Efficacy of Mobilization With Movement on Conditioned Pain Modulation in Chronic Low Back Pain Patients

Eleuterio Atanasio Sánchez Romero

Status: Completed

Conditions: Chronic Low-back Pain

Treatments: Biological: Sham mobilization with movement; Biological: Mobilization with movement

Study type: Interventional

Funder types: Other

Identifiers

NCT06078033

1811202225222

Details and patient eligibility

About

Patients with chronic low back pain may have altered endogenous mechanisms, which can be evaluated with conditioned modulation paradigms. Mobilization with movement has demonstrated improvements in endogenous analgesic mechanisms in conditions such as knee osteoarthritis or lateral epicondylalgia. However, its effects have not yet been studied in patients with chronic low back pain. The objective of this randomized clinical trial is to evaluate the efficacy of mobilization with movement compared to placebo on endogenous mechanisms in patients with chronic low back pain.

Full description

Low back pain is the leading cause of disability worldwide, and chronic low back pain (CLBP) has a prevalence of 2-25%, 80% of which are classified as non-specific low back pain because the causal factors have not yet been determined. Although different mechanisms can be attributed to the chronification of pain, a frequent denominator is the amplification of nociceptive transmission or decreased inhibition of nociceptive stimuli in the peripheral and/or central nervous system.

To assess inhibitory pathways, conditioned pain modulation (CPM) paradigms are commonly used in humans. They are based on the idea that a noxious stimulus applied to one part of the body can inhibit pain elsewhere by activating the descending inhibitory system.

When CPM is evaluated in patients with chronic low back pain, contradictory results are found, with studies reporting an alteration of pain modulation mechanisms and others not.

Different studies found that manual therapy can improve CPM compared to sham in patients with chronic musculoskeletal pain, such as lateral epicondylalgia or knee osteoarthritis. However, its effects in patients with chronic low back pain have not yet been studied.

Therefore, the aim of this study was to investigate the effect of mobilization with motion on CPM in patients with chronic musculoskeletal pain.

Enrollment: 58 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Adults with chronic low back pain (>3 months of pain duration)
• 2 or more on a scale of 0 to 10.

Exclusion criteria

• Radiculopathy
• Neurological signs, symptoms, or deficit
• Rheumatic or autoimmune disease
• Cutaneous disease
• History of fracture or spinal surgery
• Pregnancy
• Neuropathic pain
• Active cancer
• Spondylolysis/Spondylolisthesis
• Mild/Severe cognitive impairment which interferes with outcomes measurement

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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58 participants in 2 patient groups

Intervention: Mobilization with movement (MWM)

Experimental group

Description:

The MWM technique was performed by asking patients to perform their painful movement (flexion, extension...). If pain was not reproduced, a combination of movements (flexion + rotation...) was performed. The most painful vertebral level was also evaluated with passive accessory vertebral movements. Then, with the patient in a seated position on a stretcher with the feet supported and a belt around the waist, the therapist performed a sustained glide over the targeted vertebra (spinous process) with the force and direction that relieved pain to the lowest level and asked the patient to perform his previous painful movement, as described by Mulligan. Three sets of 10 repetitions were performed, with 1-2 minutes rest between sets.

Treatment:

Biological: Mobilization with movement

Control: Sham mobilization with movement

Sham Comparator group

Description:

Patients allocated to sham group received same evaluation and treatment process. However, only manual contact was performed over the spinous process of the targeted vertebra, without the sustained glide and without applying any force. Three sets of 10 repetitions were performed, with 1-2 minutes rest between sets.

Treatment:

Biological: Sham mobilization with movement