Changes in pain sensitivity following spinal manipulation: A systematic review and meta-analysis

Rogelio A. Coronado, Charles W. Gay, Joel E. Bialosky, Giselle D. Carnaby, Mark D. Bishop, Steven Z. George

    Research output: Contribution to journalArticlepeer-review

    123 Scopus citations

    Abstract

    Spinal manipulation (SMT) is commonly used for treating individuals experiencing musculoskeletal pain. The mechanisms of SMT remain unclear; however, pain sensitivity testing may provide insight into these mechanisms. The purpose of this systematic review is to examine the literature on the hypoalgesic effects of SMT on pain sensitivity measures and to quantify these effects using meta-analysis. We performed a systematic search of articles using CINAHL, MEDLINE, PsycINFO, and SPORTDiscus from each databases' inception until May 2011. We examined methodological quality of each study and generated pooled effect size estimates using meta-analysis software. Of 997 articles identified, 20 met inclusion criteria for this review. Pain sensitivity testing used in these studies included chemical, electrical, mechanical, and thermal stimuli applied to various anatomical locations. Meta-analysis was appropriate for studies examining the immediate effect of SMT on mechanical pressure pain threshold (PPT). SMT demonstrated a favorable effect over other interventions on increasing PPT. Subgroup analysis showed a significant effect of SMT on increasing PPT at the remote sites of stimulus application supporting a potential central nervous system mechanism. Future studies of SMT related hypoalgesia should include multiple experimental stimuli and test at multiple anatomical sites.

    Original languageEnglish (US)
    Pages (from-to)752-767
    Number of pages16
    JournalJournal of Electromyography and Kinesiology
    Volume22
    Issue number5
    DOIs
    StatePublished - Oct 2012

    Keywords

    • Experimental pain
    • Manual therapy
    • Pain
    • Spinal manipulation

    ASJC Scopus subject areas

    • Neuroscience (miscellaneous)
    • Biophysics
    • Clinical Neurology

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