Central Mechanisms of Intervention for Low Back Pain

Study Overview
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Brief Summary
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Body-based interventions have consistently shown clinical effectiveness in patients with back pain. The primary objective for this study is to compare the effect of body-based interventions commonly used in the management of low back pain on behavioral and cortical measures of pain sensitivity and central sensitization of pain. Participants will be randomly assigned to receive one of the interventions or be in a control group. The central hypothesis for this proposal is that spinal manipulation, a specific form of body-based intervention, inhibits central sensitization of pain normalizing pain sensitivity more rapidly than other interventions. The completion of the proposed study will elucidate underpinning mechanisms of body-based interventions. Identification of these mechanisms will improve the clinical application and utilization of these interventions in the management of musculoskeletal pain conditions, especially back pain.

Detailed Description
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170 participants will be randomly assigned to receive one of the interventions or be in a control group. The investigators will use of a model of experimentally induced low back pain to investigate the effects of manipulative and body-based interventions in acute onset low back pain without some of the clinical confounds. The investigators will collect fMRI and psychophysical data about pain sensitivity before and after the induction of pain, and before and after interventions for that pain.

Official Title
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Central Mechanisms of Body Based Intervention for Musculoskeletal Low Back Pain

Conditions
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Low Back Pain

Intervention / Treatment
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* Other: Spinal Manipulation
* Other: Spinal Mobilization
* Other: Static Touch


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: aged 18 to 40 years able to read and understand spoken English Exclusion Criteria: Previous participation in a conditioning program specific to trunk extensors in the past 6 months Any report of back or leg pain in the past 3 months Any chronic medical conditions that may affect pain perception (e.g., diabetes, high blood pressure, fibromyalgia, headaches), kidney dysfunction, muscle damage, or major psychiatric disorder History of previous injury including surgery to the lumbar spine, renal malfunction, cardiac condition, high blood pressure, osteoporosis, or liver dysfunction Consumption of any drugs (e.g., caffeine, alcohol, theophyline, tranquilizers, antidepressants) that may affect pain perception or hydration status from 24 hr. before participation until completion of the investigation Performance of any intervention for symptoms induced by exercise and before the termination of their participation or the protocol Recent illness Any contraindication to MRI e.g.: pacemakers, metal implants which are not MRI compatible (e.g. aneurysm clip), pregnancy and severe claustrophobia.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Spinal Manipulation<br>High-velocity manual technique applied to the pelvis with the participant in supine | Other: Spinal Manipulation<br>* High velocity low amplitude joint-biased intervention<br>* Other names: SMT;|
| Sham Comparator: Static Touch<br>Practitioner hands are placed on the lumbar spine with the participant in prone. | Other: Static Touch<br>* The investigators maintains hand contact with both hands over the lumbar area of the participant<br>|
| Active Comparator: Spinal Mobilization<br>Oscillation of the third lumbar level performed with the participant in prone | Other: Spinal Mobilization<br>* Low velocity, large amplitude oscillating joint biased technique<br>* Other names: Mobs;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Immediate change in temporal sensory summation | We will use both behavioral (ratings) and cortical (using fMRI) measures of temporal sensory summation. | 10 minutes post-intervention | 
| Change in temporal sensory summation | The change temporal sensory summation (determined using quantitative sensory testing and fMRI) will be calculated from pre-intervention to 48 hours post-intervention | 48 hours post-intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Physical Impairment Index | Physical Impairment Index is a group of tests including trunk and limb range of motion, muscle tenderness and abdominal muscle performance | 48 hours post-intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Spinal Manipulation, Body-based intervention, Experimental pain