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Neurophysiological mechanisms of chiropractic spinal manipulation for spine pain
Author(s) -
GeversMontoro Carlos,
Provencher Benjamin,
Descarreaux Martin,
Ortega de Mues Arantxa,
Piché Mathieu
Publication year - 2021
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1002/ejp.1773
Subject(s) - chiropractic , medicine , spinal manipulation , context (archaeology) , back pain , neck pain , physical therapy , physical medicine and rehabilitation , manual therapy , narrative review , placebo , low back pain , psychological intervention , chronic pain , alternative medicine , intensive care medicine , pathology , psychiatry , paleontology , biology
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 (SM) 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 SM and provides a perspective for future research on SM and spine pain, including the validation of placebo interventions that control for placebo effects and other non‐specific effects that may be induced by SM. Significance Spinal manipulation inhibits back and neck pain partly through spinal segmental mechanisms and potentially through peripheral mechanisms regulating inflammatory responses. Other mechanisms remain to be clarified. Controls and placebo interventions need to be improved in order to clarify the contribution of specific and non‐specific effects to pain relief by spinal manipulative therapy.