Journal article
Pressure pain thresholds in a real-world chiropractic setting: Topography, changes after treatment, and clinical relevance?
Chiropractic & Manual Therapies, Vol.30(1), Art. 25
2022
Abstract
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.
Details
- Title
- Pressure pain thresholds in a real-world chiropractic setting: Topography, changes after treatment, and clinical relevance?
- Authors/Creators
- C.G. Nim (Author/Creator) - University of Southern DenmarkS.L. Aspinall (Author/Creator) - Murdoch UniversityR. Weibel (Author/Creator) - University of Southern DenmarkM.G. Steenfelt (Author/Creator) - University of Southern DenmarkS. O’Neill (Author/Creator)
- Publication Details
- Chiropractic & Manual Therapies, Vol.30(1), Art. 25
- Publisher
- BioMed Central
- Identifiers
- 991005541201007891
- Copyright
- © 2022 The Authors.
- Murdoch Affiliation
- College of Science, Health, Engineering and Education
- Language
- English
- Resource Type
- Journal article
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- Collaboration types
- Domestic collaboration
- International collaboration
- Citation topics
- 1 Clinical & Life Sciences
- 1.129 Back pain
- 1.129.98 Low Back Pain
- Web Of Science research areas
- Rehabilitation
- ESI research areas
- Clinical Medicine