Abstract
Background: manual therapy (MT) has been shown to have positive effects in patients with osteoarthritis (OA)-related pain, and its use in clinical settings is recommended. However, the mechanisms of action for how these positive effects occur are not yet well understood. The aim of the present study was to investigate the influence of MT treatment on facilitatory nociception and endogenous pain modulation in patients with knee OA related pain. Methods: Twenty-eight patients with knee OA were included in this study. Pain intensity using the numerical pain rating scale (NPRS), temporal summation (TS), conditioned pain modulation (CPM), and local (knee) and distant (elbow) hyperalgesia through the pressure pain threshold (PPT), were assessed to evaluate the pain modulatory system. Patients underwent four sessions of MT treatments within 3 weeks and were evaluated at the baseline, after the first session and after the fourth session. Results: the MT treatment reduced knee pain after the first session (p = 0.03) and after the fourth session (p = 0.04). TS decreased significantly after the fourth session of MT (p = 0.02), while a significant increase in the CPM assessment was detected after the fourth session (p = 0.05). No significant changes in the PPT over the knee and elbow were found in the follow-ups. Conclusions: The results from our study suggest that MT might be an effective and safe method for improving pain and for decreasing temporal summation.
Highlights
Osteoarthritis (OA) is considered a progressive chronic degenerative disease of the articular cartilage in the synovial joints [1] and is one of the most common types of rheumatic disease [2], affecting 303 million people worldwide [3].The diagnosis of knee OA is mainly based on the identification of its symptoms and is confirmed by an imaging diagnosis according to the criteria of the American College of Rheumatology (ACR) and the Kellgren and Lawrence scale [4]
We found no differences in the demographic variables and in the baseline levels of the primary outcome (NPRS, temporal summation (TS), conditioned pain modulation (CPM) and pressure pain threshold (PPT))
numerical pain rating scale (NPRS) after the first session treatment decreased to 4.2 ± 3.03, (p = 0.03 vs. Pre-treatment; n = 28), and after the fourth session, patients presented an NPRS in the knee of 4.0 ± 2.6, (p = 0.04 vs. Pre-treatment; n = 28), Table 2
Summary
Osteoarthritis (OA) is considered a progressive chronic degenerative disease of the articular cartilage in the synovial joints [1] and is one of the most common types of rheumatic disease [2], affecting 303 million people worldwide [3].The diagnosis of knee OA is mainly based on the identification of its symptoms and is confirmed by an imaging diagnosis according to the criteria of the American College of Rheumatology (ACR) and the Kellgren and Lawrence scale [4]. Central sensitization (CS) is characterized by an increase in the afferent nociceptive information that could increase the excitability of neurons in the spinal dorsal horn [7]. This phenomenon would facilitate a possible sensitization at a central level, leading to signal amplification within the CNS, hypersensitivity to pain, and referred pain [8,9]. Spinal cord neurons receive information from other tissues that are far from the painful area of joint damage, such as the muscle or peri-articular tendon, generating a dysfunction of the downstream inhibitory mechanisms and an increase in temporal summation (TS) and conditioned pain modulation (CPM) alterations [10,11]. One of the main objectives of any treatment is to improve the pain modulation systems
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