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Posts Tagged ‘Spinal Manipulation’

Effectiveness of Adjustments in Chronic Migraine

Effectiveness of Adjustments in Chronic Migraine: Armed Randomized Controlled Trial. Complementary Therapies in Medicine. April 2015; Vol. 23; No. 2; pp. 149—156

Francesco Cerritelli, Liana Ginevri, Gabriella Messi, Emanuele Caprari, Marcello Di Vincenzo, Cinzia Renzetti, Vincenzo Cozzolino, Gina Barlafante, Nicoletta Foschi, Leandro Provincial: This study was carried out in the Department of Neurology of Ancona’s United Hospitals, Ancona, Italy. This article has 54 references.

The primary measurement outcome in this study is the Headache Impact Test (HIT-6); below is the conclusion from the cited reference:

“Our study shows that the HIT-6 is a reliable and valid tool for measuring the impact of headache on daily life in both episodic and chronic migraine sufferers. Furthermore, the HIT-6 tool discriminates well between chronic migraine, episodic migraine and non-migraine patients. As a brief tool, the HIT-6 is easy to score and interpret, and can be readily integrated into clinical practice, or clinical studies of migraine patients. It may offer clinicians a practical and easy-to implement tool to assist them with evaluating treatment effectiveness by obtaining input directly from the patient on aspects other than just the frequency of headache days.”

KEY POINTS FROM THIS STUDY

1) “This manipulative therapy trial is the largest ever conducted on migraine adult patients.” These authors assessed the effectiveness of manipulative treatment on 105 chronic migraine patients using:

• Headache Impact Test (HIT-6) questionnaire [main outcome measure]

• Drug consumption

• Days of migraine

• Pain intensity

• Functional disability

2) This is a randomized controlled trial. Patients received 8 treatments over a period of 6 months. Patients were randomly divided into three groups:

 

• Manipulation + medication therapy n=35

•• The manipulative techniques used in this study included myofascial release, treatment of ligamentous and membrane tensions, treatment of somatic dysfunctions, and treatment to asymmetries and imbalances in the pelvis and cranium.

• Sham manipulation + medication therapy n=35

•• The sham group received a false manipulation, in addition to drug care.

•• Sham therapy mimicked the manipulative care in terms of evaluation and treatment; it used light manual contact to ‘‘treat’’ the subject.

•• Both manipulative and sham therapy sessions lasted 30 minutes and were given weekly for the first two sessions, biweekly for the subsequent two, then monthly for the remained four sessions.

• Medication only n=35

3) “Migraine attacks are usually characterized by a unilateral and pulsating severe headache, lasting 4—72 hours, and are often associated with nausea, phono- and photophobia.”

4) “Migraine is a serious public health concern of considerable consequences to both the migraineur and society.”

5) The overall migraine prevalence in Europe is 10—15% of the population.

6) These authors make the following points pertaining to the etiology of migraine:

• In 20% of migraineurs, the attacks are anticipated by transient neurological

symptoms, the aura.

• Migraine has a genetic etiology in about 50% of cases.

• Migraine etiology also has multifactorial epigenetic mechanisms.

• During a migraine attack, high levels of inflammatory cytokines are released causing neurogenic inflammation of the meninges and transmitting pain signals to the trigeminovascular system and autonomic nervous system nuclei.

7) Criteria considered for manipulative evaluation and treatment were:

• Alteration of tissue consistency

• Asymmetry

• Range of motion restriction

• Tenderness

8) During migraine attacks, high levels of pro-inflammatory substances are released, altering neural autonomic pathways.

9) Manipulation influences the autonomic nervous system by producing a parasympathetic effect, and therefore, a “trophotropic tuning state.”

10) Manipulation is associated with a “reduction of pro-inflammatory substances.”

11) Manipulation in migraineurs could reduce the release of pro-inflammatory substances that have an effect on the autonomic nervous system function. “As a consequence, a cascade of biological and neurological events, potentially based on a rebalance of the abnormal activation of the habituation/sensitization mechanism, even between attacks, could occur resulting in an overall improvement of clinical outcomes.”

12) Manipulation “significantly reduced the frequency of migraine.”

13) At the end of the study period, there was a statistically significant difference on the overall HIT-6 score between the three groups; the manipulation group was statistically improved from control [drug only] and sham group.

14) “Considering migraine days per month, the three groups differed significantly at the end of the study period.”

15) Manipulation “significantly reduced the number of subjects taking medications.”

16) “No study participant reported any adverse effects of the [manipulation].”

17) “Migraine attacks, use of drugs, pain and disability scores were significantly reduced in the OMT group.”

18) “OMT showed a significant improvement in the migraineurs’ quality of life.”

19) Interestingly, the “sham group significantly reduced the HIT-6 score compared to the conventional [drug only] care. “The magnitude of the results suggests that the sham procedure may be clinically effective.” [Important]

20) The sham treatment used soft touch, which will induce responses at different levels of the central nervous system, reducing pain and improving well-being.

21) “The use of osteopathy [manipulative therapy] as an adjuvant therapy for migraine patients may reduce the use of drugs and optimize the clinical

management of the patients.”

22) “The present study showed significant differences between OMT group compared to drug and sham groups, suggesting that OMT may be considered a clinically valid procedure for the management of patients with migraine.”

COMMENTS

It is important to look at the numbers in the table and the graph in this Review. Again, it is noteworthy that sham manipulation is superior to drug-only treatment for migraine. Note that manipulation essentially eliminated migraine days per month, pain, disability, and reduced drug consumption by 80%. Note that for the group assigned to taking drugs-only, there was essentially no reduction in migraine days per month, pain, disability, and no reduction in drug consumption.

Our interpretation of this data is that it appears that manipulation is actually addressing the causative pathophysiology of migraine headache; in contrast, it appears that taking drugs is nothing more than temporary pain control with no benefit to the causative pathophysiological of migraine headache. We remain perplexed as to why any healthcare delivery system would favor drugs for migraine (and many other pain syndromes) over mechanical therapy.  $  ??? 😊

Glucose Metabolic Changes in the Brain and Muscles of Patients with Nonspecific Neck Pain Treated by Spinal Manipulation Therapy

Glucose Metabolic Changes in the Brain and Muscles of Patients with Nonspecific Neck Pain Treated by Spinal Manipulation Therapy:

A [18F] FDG PET Study {a radioactive glucose PET scan study}. Evidence-Based Complementary and Alternative Medicine Volume 2017

 The study has four important findings:

  • The brain is affected by chiropractic adjusting
  • Chiropractic adjusting inhibits pain
  • Chiropractic adjusting inhibits muscle tone, improving ranges of motion
  • Chiropractic adjusting inhibits sympathetic tone, a key influence on immunity and other factors in systemic wellness

 

PET (positron emission tomography) scan is a powerful neuroimaging technique to investigate neuronal activity in the human brain and muscles.

18F-labeled fluorodeoxyglucose (FDG) is a radioactive analogue of glucose, and is an excellent imaging marker of brain glucose consumption (brain metabolic activity).

 

A PET scan can visualize brain metabolic changes induced by spinal manipulative therapy (SMT). The aim of this study was to investigate changes in brain and muscle glucose metabolism using positron emission tomography with fluorodeoxyglucose.

 

Twenty-one male volunteers were recruited for the present study. Spinal manipulative therapy (SMT) was applied using an Activator in accordance with the Activator Methods protocols. The Activator applied impulses to specific vertebrae or joints. “SMT was performed on the subject in a prone position without movements such as cervical rotation, lateral flexion, and extension, in order to prevent the muscular FDG uptake due to muscle contractions during the therapeutic procedure. SMT was carried out on the whole spine, the scapulae, the ilium, and the sacrum, as necessary for each subject. The mean number of SMT adjusted sites was 8 per subject.”

 

Glucose metabolism of the brain and skeletal muscles was measured. Also measured was salivary amylase levels as an index of autonomic nervous system (ANS) activity, muscle tension, and subjective pain intensity. “Other measurements indicated relaxation of cervical muscle tension, decrease in salivary amylase level (suppression of sympathetic nerve activity), and pain relief after SMT.” “SMT on all subjects was performed by the same Chiropractor, who was an advanced practitioner of Activator Methods.”

KEY POINTS FROM THIS STUDY

 1) Spinal manipulation therapy (SMT) has “been applied mainly to musculoskeletal problems such as neck pain or low back pain.”

2) Previous studies have shown that “SMT has beneficial clinical effects, including pain relief and reduction of blood pressure.”

3) “The intensity of subjective pain was evaluated using a 0–10 visual analog scale (VAS) before and after SMT in the treatment condition.”

4) “Cervical muscle tension was measured bilaterally at the superior part of the trapezius muscle using a tissue hardness meter.”

5) “Salivary amylase levels were measured for each subject using an amylase monitor to evaluate changes in autonomic nervous system (ANS) function.”

6) “Salivary 𝛼-amylase levels correspond to plasma norepinephrine levels and are utilized as an accessible measure of sympathetic nervous reactivity in stress research, with lower levels indicating lower activity.”

7) “We observed multiple changes in brain activity after SMT.”

8) “The findings of the present study demonstrate how stimuli to the mechanoreceptors of the joints and skin during SMT are processed in the brain.”

9) “Brain processing after SMT may lead to physiological relaxation via a decrease in sympathetic nerve activity.” [Key Point]

10) “Comparisons of VAS pain scores in the treatment condition revealed a significant decrease after SMT.”

11) “Cervical muscle tension was significantly reduced bilaterally after SMT.” “Our results suggest that stimulation of joints during SMT induced relaxation of reflexive muscle tension.”

12) “Salivary amylase level decreased significantly after SMT.”

Changes Following Spinal Manipulation

-Visual Analogue Pain, VAS, Significantly Reduced By About 65%

-Muscle Tension Significantly Reduced

-Salivary Amylase (as an indicator of norepinephrine sympathetic tone)Significantly Reduced

-Cingulate Cortex (part of the limbic system)emotions, learning, memory

-Increased Cerebellar Vermis (spinal proprioception)posture/movement, emotions Increased

-Somatosensory Cortex (pain perception/localization)Reduced

-Prefrontal Cortex (executive function) personality, planning, decision making, moderating social behavior Reduced

13) The Cerebellar Vermis:

  • “The Cerebellar Vermis receives somatic sensory information from the spinal cord and via the vestibulospinal tract or reticular nuclei of the brainstem through the spinal cord, connecting indirectly or directly with motor cells on the ventral horn. These systems control involuntary muscular tension and reflexes.”
  • The cerebellum has many roles in non-motor functions.
  • “The cerebellum is also thought to have a functional role as an integrator of multiple effector systems, including affective processing, pain modulation, and sensorimotor processing.”
  • The Cerebellar Vermis is activated during mental recall of emotional personal episodes in humans. 14) “Our assessment of body responses in this study showed relaxation of muscle tension and decreased salivary amylase levels—phenomena that are associated with reduced sympathetic nerve activity.”[Key Point]

14) SMT stimuli to the joints may result in “decreased sympathetic nerve activity.” [Key Point]

15) These authors believe that the relaxation of muscle tone documented in this study occur as a consequence of two mechanisms:

  • Inhibition of sympathetic autonomic nervous activity
  • Improvement of the range of joint movement

16) “We observed that SMT stimulus induced physical responses such as muscle tension relaxation, pain relief, and reduced amylase secretion.”

17) “Neural inputs evoked by SMT stimuli via various receptors in muscles, tendons, and joints may ascend to the somatosensory areas of the brain through the medial lemniscal system. “

18) “In summary, we observed metabolic changes in the brain and skeletal muscles, as well as reductions in subjective pain, muscle tension, and salivary amylase, after SMT intervention. These results may be associated with reduced sympathetic nerve activity,” suggesting that SMT induces sympathetic inhibition (“relaxation”).

20) “The brain response to SMT may reflect the psychophysiological relaxation that accompanies reduced sympathetic nerve activity.”

COMMENTS

This study used the most sophisticated technology to date to assess the affects of chiropractic spinal adjusting:

  • Changes in radioactive glucose metabolism as measured with a PET scan in both the brain and in muscles
  • Changes in muscle tone
  • Improvement in pain using a VAS
  • Changes in sympathetic nervous system production and release of norepinephrine (sympathetic tone)

 

Akie Inami, Takeshi Ogura, Shoichi Watanuki, Mehedi Masud, Katsuhiko Shibuya,Masayasu Miyake, Rin Matsuda, Kotaro Hiraoka, Masatoshi Itoh, Arlan W. Fuhr,Kazuhiko Yanai, Manabu Tashiro:Takeshi Ogura is a chiropractor.Arlan Fuhr is a chiropractor and owner of Activator Methods International, Ltd.

This study was done at Tohoku University Graduate School of Medicine, Sendai, Japan, along with the Division of Cyclotron Nuclear Medicine at Tohoku University. This article has 47 references.