Central neuronal plasticity, low back pain and spinal manipulative therapy

Area of Science:

• Neuroscience
• Neurophysiology
• Pain Research

Background:

• Neuronal plasticity, specifically long-term potentiation (LTP) and long-term depression (LTD), occurs in spinal neurons.
• These plasticity mechanisms are implicated in the development and persistence of low back pain.
• Spinal manipulative therapy (SMT) is a common treatment for low back pain, but its underlying mechanisms are not fully understood.

Purpose of the Study:

• To review experimental evidence of LTP and LTD in spinal neurons.
• To explore the implications of this evidence for understanding low back pain.
• To propose a role for LTD in the therapeutic effects of SMT.

Main Methods:

• Literature review of neuroscience and chiropractic publications.
• Inclusion of experimental studies on LTP/LTD mechanisms in spinal neurons.
• Analysis of animal models illustrating neuronal plasticity in low back pain.

Main Results:

• Evidence for LTP and LTD in dorsal horn nociceptive neurons (in vitro and in vivo).
• LTP observed in response to noxious stimulation.
• A-delta mechanosensitive afferent activation can reverse existing LTP.

Conclusions:

• LTP may contribute to the pathophysiology of low back pain.
• LTD is proposed as a potential mechanism for SMT's pain-relieving effects.
• Further research is needed on temporal/spatial changes post-SMT and demonstrating LTD in spinal neurons after SMT-like stimulation.