SIB #451 -Spinal Manipulation and Inflammation in LBP Patients
The Study: Effects of spinal manipulative therapy on inflammatory mediators in patients with non-specific low back pain: a nonrandomized controlled clinical trial.
Overview: This is a small, non randomized controlled clinical trial which looked at the effects of spinal manipulative therapy on production of inflammatory chemokines in patients with both acute and chronic lower back pain
Key Points:
· Patients with both acute and chronic nonspecific lower back pain tend to present with distinct inflammatory profiles.
· Prior studies have only looked at the effects of spinal manipulative therapy (SMT) on inflammatory aspects of the immune response in asymptomatic subjects
· This study looked at a total of 47 LBP patients (22 acute and 25 chronic) from the outpatient clinic of Canadian Memorial Chiropractic College.
· Blood samples were obtained at the outset of the study and again after two weeks of spinal manipulative therapy (Six treatments in total) consisting of high velocity, low amplitude thrusts to the lumbar spine.
· Additionally, pre and post samples were taken from a cohort of asymptomatic subjects served as a control group for “differences in the ability of cells from SMT-treated LBP patients, to produce inflammatory mediators relative to cells from asymptomatic subjects”.
· Following treatment, samples were assayed for an array of both pro and anti inflammatory cytokines to look at the effect(s) of SMT in modulating inflammatory mediators.
Author’s Conclusions: Following the short course of SMT, “a significant reduction in the production of IL-6 in chronic patients, and an enhanced IL-2 production in acute patients were observed along with reduction in pain and self-reported functional outcomes.” “the significance and direction of SMT related change scores as well as the moderate-to-large effect sizes observed for several mediator levels studied indicate the potential of this intervention to impact the inflammatory process in LBP patients.”
Reviewer's Comments: It should be noted that SMT did not appear to modulate other chemokines in the assay other than those listed above. Nevertheless, this is an interesting study because it suggests a non spinal mechanism by which SMT may be effective in reducing pain and/or inflammation in both acute and chronic LBP patients.
Reviewer: Mark R. Payne DC
Reference: Julita A. Teodorczyk-Injeyan , John J. Triano , Robert Gringmuth , Christopher DeGraauw , Adrian Chow and H. Stephen Injeyan. Effects of spinal manipulative therapy on inflammatory mediators in patients with non-specific low back pain: a nonrandomized controlled clinical trial. Chiropractic & Manual Therapies 2021
Link to Full Text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7792327/