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Pressure pain thresholds in a real-world chiropractic setting: topography, changes after treatment, and clinical relevance?

BACKGROUND: Changes in pain sensitivity are a commonly suggested mechanism for the clinical effect of spinal manipulative therapy (SMT). Most research has examined pressure pain thresholds (PPT) and has primarily been conducted in controlled experimental setups and on asymptomatic populations. Many...

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Autores principales: Nim, Casper G., Aspinall, Sasha L., Weibel, Rasmus, Steenfelt, Martin G., O’Neill, Søren
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9097359/
https://www.ncbi.nlm.nih.gov/pubmed/35550595
http://dx.doi.org/10.1186/s12998-022-00436-2
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author Nim, Casper G.
Aspinall, Sasha L.
Weibel, Rasmus
Steenfelt, Martin G.
O’Neill, Søren
author_facet Nim, Casper G.
Aspinall, Sasha L.
Weibel, Rasmus
Steenfelt, Martin G.
O’Neill, Søren
author_sort Nim, Casper G.
collection PubMed
description BACKGROUND: Changes in pain sensitivity are a commonly suggested mechanism for the clinical effect of spinal manipulative therapy (SMT). Most research has examined pressure pain thresholds (PPT) and has primarily been conducted in controlled experimental setups and on asymptomatic populations. Many important factors are likely to differ between research and clinical settings, which may affect PPT changes following SMT. Therefore, we planned to investigate PPT before and after clinical chiropractic care and investigate relationships with various potentially clinically-relevant factors. METHODS: We recruited participants from four Danish chiropractic clinics between May and August 2021. A total of 129 participants (72% of the invited) were included. We measured PPT at eight pre-determined test sites (six spinal and two extra-spinal) immediately before (pre-session) and immediately after (post-session) the chiropractic consultation. We used regression analyses to investigate PPT changes, including the following factors: (i) vertebral distance to the nearest SMT site, (ii) rapid clinical response, (iii) baseline PPT, (iv) number of SMTs performed, (v) at the region of clinical pain compared to other regions, and (vi) if other non-SMT treatment was provided. We also performed topographic mapping of pre-session PPTs. RESULTS: After the consultation, there was a non-significant mean increase in PPT of 0.14 kg (95% CIs = − 0.01 to 0.29 kg). No significant associations were found with the distance between the PPT test site and nearest SMT site, the clinical response of participants to treatment, the pre-session PPT, the total number of SMTs performed, or the region/s of clinical pain. A small increase was observed if myofascial treatment was also provided. Topographic mapping found greater pre-session PPTs in a caudal direction, not affected by the region/s of clinical pain. CONCLUSIONS: This study of real-world chiropractic patients failed to demonstrate a substantial local or generalized increase in PPT following a clinical encounter that included SMT. This runs counter to prior laboratory research and questions the generalizability of highly experimental setups investigating the effect of SMT on PPT to clinical practice. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12998-022-00436-2.
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spelling pubmed-90973592022-05-13 Pressure pain thresholds in a real-world chiropractic setting: topography, changes after treatment, and clinical relevance? Nim, Casper G. Aspinall, Sasha L. Weibel, Rasmus Steenfelt, Martin G. O’Neill, Søren Chiropr Man Therap Research BACKGROUND: Changes in pain sensitivity are a commonly suggested mechanism for the clinical effect of spinal manipulative therapy (SMT). Most research has examined pressure pain thresholds (PPT) and has primarily been conducted in controlled experimental setups and on asymptomatic populations. Many important factors are likely to differ between research and clinical settings, which may affect PPT changes following SMT. Therefore, we planned to investigate PPT before and after clinical chiropractic care and investigate relationships with various potentially clinically-relevant factors. METHODS: We recruited participants from four Danish chiropractic clinics between May and August 2021. A total of 129 participants (72% of the invited) were included. We measured PPT at eight pre-determined test sites (six spinal and two extra-spinal) immediately before (pre-session) and immediately after (post-session) the chiropractic consultation. We used regression analyses to investigate PPT changes, including the following factors: (i) vertebral distance to the nearest SMT site, (ii) rapid clinical response, (iii) baseline PPT, (iv) number of SMTs performed, (v) at the region of clinical pain compared to other regions, and (vi) if other non-SMT treatment was provided. We also performed topographic mapping of pre-session PPTs. RESULTS: After the consultation, there was a non-significant mean increase in PPT of 0.14 kg (95% CIs = − 0.01 to 0.29 kg). No significant associations were found with the distance between the PPT test site and nearest SMT site, the clinical response of participants to treatment, the pre-session PPT, the total number of SMTs performed, or the region/s of clinical pain. A small increase was observed if myofascial treatment was also provided. Topographic mapping found greater pre-session PPTs in a caudal direction, not affected by the region/s of clinical pain. CONCLUSIONS: This study of real-world chiropractic patients failed to demonstrate a substantial local or generalized increase in PPT following a clinical encounter that included SMT. This runs counter to prior laboratory research and questions the generalizability of highly experimental setups investigating the effect of SMT on PPT to clinical practice. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12998-022-00436-2. BioMed Central 2022-05-12 /pmc/articles/PMC9097359/ /pubmed/35550595 http://dx.doi.org/10.1186/s12998-022-00436-2 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Nim, Casper G.
Aspinall, Sasha L.
Weibel, Rasmus
Steenfelt, Martin G.
O’Neill, Søren
Pressure pain thresholds in a real-world chiropractic setting: topography, changes after treatment, and clinical relevance?
title Pressure pain thresholds in a real-world chiropractic setting: topography, changes after treatment, and clinical relevance?
title_full Pressure pain thresholds in a real-world chiropractic setting: topography, changes after treatment, and clinical relevance?
title_fullStr Pressure pain thresholds in a real-world chiropractic setting: topography, changes after treatment, and clinical relevance?
title_full_unstemmed Pressure pain thresholds in a real-world chiropractic setting: topography, changes after treatment, and clinical relevance?
title_short Pressure pain thresholds in a real-world chiropractic setting: topography, changes after treatment, and clinical relevance?
title_sort pressure pain thresholds in a real-world chiropractic setting: topography, changes after treatment, and clinical relevance?
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9097359/
https://www.ncbi.nlm.nih.gov/pubmed/35550595
http://dx.doi.org/10.1186/s12998-022-00436-2
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