运动疗法对慢性下腰痛成人的条件性疼痛调制、机械性痛觉过敏和疼痛强度的有效性：一项随机对照试验。

Effectiveness of mobilization with movement on conditioned pain modulation, mechanical hyperalgesia, and pain intensity in adults with chronic low back pain: A randomized controlled trial.

作者信息

Martínez Pozas Oliver, Cuenca-Zaldívar Juan Nicolás, González-Alvarez M Elena, Selva Sarzo Francisco José, Beltran-Alacreu Hector, Carnero Josué Fernández, Sánchez Romero Eleuterio A

机构信息

Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933, Alcorcón, Madrid, Spain; Cognitive Neuroscience, Pain, and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, 28922, Madrid, Spain; Interdisciplinary Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain.

Interdisciplinary Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain; Universidad de Alcalá, Facultad de Medicina y Ciencias de la Salud, Departamento de Enfermería y Fisioterapia, Grupo de Investigación en Fisioterapia y Dolor, 28801, Alcalá de Henares, Spain; Research Group in Nursing and Health Care, Puerta de Hierro Health Research Institute-Segovia de Arana (IDIPHISA), 28222, Majadahonda, Spain; Physical Therapy Unit, Primary Health Care Center "El Abajón", 28231, Las Rozas de Madrid, Spain.

出版信息

Musculoskelet Sci Pract. 2025 Feb;75:103220. doi: 10.1016/j.msksp.2024.103220. Epub 2024 Nov 22.

DOI:10.1016/j.msksp.2024.103220

PMID:39644690

Abstract

BACKGROUND

Chronic low back pain is associated with dysfunctions in endogenous analgesia mechanisms, as evaluated through conditioned pain modulation paradigms. Although mobilization with movement has demonstrated enhancements in conditioned pain modulation among patients with conditions such as knee osteoarthritis, its efficacy in chronic low back pain patients has yet to be established.

OBJECTIVES

To investigate the effects of mobilization with movement compared to sham mobilization in conditioned pain modulation, mechanical hyperalgesia, and pain intensity in chronic low back pain patients.

DESIGN

Randomized controlled trial following CONSORT and TIDieR guidelines.

METHOD

Fifty-eight patients with chronic low back pain (mean age 48.77 ± 13.92 years) were randomized into the experimental group, which received real mobilization with movement (n = 29), or the sham mobilization with movement group (n = 29). Only one intervention was performed. Patients were assessed before and after intervention. Conditioned pain modulation, mechanical hyperalgesia and pain intensity were assessed.

RESULTS

Mobilization with movement resulted in no statistically significant differences compared to sham mobilization for conditioned pain modulation (post-treatment difference: 0.023 [-0.299, 0.345], p = 0.158), mechanical hyperalgesia (post-treatment difference: -0.198 [-0.505, 0.109], p = 0.207), or movement-related pain intensity (post-treatment difference: 0.548 [-0.068, 1.236], p = 0.079) improvements post-intervention. Effect sizes were small for conditioned pain modulation (r = 0.126), mechanical hyperalgesia (r = 0.101), and pain intensity (r = 0.208).

CONCLUSIONS

Mobilization with movement resulted in no significant differences compared to sham mobilization with movement after one intervention for conditioned pain modulation, mechanical hyperalgesia or pain intensity, with small effect sizes. However, the findings should be interpreted with caution due to absence of screening for appropriately eligible patients.

摘要

背景

慢性下腰痛与内源性镇痛机制功能障碍有关，这是通过条件性疼痛调制范式评估得出的。尽管运动松动术已证明可增强膝骨关节炎等疾病患者的条件性疼痛调制能力，但其在慢性下腰痛患者中的疗效尚未得到证实。

目的

研究运动松动术与假运动松动术相比，对慢性下腰痛患者条件性疼痛调制、机械性痛觉过敏和疼痛强度的影响。

设计

遵循CONSORT和TIDieR指南的随机对照试验。

方法

58例慢性下腰痛患者（平均年龄48.77±13.92岁）被随机分为实验组（n = 29），接受真正的运动松动术，或假运动松动术组（n = 29）。仅进行一次干预。在干预前后对患者进行评估。评估条件性疼痛调制、机械性痛觉过敏和疼痛强度。

结果

与假运动松动术相比，运动松动术在条件性疼痛调制（治疗后差异：0.023[-0.299, 0.345]，p = 0.158）、机械性痛觉过敏（治疗后差异：-0.198[-0.505, 0.109]，p = 0.207）或与运动相关的疼痛强度（治疗后差异：0.548[-0.068, 1.236]，p = 0.079）方面，干预后改善无统计学显著差异。条件性疼痛调制（r = 0.126）、机械性痛觉过敏（r = 0.101）和疼痛强度（r = 0.208）的效应量较小。