Effects of Spinal Manipulative Therapy on Inflammatory Mediators in Patients with Non-specific Low Back Pain: A Non-randomized Controlled Clinical Trial
SOURCE: Chiropractic & Manual Therapies 2021 (Jan 8); 29 (1): 3
Julita A. Teodorczyk-Injeyan, John J. Triano, Robert Gringmuth, Christopher DeGraauw, Adrian Chow & H.
Graduate Education and Research Programs,
Canadian Memorial Chiropractic College,
Toronto, Ontario, Canada
Background: The inflammatory profiles of patients with acute and chronic nonspecific low back pain (LBP) patients are distinct. Spinal manipulative therapy (SMT) has been shown to modulate the production of nociceptive chemokines differently in these patient cohorts. The present study further investigates the effect(s) of SMT on other inflammatory mediators in the same LBP patient cohorts.
Methods: Acute (n = 22) and chronic (n = 25) LBP patients with minimum pain scores of 3 on a 10-point numeric scale, and asymptomatic controls (n = 24) were recruited according to stringent exclusion criteria. Blood samples were obtained at baseline and after 2 weeks during which patients received 6 SMTs in the lumbar or lumbosacral region. The in vitro production of tumor necrosis factor (TNFα), interleukin-1 β (IL-1β), IL-6, IL-2, interferon γ (IFNγ), IL-1 receptor antagonist (IL-1RA), TNF soluble receptor type 2 (sTNFR2) and IL-10 was determined by specific immunoassays. Parametric as well as non-parametric statistics (PAST 3.18 beta software) was used to determine significance of differences between and within study groups prior and post-SMT. Effect size (ES) estimates were obtained using Cohen’s d.
Results: Compared with asymptomatic controls, SMT-related change scores were significant (P = 0.03–0.01) in reducing the production levels of TNFα in both patient cohorts and those of IL-6, IFNγ and sTNFR2 (P = 0.001–0.02) in patients with chronic LBP. Above-moderate to large ES (d > 0.6–1.4) was observed for these mediators. Compared with respective baselines, a significant post-SMT reduction (P = 0.01) of IL-6 production was detected only in patients with chronic LBP while a significant increase of IL-2 production (P = 0.001 vs. control, and P = 0.004 vs. chronic LBP group) and a large ES (d = 0.87) were observed in patients with acute LBP. Pain and disability scores declined significantly (P < 0.001) in all LBP patients, and were positively correlated (P = 0.03) with IFNγ and IL-2 levels in the acute LBP cohort.
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Conclusion: The short course of SMT treatments of non-specific LBP patients resulted in significant albeit limited and diverse alterations in the production of several of the mediators investigated in this study. This exploratory study highlights the potential of SMT to modulate the production of inflammatory components in acute and chronic non-specific LBP patients and suggests a need for further, randomized controlled clinical trials in this area.
Trial registration: This study was prospectively registered April 2012 with Clinical Trials.gov
NCT01766141
Keywords: Cytokine; Inflammatory mediators; Low back pain; Spinal manipulation.
This is great. I love this stuff that explains how and why we get the results we do. I know that I’ve had a few patients who have had steroid injections into what I thought was a nearly ankylosed neck, and when they come back, it palpates as if it’s got full range of motion again. If course this only last for so long.
I wonder if the great results we see from adjusting has the same effect, but smaller? Just safer and more effective in smaller doses over time.
Thanks for keeping this website going, Frank. We all appreciate it.
Thanks Todd !