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23. Effectiveness of spinal manipulation in influencing the autonomic nervous system - a systematic review and meta-analysis.

Author

Kovanur Sampath, Kesava, Tumilty, Steve, Wooten, Liana, Belcher, Suzie, Farrell, Gerard, and Gisselman, Angela Spontelli

Subjects
*PARASYMPATHETIC nervous system, *CERVICAL vertebrae, *MEDICAL databases, *CINAHL database, *MEDICINE, *ONLINE information services, *AUTONOMIC nervous system, *META-analysis, *HEMOGLOBINS, *SYSTEMATIC reviews, *ADRENALINE, *CONTENT mining, *MANIPULATION therapy, *HEART beat, *DESCRIPTIVE statistics, *MEDLINE
Abstract

Background: Spinal manipulation (SM) has been hypothesized to influence the autonomic nervous system (ANS). Further, it has been proposed that the effects may vary depending on the segment manipulated. The aim of this systematic review was to synthesize the current level of evidence for SM in influencing the ANS in healthy and/or symptomatic population. Methods: Various databases (n = 8) were searched (inception till May 2023) and 14 trials (n = 618 participants) were included in the review. Two authors independently screened, extracted and assessed the risk of bias in included studies. The data were synthesized using standard mean differences and meta-analysis for the primary outcome measures. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the quality of the body of evidence for each outcome of interest. Results: Overall, there was low quality evidence that SM did not influence any measure of ANS including heart rate variability (HRV), oxy-hemoglobin, blood pressure, epinephrine and nor-epinephrine. However, there was low quality evidence that cervical spine manipulation may influence high frequency parameter of HRV, indicating its influence on the parasympathetic nervous system. Conclusion: When compared with control or sham interventions, SM did not alter the ANS. Due to invalid methodologies and the low quality of included studies, findings must be interpreted with great caution. Future studies are needed which employ rigorous data collection processes to verify the true physiological implications of SM on ANS. [ABSTRACT FROM AUTHOR]

Published
2024
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50. Sensitivity to movement‐evoked pain, central sensitivity symptoms, and pro‐nociceptive profiles in people with chronic shoulder pain: A parallel‐group cross‐sectional investigation.

Author

Othman, Rani, Swain, Nicola, Tumilty, Steve, Jayakaran, Prasath, and Mani, Ramakrishnan

Subjects
SHOULDER physiology, CENTRAL nervous system physiology, SHOULDER pain, CHRONIC pain, EVALUATION of medical care, CROSS-sectional method, LIFTING & carrying (Human mechanics), PAIN threshold, SENSORY stimulation, COMPARATIVE studies, PATIENTS' attitudes, BODY movement, QUESTIONNAIRES, SENSITIVITY & specificity (Statistics), NOCICEPTIVE pain, PAIN management
Abstract

Objective: To investigate whether sensitivity to movement‐evoked pain (SMEP), central sensitivity symptom burden, and quantitative sensory testing (QST) outcomes differ between healthy controls and people with chronic shoulder pain. Methods: People with chronic shoulder pain (n = 39) and healthy controls (n = 26) completed validated questionnaires measuring demographic, pain characteristics, psychological factors, social support, sleep quality, central sensitivity inventory (CSI), and physical activity levels. A blinded assessor administered QST measuring pressure pain threshold, temporal summation, conditioned pain modulation, and cold hyperalgesia. All participants performed repeated lifting of weighted canisters and reported severity of pain over successive lifts of the weighted canisters. Between‐group differences in the QST, SMEP and CSI scores were investigated. Demographic and psychosocial variables were adjusted in the analyses. Results: Dynamic mechanical allodynia, mechanical temporal summation, movement‐evoked pain scores, SMEP index, and CSI scores were significantly (p ≤ 0.05) higher in the chronic shoulder pain group than in healthy controls. A significant proportion of people with chronic shoulder pain presented with pro‐nociceptive profiles and experienced higher pain severity, interference, and disability. Conclusions: People with chronic shoulder pain displayed symptoms and signs of central sensitization. Future research should investigate the predictive role of central sensitization on clinical outcomes in shoulder pain. [ABSTRACT FROM AUTHOR]

Published
2023
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