Clinical Relevance of Pressure Pain Thresholds in Real‑World Chiropractic Practice

Clinical Instrument to Identify Appropriate Patients for Low Back Pain Maintenance Care

Clinical Relevance of Pressure Pain Thresholds in Real‑World Chiropractic Practice

This Resrach Review contains a guest commentary from the study’s lead author and one of our professions rising research stars – Dr. Casper Glissmann Nim!

Pressure pain threshold (PPT) is a concept within manual therapies that is proffered as a partial explanation as to why spinal manipulative therapy (SMT) is associated with decreased pain. PPT involves testing deep tissue sensitivity by determining the amount of pressure over a given area in which a steadily increasing nonpainful pressure stimulus turns into a painful pressure sensation. SMT is thought to increase the PPT in the short-term (representing a reduction in mechanical pain sensitivity) in both symptomatic and asymptomatic patients.  In this context, PPT falls under the umbrella of quantitative sensory tests (QSTs), where painful stimuli can be used to investigate the neurophysiology of pain and the effects of various interventions.  The evidence in support of SMT as a modifier of PPT is varied and relatively inconclusive, with some systematic reviews showing that PPT increases with SMT and others showing no change in PPT following SMT.

An interesting topic within QST research is the use of topographical mapping, which provides data on responses to stimuli and/or treatment using various test sites.  While mapping responses can improve the understanding and knowledge of pain-generating conditions, there are questions as to whether research typically performed in experimental settings offers valid and valuable information for clinicians. To address this, the authors sought to evaluate the effect of SMT on PPT in a real-world clinical setting. 

RESEARCH REVIEW: “Clinical Relevance of Pressure Pain Thresholds in Real‑World Chiropractic Practice”

This paper was published in Chiropractic & Manual Therapies (2022) and this Review is posted in Spinal Manipulation – Mechanisms of Action and the 2023 Archive.

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