Reducing Mechanical Hyperalgesia & Pain Catastrophizing Via Spinal Manipulation for Low Back Pain
May
Musculoskeletal pain is generally classified based on three main descriptors: nociceptive, neuropathic, and nociplastic. Compared to a specific musculoskeletal tissue pathology, altered nociceptive processing in chronic low back pain is thought to contribute to nociplastic pain. Further, central sensitization likely enhances the degree of nociceptive transmission in chronic low back pain patients.
Most clinical practice guidelines recommend spinal manipulative therapy (SMT) for the management of chronic low back pain. Further to its treatment specific effects, contextual factors may contribute significantly to the observed effects we see following SMT. Basic science studies suggest that SMT relieves back pain by reducing inflammation and inhibiting nociplastic pain mechanisms, leading to decreased spinal nociceptive transmission. Based on the proposed mechanisms of SMT and pathophysiology of chronic low back pain, patients with nociplastic low back pain may respond differently to SMT depending on individual factors. Understanding these factors and which ones are associated with improvements following SMT can be of significant clinical benefit.
The aim of this study was to assess the processes underlying nociplastic pain and determine which factors in patients with chronic low back pain result in improved clinical outcomes following treatment with SMT.
RESEARCH REVIEW: Reducing Mechanical Hyperalgesia & Pain Catastrophizing Via Spinal Manipulation for Low Back Pain
This paper was published in The Journal of Pain (2024)
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