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Updated: May 16, 2025
Manual Therapy for a Chronic Non-Specific Low Back Pain Rat Model
Published on: August 11, 2023
Limited association between central pain processing and clinical outcomes in non-specific chronic neck pain after a
Josu Zabala-Mata1, Jon Jatsu Azkue2, Joel E Bialosky3
1Department of Physical Therapy, Deusto Physical Therapiker, Faculty of Health Science, University of Deusto, San Sebastian, Spain; Department of Neurosciences, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, Leioa, Spain.
Background:
Non-specific chronic neck pain (NSCNP) is a prevalent condition causing significant disability. While manual therapy is recommended, its clinical benefits are limited. The relationship between central pain processing and treatment outcomes in NSCNP remains unclear.
Objectives:
To assess whether central pain processing measures could predict manual therapy outcomes in NSCNP patients.
Design:
Pre-planned secondary analysis.
Methods:
Sixty-three NSCNP patients underwent a four-week manual therapy regimen. Central pain processing mechanisms were assessed using Pressure Pain Threshold (PPT), Temporal Summation of Pain (TSP), and Conditioned Pain Modulation (CPM). Clinical outcomes were measured using the Neck Disability Index (NDI), pain intensity, and the Global Rating of Change Scale (GRoC). Univariate and multivariate regression models explored associations between baseline variables and treatment outcomes.
Results:
Multivariate analysis identified baseline CPM and neck pain duration as significant predictors of treatment outcome based on GRoC. A weak negative association was found between CPM and GRoC (p < 0.05), suggesting that patients with lower CPM response reported better perceived outcomes. Baseline NDI was inversely associated with changes in disability (p < 0.01). Baseline pain intensity (p < 0.01) and duration (p < 0.05) were inversely related to pain reduction, while baseline CPM narrowly missed significance. No significant associations were found between TSP, PPT, and clinical outcomes.
Conclusion:
The findings suggest a limited association between pre-treatment central pain processing status and manual therapy outcomes in NSCNP patients. The lower CPM response was modestly predictive of better outcomes, contrary to expectations. Routine use of QST measures to guide treatment decisions in this population is not supported by current data.
