The Comparative Effects of Spinal and Peripheral Thrust Manipulation and Exercise on Pain Sensitivity and the Relation to Clinical Outcome: A Mechanistic Trial Using a Shoulder Pain Model
The Comparative Effects of Spinal and Peripheral Thrust Manipulation and Exercise on Pain Sensitivity and the Relation to Clinical Outcome: A Mechanistic Trial Using a Shoulder Pain Model
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DOI：
10.2519/jospt.2015.5745
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发表时间：
2015-04-01
影响因子：
6.1
通讯作者：
George, Steven Z.
中科院分区：
文献类型：
--
作者：
Coronado, Rogelio A.;Bialosky, Joel E.;George, Steven Z.
研究设计：单盲随机试验。结论：比较颈部和肩部推力操作（TM）和运动对疼痛敏感性的影响，并探讨与肩痛患者临床结局的相关性。背景：实验研究表明，脊柱TM对中枢疼痛过程有影响，支持其应用于治疗四肢疾病。脊柱和外周TM对疼痛敏感性的直接比较尚未得到广泛的examined.METHODS：78名肩痛患者（36名女性;平均+/- SD年龄，39.0 +/- 14.5岁）被随机分为3组，分别接受颈部TM（n = 26）、肩部TM（n = 27）或肩部锻炼（n = 25）治疗2周以上。25名健康受试者（13名女性;平均SD年龄，35.2 - 11.1岁）进行了评估，比较疼痛敏感性与临床参与者在基线。主要结局为2周内局部（如肩关节）和远端（如胫骨前肌）压痛阈值和热痛阈值的变化。次要结局为第4、8和12周时的肩痛强度和患者评定功能。方差分析模型和偏相关分析进行检查比较效果和措施之间的关系。结果：在基线，临床参与者表现出较低的局部（平均差异，-1.63 kg; 95%置信区间[CI]：-2.40，-0.86）和远程压痛阈值（平均值，差异，-1.96 kg; 95%CI：-3.09，-0.82）和热痛阈值（平均值差异，-1.15 ℃; 95%CI：-2.06，-0.24），表明疼痛敏感性增强。干预后，疼痛敏感性或临床结局无组间差异（P> 0.05）。然而，无论是否进行干预，（平均差异范围，0.22-0.32 kg; 95% CI：0.03，0.43），热痛阈值（平均差异范围，0.30-0.58：-95% CI：0.06，0.96），疼痛强度（平均差异范围，-1.79至-1.45; 95% CI：-2.34，-0.94）和功能（平均差异范围，3.15-3.82; 95% CI：0.69，6.20）。我们没有发现疼痛敏感性变化和临床结局之间的关联（P> 0.05）。结论：临床参与者表现出增强的疼痛敏感性，但对颈部或外周TM没有不同的反应。事实上，在这个样本中，颈部TM、肩部TM和肩部锻炼具有相似的疼痛敏感性和临床效果。疼痛敏感性与临床疼痛和功能结局之间缺乏相关性，表明TM或运动后临床获益的疼痛途径不同（例如，非特异性）。
STUDY DESIGN: Single-blind randomized trial.OBJECTIVES: To compare the effects of cervical and shoulder thrust manipulation (TM) and exercise on pain sensitivity, and to explore associations with clinical outcomes in patients with shoulder pain.BACKGROUND: Experimental studies indicate that spinal TM has an influence on central pain processes, supporting its application for treatment of extremity conditions. Direct comparison of spinal and peripheral TM on pain sensitivity has not been widely examined.METHODS: Seventy-eight participants with shoulder pain (36 female; mean +/- SD age, 39.0 +/- 14.5 years) were randomized to receive 3 treatments of cervical TM (n = 26), shoulder TM(n = 27),.or shoulder exercise (n = 25) over 2 weeks. Twenty-five healthy participants (13 female; mean SD age, 35.2 11.1 years) were assessed to compare pain sensitivity with that in clinical participants at baseline. Primary outcomes were changes in local (eg, shoulder) and remote (eg, tibialis anterior) pressure pain threshold and heat pain threshold occurring over 2 weeks. Secondary outcomes were shoulder pain intensity and patient-rated function at 4, 8, and 12 weeks. Analysis-of-variance models and partial-correlation analyses were conducted to examine comparative effects and the relationship between measures.RESULTS: At baseline, clinical participants demonstrated lower local (mean difference, -1.63 kg; 95% confidence interval [CI]: -2.40, -0.86) and remote pressure pain threshold (mean,difference, -1.96 kg; 95% Cl: -3.09, -0.82) and heat pain threshold (mean difference, -1.15 C; 95% CI: -2.06, -0.24) compared to controls, suggesting enhanced pain sensitivity. Following intervention, there were no between-group differences in pain sensitivity or clinical outcome (P>.05). However, improvements were noted, regardless of intervention, for pressure pain threshold (range of mean differences, 0.22-0.32 kg; 95% CI: 0.03, 0.43), heat pain threshold (range of mean differences, 0.30-0.58:- 95% CI: 0.06, 0.96), pain intensity (range of mean differences, -1.79 to -1.45; 95% CI: -2.34, -0.94), and function (range of mean differences, 3.15-3.82; 95% CI: 0.69, 6.20) at all time points. We did not find an association between pain sensitivity changes and clinical outcome (P>.05).CONCLUSION: Clinical participants showed enhanced pain sensitivity, but did not respond differently to cervical or peripheral TM. In fact, in this sample, cervical TM, shoulder TM, and shoulder exercise had similar pain sensitivity and clinical effects. The lack of association between pain sensitivity and clinical pain and function outcomes suggests different (eg, nonspecific) pain pathways for clinical benefit following TM or exercise.