Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Program Musculoskeletal Health, Van Der Boechorststraat 9, 1081BT, Amsterdam, The Netherlands.
Laboratory Medical Immunology, Department of Clinical Chemistry, Amsterdam University Medical Centre, Location VUmc, Amsterdam, The Netherlands.
Sci Rep. 2023 Aug 7;13(1):12804. doi: 10.1038/s41598-023-39839-3.
Spinal mobilisation/manipulation is a common intervention for spinal pain, yet the working mechanisms are largely unknown. A randomised placebo-controlled trial was conducted to (1) compare the immediate neuroimmune responses following spinal mobilisation/manipulation and placebo spinal mobilisation/manipulation; (2) compare the immediate neuroimmune responses of those with a good outcome with those of a poor outcome following spinal mobilisation/manipulation; and (3) explore the association between neuroimmune responses and pain reduction. One hundred patients were randomly allocated to spinal mobilisation/manipulation or a placebo mobilisation/manipulation. Primary outcomes were whole blood in-vitro evoked released concentrations of IL-1β and TNF-α measured 10 min and 2 h after the intervention. Immediate effects were studied because successful mobilisation/manipulation is often associated with immediate pain reduction, and immediate neuroimmune responses are less affected by potential confounders than long-term responses. Secondary outcomes included multiple systemic inflammatory marker concentrations, phenotypic analysis of white blood cells and clinical outcomes. Outcomes were compared between the experimental and placebo group, and between people with a good and poor outcome in the experimental group. Estimates of intervention effects were based on intention-to-treat analyses, by using linear mixed-effect models. Although there was a substantial difference in pain reduction between groups (mean (SD) difference visual analogue scale: 30 (21) mm at 10 min and 32 (21) mm at 2 h (p < 0.001) in favour of mobilisation/manipulation, there were no differences in primary outcomes between groups or between people with a good and poor outcome (p ≥ 0.10). In conclusion, possible neuroimmune responses following spinal mobilisations/manipulation cannot be identified at a systemic level. Future research may focus on longer treatment duration and more localised neuroimmune responses.
脊柱推拿/手法治疗是一种常见的治疗脊柱疼痛的方法，但作用机制尚不清楚。本研究采用随机安慰剂对照试验，旨在：（1）比较脊柱推拿/手法治疗和安慰剂脊柱推拿/手法治疗后即刻的神经免疫反应；（2）比较脊柱推拿/手法治疗后疗效良好和疗效不佳患者的即刻神经免疫反应；（3）探讨神经免疫反应与疼痛缓解之间的关系。将 100 例患者随机分配至脊柱推拿/手法治疗组或安慰剂脊柱推拿/手法治疗组。主要结局指标为干预后 10min 和 2h 时全血体外诱发出的白细胞介素-1β（IL-1β）和肿瘤坏死因子-α（TNF-α）的释放浓度。本研究关注即时效应，因为成功的推拿/手法治疗通常与即刻疼痛缓解相关，且即时神经免疫反应受潜在混杂因素的影响小于长期反应。次要结局指标包括多种系统性炎症标志物浓度、白细胞表型分析和临床结局。在实验组中，将实验组与安慰剂组、实验组中疗效良好和疗效不佳的患者进行比较。采用线性混合效应模型，基于意向治疗分析来比较干预效果的估计值。虽然两组之间的疼痛缓解程度存在显著差异（10min 时视觉模拟评分：推拿/手法组为 30（21）mm，安慰剂组为 21（21）mm；2h 时为 32（21）mm 和 21（21）mm，推拿/手法组更优，p < 0.001），但两组之间或疗效良好和疗效不佳的患者之间在主要结局指标上没有差异（p ≥ 0.10）。总之，在系统性水平上无法确定脊柱推拿/手法治疗后可能出现的神经免疫反应。未来的研究可能集中在更长的治疗时间和更局部的神经免疫反应上。
