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

Rogelio A. Coronado, Joel E. Bialosky, Mark D. Bishop, Joseph L. Riley, Michael E. Robinson, Lori A. Michener, Steven Z. George

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

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 ±v SD age, 39.0 ±v 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 ±v SD age, 35.2 ±v 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. Analysisof- 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% CI: .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. LEVEL OF EVIDENCE: Therapy, level 1b-.

Original languageEnglish (US)
Pages (from-to)252-264
Number of pages13
JournalJournal of Orthopaedic and Sports Physical Therapy
Volume45
Issue number4
DOIs
StatePublished - Apr 1 2015
Externally publishedYes

Fingerprint

Shoulder Pain
Exercise
Pain
Pain Threshold
Confidence Intervals
Spinal Manipulation
Hot Temperature
Pressure
Critical Pathways
Healthy Volunteers

Keywords

  • Manual therapy
  • Pain mechanism
  • Quantitative sensory testing
  • Shoulder

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

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. / Coronado, Rogelio A.; Bialosky, Joel E.; Bishop, Mark D.; Riley, Joseph L.; Robinson, Michael E.; Michener, Lori A.; George, Steven Z.

In: Journal of Orthopaedic and Sports Physical Therapy, Vol. 45, No. 4, 01.04.2015, p. 252-264.

Research output: Contribution to journalArticle

Coronado, Rogelio A. ; Bialosky, Joel E. ; Bishop, Mark D. ; Riley, Joseph L. ; Robinson, Michael E. ; Michener, Lori A. ; George, Steven Z. / 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. In: Journal of Orthopaedic and Sports Physical Therapy. 2015 ; Vol. 45, No. 4. pp. 252-264.
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abstract = "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 ±v SD age, 39.0 ±v 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 ±v SD age, 35.2 ±v 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. Analysisof- 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{\%} CI: .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. LEVEL OF EVIDENCE: Therapy, level 1b-.",
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T1 - The comparative effects of spinal and peripheral thrust manipulation and exercise on pain sensitivity and the relation to clinical outcome

T2 - A mechanistic trial using a shoulder pain model

AU - Coronado, Rogelio A.

AU - Bialosky, Joel E.

AU - Bishop, Mark D.

AU - Riley, Joseph L.

AU - Robinson, Michael E.

AU - Michener, Lori A.

AU - George, Steven Z.

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N2 - 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 ±v SD age, 39.0 ±v 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 ±v SD age, 35.2 ±v 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. Analysisof- 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% CI: .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. LEVEL OF EVIDENCE: Therapy, level 1b-.

AB - 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 ±v SD age, 39.0 ±v 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 ±v SD age, 35.2 ±v 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. Analysisof- 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% CI: .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. LEVEL OF EVIDENCE: Therapy, level 1b-.

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KW - Pain mechanism

KW - Quantitative sensory testing

KW - Shoulder

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