Douleur

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Treatment of central pain mechanisms is a new horizon for manual therapists. This paper presents key points about central pain mechanisms and how they can be treated by the manual therapist. Included are facets of conditioning, memory and learning; some types of central problems and cognitive-behavioural and physical techniques for use by manual therapists. The concept of treatment through central pain mechanisms is concluded with a case study illustrating the relevant clinical application. Education of central pain mechanisms and, for that matter, the pain paradigm, should become an integral part of physiotherapy education.

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Excellent article. Lecture obligatoire!

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The mechanisms thorough which spinal manipulative therapy (SMT) exerts clinical effects are not established. A prior study has suggested a dorsal horn modulated effect; however, the role of subject expectation was not considered. The purpose of the current study was to determine the effect of subject expectation on hypoalgesia associated with SMT.

Sixty healthy subjects agreed to participate and underwent quantitative sensory testing (QST) to their leg and low back. Next, participants were randomly assigned to receive a positive, negative, or neutral expectation instructional set regarding the effects of a specific SMT technique on pain perception. Following the instructional set, all subjects received SMT and underwent repeat QST.

No interaction (p = 0.38) between group assignment and pain response was present in the lower extremity following SMT; however, a main effect (p < 0.01) for hypoalgesia was present. A significant interaction was present between change in pain perception and group assignment in the low back (p = 0.01) with participants receiving a negative expectation instructional set demonstrating significant hyperalgesia (p < 0.01).

The current study replicates prior findings of c- fiber mediated hypoalgesia in the lower extremity following SMT and this occurred regardless of expectation. A significant increase in pain perception occurred following SMT in the low back of participants receiving negative expectation suggesting a potential influence of expectation on SMT induced hypoalgesia in the body area to which the expectation is directed

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Rien de très surprenant ici. Donc preuves d'efficacité des manipulations, qui sont sujettes au placebo et nocebo.

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This study compared the effect of 2 specific cervical flexor muscle exercise protocols on immediate pain relief in the cervical spine of people with chronic neck pain. In addition, the study evaluated whether these exercise protocols elicited any systemic effects by studying sympathetic nervous system (SNS) function and pain at a location distant from the cervical spine. Participants were randomly allocated into either a cranio-cervical flexion (CCF) coordination exercise group (n = 24) or a cervical flexion (CF) endurance exercise group (n = 24). Measures of pain and SNS function were recorded immediately before and after a single session of the exercise interventions. Pain measures included visual analogue scale (VAS) ratings of neck pain at rest and during active cervical motion and pressure pain threshold (PPT) and thermal pain threshold (TPT) recordings over the cervical spine and at a remote site on the leg. Measures of SNS function consisted of blood flow, skin conductance, skin temperature, heart rate, and blood pressure. Immediately after 1 session of exercise, there was a reasonably sized increase of 21% (P < .001, d = 0.88) and 7.3% (P = .03, d = 0.47) in PPT locally at the neck for the CCF exercise and the CF exercise, respectively. There were no changes in local neck TPT with either exercise. Pressure pain threshold and TPT at the leg and SNS did not change after exercise. Only the CCF exercise demonstrated a small improvement in VAS ratings during active movement (change on 10-cm VAS: CCF, 0.42 cm (P = .04). This study shows that specific CCF therapeutic exercise is likely to provide immediate change in mechanical hyperalgesia local to the neck with translation into perceived pain relief on movement in patients with chronic neck pain. PERSPECTIVE: This study showed an immediate local mechanical hypoalgesic response to specific exercise of the cervical spine. Understanding the pain-relieving effects of exercise will assist the clinician in prescribing the most appropriate exercise protocols for patients with chronic neck pain.

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This study was undertaken to investigate any relationship between sensory features and neck pain in female office workers using quantitative sensory measures to better understand neck pain in this group. Office workers who used a visual display monitor for more than four hours per day with varying levels of neck pain and disability were eligible for inclusion. There were 85 participants categorized according to their scores on the neck disability index (NDI): 33 with no pain (NDI<8); 38 with mild levels of pain and disability (NDI 9-29); 14 with moderate levels of pain (NDI30). A fourth group of women without neck pain (n=22) who did not work formed the control group. Measures included: thermal pain thresholds over the posterior cervical spine; pressure pain thresholds over the posterior neck, trapezius, levator scapulae and tibialis anterior muscles, and the median nerve trunk; sensitivity to vibrotactile stimulus over areas of the hand innervated by the median, ulnar and radial nerves; sympathetic vasoconstrictor response. All tests were conducted bilaterally. ANCOVA models were used to determine group differences between the means for each sensory measure. Office workers with greater self-reported neck pain demonstrated hyperalgesia to thermal stimuli over the neck, hyperalgesia to pressure stimulation over several sites tested; hypoaesthesia to vibration stimulation but no changes in the sympathetic vasoconstrictor response. There is evidence of multiple peripheral nerve dysfunction with widespread sensitivity most likely due to altered central nociceptive processing initiated and sustained by nociceptive input from the periphery.

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Cet article démontre bien l'importance des douleurs centrales comme composante dans divers syndromes douloureux qui semblent être d'origine mécanique.