasting.     

Enhanced phagocytic cell respiratory burst induced by spinal manipulation: potential role of substance P.

The effect of spinal manipulation on the respiratory burst of polymorphonuclear neutrophils (PMN) and monocytes from treated adults was measured by zymosan-stimulated chemiluminescence (CL). Peripheral blood was collected 15 min before and 15 min after treatment (sham manipulation, thoracic spine manipulation, or soft tissue manipulation), the cells were isolated, challenged with a standardized, opsonized luminol-containing suspension of zymosan, and monitored for CL. Plasma from two subsets of subjects was radioimmunoassayed for Substance P (SP). PMN were also preincubated with SP in vitro over the dose range 5 x 10(-12) M to 5 x 10(-8) M and the CL response monitored. The CL responses of both PMN and monocytes from subjects who received spinal manipulation were significantly higher after than before treatment, and significantly higher than the response in sham or soft-tissue treated subjects. Measurement of the force applied by sham and spinal manipulation suggested a force threshold for the enhancement of the CL response. Plasma levels of SP before and after treatment in sham treated subjects did not differ significantly; however, elevated plasma SP was observed in subjects after spinal manipulation. Preincubation of PMN with 1 x 10(-11) M, 5 x 10(-11) M or 1 x 10(-10) M SP in vitro primed PMN for an enhanced respiratory burst when the cells were subsequently challenged.     

Conservative methods for reducing lateral translation postures of the head: a nonrandomized clinical control trial

Fifty-one retrospective, consecutive patients were compared to twenty-six prospective volunteer controls in a nonrandomized clinical control trial. Both groups had chronic neck pain and lateral head translation posture. For treatment subjects, beginning and follow-up pain scales and anteroposterior (AP) cervical radiographs were obtained after 12.8 weeks of care (average of 37 visits), while the duration was a mean of 12 months for control subjects. Digitized radiographs were analyzed for Risser-Ferguson angles and a horizontal translation distance of C2 from a vertical line through T3. For treatment, patients received the Harrison mirror-image postural methods, which include mechanically assisted manipulation, opposite head posture exercise, and opposite head translation posture traction. While no significant differences were found in the control group subjects' pain scores and AP radiographic measurements, statistically significant improvements were observed in the treatment group subjects' pain scores and lateral translation displacements of C2 compared to T3 (pretrial score: 13.7 mm, posttrial score: 6.8 mm) and in angle measurements.