@article{ecf58b5dcd4a4c94b142c70dc09e41c5,
title = "Changes in pain sensitivity following spinal manipulation: A systematic review and meta-analysis",
abstract = "Spinal manipulation (SMT) is commonly used for treating individuals experiencing musculoskeletal pain. The mechanisms of SMT remain unclear; however, pain sensitivity testing may provide insight into these mechanisms. The purpose of this systematic review is to examine the literature on the hypoalgesic effects of SMT on pain sensitivity measures and to quantify these effects using meta-analysis. We performed a systematic search of articles using CINAHL, MEDLINE, PsycINFO, and SPORTDiscus from each databases' inception until May 2011. We examined methodological quality of each study and generated pooled effect size estimates using meta-analysis software. Of 997 articles identified, 20 met inclusion criteria for this review. Pain sensitivity testing used in these studies included chemical, electrical, mechanical, and thermal stimuli applied to various anatomical locations. Meta-analysis was appropriate for studies examining the immediate effect of SMT on mechanical pressure pain threshold (PPT). SMT demonstrated a favorable effect over other interventions on increasing PPT. Subgroup analysis showed a significant effect of SMT on increasing PPT at the remote sites of stimulus application supporting a potential central nervous system mechanism. Future studies of SMT related hypoalgesia should include multiple experimental stimuli and test at multiple anatomical sites.",
keywords = "Experimental pain, Manual therapy, Pain, Spinal manipulation",
author = "Coronado, {Rogelio A.} and Gay, {Charles W.} and Bialosky, {Joel E.} and Carnaby, {Giselle D.} and Bishop, {Mark D.} and George, {Steven Z.}",
note = "Funding Information: We would like to acknowledge Jason M. Beneciuk PT, DPT, FAAOMPT and Corey B. Simon PT, DPT, FAAOMPT for their review of this manuscript. This manuscript was written while C.W.G received funding from the University of Florida Alumni Fellowship and NCMIC Foundation Educational Grant . J.E.B. received support from the Rehabilitation Research Career Development Program ( 5K12HD055929-02 ). M.D.B. and S.Z.G. received support from the National Center for Complementary and Alternative Medicine ( R01AT006334 ). Funding Information: Giselle D. Carnaby is an Associate Professor in the Department of Behavioral Science and Community Health, Director of the Ph.D. in Public health (SBS track) and Co director of the Swallowing Research Laboratory at the University of Florida. She specializes and teaches in research epidemiology and biostatistics. Her research focus lies in the rehabilitation of swallowing disorders following Stroke and Head/Neck Cancer and she is currently funded as PI on NIH and American Cancer Society grants. She is a life time Research Scholar for the American Cancer Society. Funding Information: Steven Z. George is Associate Professor and Assistant Department Chair at the University of Florida, Department of Physical Therapy. He received his bachelor{\textquoteright}s degree in physical therapy from West Virginia University in 1994. He received a master{\textquoteright}s degree in orthopedic physical therapy and a doctoral degree in rehabilitation science from the University of Pittsburgh in 1997 and 2002, respectively. Dr. George{\textquoteright}s primary research interests involve the utilization of biopsychosocial models for the prevention and treatment of chronic musculoskeletal pain disorders. He has authored over 105 peer-reviewed publications in physical therapy, rehabilitation, orthopedic, and pain research journals. Dr. George{\textquoteright}s research programs have been supported by the University of Florida, the National Institutes of Health, the Department of Defense, and the Foundation for Physical Therapy.",
year = "2012",
month = oct,
doi = "10.1016/j.jelekin.2011.12.013",
language = "English (US)",
volume = "22",
pages = "752--767",
journal = "Journal of Electromyography and Kinesiology",
issn = "1050-6411",
publisher = "Elsevier Ltd",
number = "5",
}