Arribas-Romano Alberto, Fernández-Carnero Josué, González-Zamorano Yeray, Rodríguez-Lagos Leonardo, Alguacil-Diego Isabel María, Molina-Álvarez Miguel, Tejera David Morales, Mercado-Romero Francisco
Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, 28922 Madrid, Spain.
Cognitive Neuroscience, Pain, and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain.
J Clin Med. 2023 Jun 7;12(12):3894. doi: 10.3390/jcm12123894.
Manual therapy (MT) is a treatment recommended by clinical practice guidelines in the management of patients with neck pain. However, the mechanisms through which MT works remain unknown. The aim of the present study is to investigate if MT is mediated by mechanisms related to conditioned pain modulation (CPM), comparing the effects of painful with a pain-free MT treatment.
A two-arm, parallel, randomized controlled clinical trial with concealed allocation and blinding of the outcome assessor was conducted in university students with chronic or recurrent nonspecific neck pain (NSNP). Participants received either a painful or pain-free MT session. Psychophysical variables including pressure pain thresholds, CPM, temporal summation of pain and cold pain intensity were assessed before and immediately after treatment. In addition, changes in neck pain intensity over the following 7 days and self-perceived improvement immediately and 7 days after treatment were assessed.
No significant differences were found between groups in any of the psychophysical variables or in patients' self-perceived improvement. Only a significantly greater decrease in neck pain intensity immediately after treatment was found in the pain-free MT group compared to the painful MT group.
The results suggest that the immediate and short-term effects of MT on NSNP are not mediated by CPM-related mechanisms.
手法治疗（MT）是临床实践指南推荐用于颈部疼痛患者管理的一种治疗方法。然而，MT起作用的机制尚不清楚。本研究的目的是通过比较疼痛性与无痛性MT治疗的效果，探讨MT是否通过与条件性疼痛调制（CPM）相关的机制介导。
在患有慢性或复发性非特异性颈部疼痛（NSNP）的大学生中进行了一项双臂、平行、随机对照临床试验，采用隐藏分配和结果评估者盲法。参与者接受疼痛性或无痛性MT治疗。在治疗前和治疗后立即评估包括压力疼痛阈值、CPM、疼痛的时间总和以及冷痛强度在内的心理物理学变量。此外，评估接下来7天内颈部疼痛强度的变化以及治疗后立即和7天的自我感觉改善情况。
在任何心理物理学变量或患者的自我感觉改善方面，两组之间均未发现显著差异。与疼痛性MT组相比，仅在无痛性MT组中发现治疗后立即颈部疼痛强度有显著更大程度的降低。
结果表明，MT对NSNP的即时和短期作用并非由CPM相关机制介导。
