9 research outputs found
Neurophysiological mechanisms of chronic primary spine pain relief by chiropractic spinal manipulation = Mécanismes neurophysiologiques du soulagement de la douleur vertébrale chronique primaire par les manipulations vertébrales chiropratiques
La chiropratique est une profession de la santĂ© qui sâintĂ©resse au diagnostic, au traitement, et Ă la prĂ©vention des troubles musculosquelettiques. Lâintervention la plus communĂ©ment utilisĂ©e en chiropratique est la manipulation vertĂ©brale (dite « ajustement chiropratique »). Dâailleurs, les consultations en chiropratique sont principalement pour des douleurs vertĂ©brales, particuliĂšrement dans la rĂ©gion lombaire. La lombalgie est la principale cause d'incapacitĂ© Ă travers le monde. Elle engendre des coĂ»ts considĂ©rables pour la sociĂ©tĂ© et les individus atteints. Chez environ un tiers des individus, la lombalgie persiste et devient chronique, entraĂźnant une incapacitĂ© et une diminution de la qualitĂ© de vie. Chez ces individus, aucun processus pathologique affectant les tissus vertĂ©braux ne peut ĂȘtre mis en Ă©vidence. En effet, cette douleur, dite nociplastique, serait plutĂŽt causĂ©e par des mĂ©canismes pathologiques du systĂšme nociceptif. La lombalgie chronique, dite primaire chez ces individus, est ainsi considĂ©rĂ©e comme le diagnostic en soi, et non un symptĂŽme secondaire Ă une pathologie sous-jacente. Chez certains individus, les manipulations vertĂ©brales peuvent soulager la lombalgie chronique primaire. Cependant, leur efficacitĂ© comme intervention de premiĂšre ligne et leurs mĂ©canismes hypoalgĂ©siques restent Ă dĂ©montrer.
L'objectif gĂ©nĂ©ral de cette thĂšse est dâexaminer les mĂ©canismes hypoalgĂ©siques des manipulations vertĂ©brales. Le premier objectif spĂ©cifique est dâexaminer les mĂ©canismes hypoalgĂ©siques dâune manipulation vertĂ©brale Ă lâaide dâun modĂšle expĂ©rimental de douleur persistante chez des individus en santĂ©. Le deuxiĂšme objectif spĂ©cifique est dâexaminer les mĂ©canismes du soulagement de la douleur lombaire chronique primaire par une intervention chiropratique de quatre semaines, qui comprend douze sĂ©ances de manipulations vertĂ©brales. La thĂšse comprend deux Ă©tudes empiriques, soit une Ă©tude expĂ©rimentale et une Ă©tude clinique, qui sont prĂ©cĂ©dĂ©es dâune revue de littĂ©rature ciblĂ©e. Le premier article est une revue narrative explorant les mĂ©canismes neurophysiologiques de la manipulation vertĂ©brale pour soulager la douleur vertĂ©brale. Le deuxiĂšme article dĂ©crit les rĂ©sultats dâune Ă©tude expĂ©rimentale chez des individus en santĂ©. Dans cette Ă©tude, nous avons examinĂ© les mĂ©canismes d'inhibition de la douleur en rĂ©ponse Ă une manipulation vertĂ©brale ciblant un segment vertĂ©bral dont la peau a Ă©tĂ© sensibilisĂ©e par une application topique de capsaĂŻcine. Le troisiĂšme article est une revue narrative examinant l'efficacitĂ© des manipulations vertĂ©brales pour le traitement des douleurs vertĂ©brales. Le quatriĂšme article dĂ©crit les rĂ©sultats dâun essai contrĂŽlĂ© randomisĂ© avec groupe placebo chez des individus atteints de lombalgie chronique primaire. Dans cette Ă©tude, nous avons examinĂ© si le soulagement de la lombalgie chronique primaire par une intervention chiropratique sâaccompagne dâune attĂ©nuation de processus pathologiques contribuant Ă la douleur nociplastique.
Les rĂ©sultats indiquent quâune manipulation vertĂ©brale peut attĂ©nuer lâhyperalgĂ©sie mĂ©canique secondaire observĂ©e avec le modĂšle expĂ©rimental de douleur persistante. Ceci suggĂšre quâune manipulation vertĂ©brale pourrait agir sur des processus pathologiques qui mĂšnent Ă la douleur chronique. Ces rĂ©sultats sont cohĂ©rents avec la rĂ©duction de la douleur observĂ©e chez les patients atteints de lombalgie chronique primaire recevant des manipulations vertĂ©brales. De plus, la rĂ©duction de la lombalgie chronique Ă©tait accompagnĂ©e dâune rĂ©duction de lâhyperalgĂ©sie mĂ©canique lombaire et de la dramatisation de la douleur. Dans lâensemble, ces rĂ©sultats suggĂšrent quâune intervention chiropratique comprenant des manipulations vertĂ©brales est efficace pour rĂ©duire la lombalgie chronique primaire, et que cet effet pourrait dĂ©couler en partie dâune rĂ©duction de processus contribuant Ă la douleur nociplastique. Ceci renforce les recommandations cliniques sur lâutilisation de la chiropratique pour le soulagement de la lombalgie chronique primaire. Dâautres Ă©tudes seront nĂ©cessaires pour clarifier les mĂ©canismes neurophysiologiques et anti-inflammatoires des manipulations vertĂ©brales.Chiropractic is a health profession focused on the diagnosis, treatment, and prevention of musculoskeletal disorders, mainly through spinal manipulation (also known as "chiropractic adjustment"). The majority of patients consult a chiropractor seeking spine pain relief, primarily in the lower back. Low back pain is the leading cause of global disability, generating considerable costs for society and affected individuals. At least one third of people with low back pain experience persistent pain, leading to chronic disability and a decrease in quality of life. In affected individuals, no pathological process affecting the spinal tissues can be identified. Instead, this pain, called nociplastic, is presumed to be caused by pathological mechanisms within the nociceptive system. Thus, in these individuals, low back pain is considered as chronic primary pain, and not the symptom of an underlying disease. In some individuals, spinal manipulations can relieve chronic primary low back pain. However, their effectiveness as a first-line intervention and their hypoalgesic mechanisms remain to be demonstrated.
The overarching aim of this thesis is to examine the hypoalgesic mechanisms of chiropractic spinal manipulations. The first specific objective is to investigate the hypoalgesic mechanisms of a spinal manipulation using an experimental model of persistent back pain in healthy individuals. The second specific objective is to investigate the mechanisms of relief of chronic primary low back pain by a four-week chiropractic intervention, including twelve sessions of spinal manipulations. The thesis includes two empirical studies: an experimental study and a clinical study, both preceded by a targeted literature review. The first study is a narrative review exploring the neurophysiological mechanisms of spinal manipulation to relieve spine pain. The second article describes the results of an experimental trial on healthy individuals, where we examined the mechanisms of pain inhibition following a spinal manipulation targeting a spinal segment sensitized by the topical application of capsaicin The third article is a narrative review examining the effectiveness of spinal manipulation for the treatment of spine pain. The fourth article describes the results of a randomized placebo-controlled trial with individuals suffering from chronic primary low back pain. In this study, we examined whether the relief of chronic primary low back pain by a chiropractic intervention is accompanied by an attenuation of pathological processes contributing to nociplastic pain.
The results indicate that a single spinal manipulation can mitigate segmental mechanical hyperalgesia observed with the experimental model of persistent pain. This suggests that spinal manipulations could act on pathological processes that lead to chronic pain. These results are consistent with the pain reduction observed in patients with chronic primary low back pain receiving spinal manipulations. Furthermore, low back pain relief was accompanied by a reduction in mechanical hyperalgesia and in pain catastrophizing. Overall, these results indicate that a chiropractic intervention including spinal manipulations is efficacious in reducing chronic primary low back pain, and that this effect could in part stem from a reduction in processes contributing to nociplastic pain. This reinforces clinical recommendations on the use of chiropractic for the relief of chronic primary low back pain. Further studies will be needed to clarify the neurophysiological and anti-inflammatory mechanisms of spinal manipulations
Neurophysiological mechanisms of chronic primary spine pain relief by chiropractic spinal manipulation = Mécanismes neurophysiologiques du soulagement de la douleur vertébrale chronique primaire par les manipulations vertébrales chiropratiques
Urinary TNF-α as a potential biomarker for chronic primary low back pain
IntroductionOver two thirds of individuals with low back pain (LBP) may experience recurrent or persistent symptoms in the long term. Yet, current data do not allow to predict who will develop chronic low back pain and who will recover from an acute episode. Elevated serum levels of the proinflammatory cytokine tumor necrosis factor-α (TNF-α) have been associated with poor recovery and persistent pain following an acute episode of LBP. Inflammatory cytokines may also mediate mechanisms involved in nociplastic pain, and thus, have significant implications in chronic primary low back pain (CPLBP).MethodsThis study aimed to investigate the potential of urinary TNF-α levels for predicting outcomes and characterizing clinical features of CPLBP patients. Twenty-four patients with CPLBP and 24 sex- and age-matched asymptomatic controls were recruited. Urinary TNF-α concentrations were measured at baseline and after 4 weeks, during which CPLBP patients underwent spinal manipulative therapy (SMT).ResultsConcentrations of TNF-α were found to be elevated in baseline urine samples of CPLBP patients compared to asymptomatic controls. Moreover, these values differed among patients depending on their pain trajectory. Patients with persistent pain showed higher levels of TNF-α, when compared to those with episodic CPLBP. Furthermore, baseline TNF-α concentrations and their changes after 4 weeks predicted alterations in pain intensity and disability following SMT in patients with CPLBP.DiscussionThese findings warrant further research on the potential use of urinary TNF-α concentrations as a prognostic biomarker for CPLBP
The interaction between language and working memory:a systematic review of fMRI studies in the past two decades
A network analysis on biopsychosocial factors and painârelated outcomes assessed during a COVIDâ19 lockdown
Neurophysiological mechanisms of chiropractic spinal manipulation for spine pain
Abstract Together, neck pain and back pain are the first cause of disability worldwide, accounting for more than 10% of the total years lived with disability. In this context, chiropractic care provides a safe and effective option for the management of a large proportion of these patients. Chiropractic is a healthcare profession mainly focused on the spine and the treatment of spinal disorders, including spine pain. Basic studies have examined the influence of chiropractic spinal manipulation on a variety of peripheral, spinal, and supraspinal mechanisms involved in spine pain. While spinal cord mechanisms of pain inhibition contribute at least partly to the pain-relieving effects of chiropractic treatments, the evidence is weaker regarding peripheral and supraspinal mechanisms, which are important components of acute and chronic pain. This narrative review highlights the most relevant mechanisms of pain relief by spinal manipulation and provides a perspective for future research on spinal manipulation and spine pain, including the validation of placebo interventions that control for placebo effects and other non-specific effects that may be induced by spinal manipulation
From hands-on to remote:Moderators of response to a novel self-management telehealth programme during the COVID-19 pandemic
BACKGROUND: In March 2020, stateâwide lockdowns were declared in many countries, including Spain. Citizens were confined to their homes and remotely supported activities were prioritized as an alternative to inâperson interactions. Previous data suggest that remote and selfâmanagement interventions may be successful at reducing pain and related psychological variables. However, individual factors influencing the effectiveness of these interventions remain to be identified. We aimed to investigate the psychological and motivational factors moderating changes in pain observed in chiropractic patients undertaking a novel telehealth selfâmanagement programme. METHODS: A cohort of 208 patients from a chiropractic teaching clinic was recruited to participate in the study. Patients received telehealth consultations and individualized selfâmanagement strategies tailored for their current complaint. They were encouraged to make use of these strategies daily for 2â4âweeks, whilst rating their pain intensity, motivation and adherence. Validated questionnaires were completed online to assess catastrophizing, kinesiophobia and anxiety. RESULTS: A total of 168 patients completed the first 2âweeks of the programme, experiencing significant reductions in all variables. Kinesiophobia emerged as a key factor influencing pain reduction and moderating the association between motivation and pain relief. In turn, adherence to the programme was associated with lower pain intensity, although moderated by the degree of motivation. CONCLUSIONS: In the context of COVIDâ19, when introducing remote and selfâmanagement strategies, pain cognitions and motivational factors should be taken into consideration to foster adherence and yield better pain outcomes