Physical Medine and Rehabilitation Service, Department of Veterans Affairs Medical Center, Cleveland, OH, USA.
Department of Graduate Studies in Health and Rehabilitation Sciences, Youngstown State University, Youngstown, OH, USA.
J Man Manip Ther. 2024 Feb;32(1):111-117. doi: 10.1080/10669817.2023.2262336. Epub 2024 Jan 16.
Force-Based Manipulation (FBM) including light touch, pressure, massage, mobilization, thrust manipulation, and needling techniques are utilized across several disciplines to provide clinical analgesia. These commonly used techniques demonstrate the ability to improve pain-related outcomes; however, mechanisms behind analgesia occurs with these hands-on interventions has been understudied. Neurological, neuroimmune, biomechanical, neurovascular, neurotransmitter, and contextual factor interactions have been proposed to influence response; however, the specific relationships to clinical pain outcomes has not been well established. The purpose of this study was to identify gaps present within mechanism-based research as it relates to FBM. An international multidisciplinary nominal group technique (NGT) was performed and identified 37 proposed gaps across eight domains. Twenty-three of these gaps met consensus across domains supporting the complex multisystem mechanistic response to FBM. The strength of support for gaps within the biomechanical domain had less overall support than the others. Gaps assessing the influence of contextual factors had strong support as did those associating mechanisms with clinical outcomes (translational studies). The importance of literature investigating how FBM differs with individuals of different pain phenotypes (pain mechanism phenotypes and clinical phenotypes) was also presented aligning with other analgesic techniques trending toward patient-specific pain management (precision medicine) through the use of pain phenotyping.
力控手法（FBM）包括轻触、施压、按摩、松动、推扳手法和针刺技术，被广泛应用于多个学科领域，以提供临床镇痛。这些常用技术显示出改善与疼痛相关的结果的能力；然而，这些手法干预背后发生镇痛的机制尚未得到充分研究。神经、神经免疫、生物力学、神经血管、神经递质和情境因素的相互作用被认为会影响反应；然而，与临床疼痛结果的具体关系尚未得到很好的确定。本研究的目的是确定与 FBM 相关的基于机制的研究中存在的差距。采用了一项国际多学科名义小组技术（NGT），并在八个领域中确定了 37 个拟议差距。这 23 个差距在各个领域中得到了共识，支持了 FBM 的复杂多系统机制反应。生物力学领域的差距得到的支持力度不如其他领域，评估情境因素影响的差距得到了强有力的支持，将机制与临床结果联系起来的研究（转化研究）也是如此。研究 FBM 在不同疼痛表型（疼痛机制表型和临床表型）个体中的差异的文献的重要性也得到了强调，这与其他镇痛技术一样，通过使用疼痛表型，朝着针对患者的疼痛管理（精准医学）趋势发展。
