Center for Pain Research and Behavioral Health, Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida.
Department of Orthopedic Surgery and Doctor of Physical Therapy Division, Duke University, Durham, North Carolina.
J Pain. 2017 Nov;18(11):1397-1408. doi: 10.1016/j.jpain.2017.07.007. Epub 2017 Aug 9.
The purpose of this study was to compare the immediate change in temporal summation of heat pain (TSP) between spinal manipulation (SMT) and spinal mobilization (MOB) in healthy volunteers. Ninety-two volunteers (24 male; 23.8 ± 5.3 years) were randomized to receive SMT, MOB, or no treatment (REST) for 1 session. Primary outcomes were changes in TSP, measured at the hand and foot, immediately after the session. A planned subgroup analysis investigated effects across empirically derived TSP clusters. For the primary outcome there were no differences in the immediate change in TSP measured at the foot between SMT and MOB, however, both treatments were superior to the REST condition. In the subgroup analysis the response to a standard TSP protocol was best characterized by 3 clusters: 52% no change (n = 48, 52%); facilitatory response (n = 24, 26%), and inhibitory response (n = 20, 22%). There was a significant Time × Treatment group × Cluster interaction for TSP measured at the foot. The inhibitory cluster showed the greatest attenuation of TSP after SMT and MOB compared with REST. These data suggest lumbar manual therapies of different velocities produce a similar localized attenuation of TSP, compared with no treatment. Attenuation of localized pain facilitatory processes by manual therapies was greatest in pain-free individuals who show an inhibitory TSP response.
The attenuation of pain facilitatory measures may serve an important underlying role in the therapeutic response to manual therapies. Identifying patients in pain who still have an inhibitory capacity (ie, an inhibitory response subgroup) may be useful clinically in identifying the elusive "manual therapy" responder.
本研究旨在比较健康志愿者中脊柱手法（SMT）和脊柱松动（MOB）治疗即刻对热痛时程总和（TSP）的影响。
92 名志愿者（24 名男性；23.8±5.3 岁）被随机分为 SMT、MOB 或不治疗（REST）组，每组各 30 名。主要结局是治疗后即刻 TSP 的变化，在手部和足部进行测量。计划进行亚组分析，以调查基于经验的 TSP 聚类的治疗效果。
主要结局显示，足部 TSP 的即刻变化在 SMT 和 MOB 之间没有差异，但这两种治疗均优于 REST 组。在亚组分析中，标准 TSP 方案的反应最好用 3 个聚类来描述：52%无变化（n=48，52%）；易化反应（n=24，26%）和抑制反应（n=20，22%）。足部 TSP 的治疗时间、治疗组和聚类的交互作用具有统计学意义。与 REST 相比，SMT 和 MOB 后抑制聚类 TSP 下降最大。这些数据表明，与不治疗相比，不同速度的腰椎手法治疗产生了类似的局部 TSP 衰减。与 REST 相比，手法治疗对无痛个体的局部疼痛易化过程的抑制作用最大，这些个体表现出抑制性 TSP 反应。
疼痛易化措施的衰减可能在手法治愈中起着重要的潜在作用。在疼痛患者中，确定仍然具有抑制能力的患者（即抑制性反应亚组）在临床上可能有助于识别难以捉摸的“手法治疗”反应者。
