Comparison of the Effect of Spine Grade I and II Manipulation and a PNE Video on Brainwaves: Pilot Study
Condition: Chronic Pain; Manipulation; Psychologic
MeSH terms: Chronic Pain
Study type: Interventional

Summary: 
      The purpose of this study is to determine the effect of the use of a pain neuroscience
      educational video instruction on brainwave activity and compare this to the effects of a
      grade I & II PA spinal oscillations of the spine using EEG in individuals with chronic pain.
    

Detailed description: 
      This quasi-experimental pilot study compared differences in brainwave activity in subjects
      with chronic spinal pain following PA spinal oscillations and after viewing a 5-minute pain
      neuroscience educational video.

      In this within subject's design all subjects were given the two interventions on two
      different days. To prevent the order of the intervention to influence the study results the
      subjects were randomized into two different groups, A and B. Group A received PA spinal
      oscillations on their first visit and. Group B's underwent the opposite and watched a pain
      neuroscience education video on their first visit and received PA spinal oscillations on
      their first visit. Both sessions and interventions were lead and performed by the Doctor of
      Physical Therapy student under the direct supervision of the lead physical therapist, who is
      manually trained and holds a Cranio-Facial Certification. In order to standardize the
      location of the PA spinal oscillation intervention so brain activity and response can be
      properly compared, C7, T4 and L4 were identified and marked with a pen prior to any measures.
      Identification of L4 was achieved by placing hands on the subject's iliac crests with thumbs
      pointing toward one another. Keeping hands straight and parallel to the floor, thumbs will
      move medially, landing on L4.25 To identify C7, the subject was taken through cervical
      extension, where C6 will disappear and C7 remains in place.26 Once C7 was located, the
      spinous processes were palpated and counted until the level of T4, which was marked. Various
      factors can affect the reliability of this process, such as subject obesity, therapist
      experience, and anatomical differences.25 Studies show reliability for this method to be
      low.25,26 However, these studies, as with most, use a small sample size and only using one
      palpatory landmark for each level examined.25,26 To standardize variables, the methods above
      were used in conjunction with palpation of surrounding vertebrae. To measure brain wave
      activity during this study the 14-lead Emotiv EPOC portable EEG headset was used. Each
      participant wore the headset throughout the measurement and was in a seated position. After
      the EEG headset was placed properly and connection with the system had been appropriately
      established the subjects remained seated in a quiet room for three minutes to accommodate to
      the room environment before the first EEG measurement. After this, a 1-minute EEG recording
      was taken. This measurement served as the participant's baseline measurement. Group A
      subjects then received a grade I & II spinal oscillations of three identified segments (C7,
      T4, and L4), 1 minute per segment for a total of 3 minutes. Directly following this a second
      1-minute EEG recording was taken. On the subsequent visit, group A again underwent the
      three-minute seated accommodation period with the EEG headset on, followed by a 1 minute
      baseline EEG measurement prior to watching a 5 minute pain neuroscience educational video
      Understanding Pain in less than 5 minutes, and what to do about it!
      https://www.youtube.com/watch?v=C_3phB93rvI. A 1-minute EEG recording was taken during the
      first minute of the video and again during the last minute of the video. Immediately after
      watching the pain neuroscience educational video a 1-minute EEG recording was taken. The
      measurement protocol for group B was the same, but in reversed order. They watched the pain
      neuroscience educational video at their first visit and the PA spinal oscillations on their
      next visit.
    

Intervention name(s): Understanding Pain in less than 5 minutes, and what to do about it! https://www.youtube.com/watch?v=C_3phB93rvI; PA manipulation
Intervention type(s): Behavioral; Procedure
Intervention description(s): Watching pain neuroscience education video; Low grade PA manipulation on the cervical, thoracic and lumbar spine
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Intervention model description: Half of the group was assigned randomly to receive intervention 1 and during the second visit intervention 2. The other half received intervention 2 first followed by intervention 1 on subsequent visit
Masking: Double (Participant, Investigator)
Primary purpose: Basic Science
Keywords: Pain neuroscience education; EEG; Spinal manipulation