Mechanisms of Neural Mobilization for Chronic Pain

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DESCRIPTION (provided by applicant): Chronic pain is a prevalent and disabling problem for society. The National Institute of Neurological Disorders and Stroke (NINDS, 1997) has succinctly summarized chronic pain's impact on public health with the following statement, "Chronic pain is the most costly health problem in America." Carpal tunnel syndrome (CTS) is a commonly occurring example of upper extremity chronic pain that causes disability. Conservative treatment of CTS involves medication, splinting, and exercise and is frequently prescribed for patients with mild to moderate CTS. Given that conservative treatment of CTS has demonstrated unsatisfactory outcomes and limited efficacy, investigation of alternative and complementary approaches seems warranted. Neural mobilization technique (NMT) for the median nerve is a manipulative and body- based method that has been used to treat CTS. Clinical studies have indicated favorable outcomes are associated with median nerve NMT when treating patients with CTS. Anatomical studies have demonstrated the median nerve is specifically stressed with NMT and improvements in motor function have also been reported when using median nerve NMT. These studies provide initial support for NMT, but rigorous clinical studies regarding NMT efficacy have not been performed and NMT mechanisms have not been elucidated. The purpose of this grant proposal is to investigate the impact a manipulative and body-based method has on the nervous system. Specifically, we will investigate median nerve NMT for its effect on a neurophysiological mechanism involved in the development and maintenance of chronic pain (ie, central sensitization of pain). Our first specific aim is to determine if patients with CTS demonstrate excessive central sensitization of pain, when compared to healthy control subjects. Our second specific aim is to determine if the median nerve NMT's effect on the nervous system is a reduction in central sensitization of pain. This study will use novel measures of pain sensitivity to investigate one aspect of the underlying neurophysiology of manipulative and body-based methods. These data may also provide support for a future clinical trial investigating the efficacy of median nerve NMT for patients with CTS.