Immediate effect of manual therapy on the cardiac autonomic nervous system in individuals with musculoskeletal pain

Authors

  • Pedro Teixeira Vidinha Rodrigues Autor

Keywords:

Musculoskeletal Pain, Autonomic Nervous System, Manual Therapy, Placebo Effect

Abstract

Introduction: Manual Manipulative Therapy (MMT) is one of the main resources in the conservative treatment of musculoskeletal pain, however the mechanisms by which it generates pain relief are not yet fully established. The autonomic nervous system
(ANS) is identified as one of the factors involved in the origin and maintenance of painful conditions, being altered in both acute and chronic musculoskeletal pathologies. The mechanisms of action of MMT on painful conditions are not yet fully understood and its effect on ANS is listed as a possible mechanism for pain improvement. The analgesic effect in distant places where the local spinal
manipulation was performed also supports a potential involvement of the central nervous system and may be connected to the SNA. The literature reports the lack of studies on the effect of MMT in a symptomatic population. Objective: To evaluate the immediate effect of spinal manipulation techniques in the upper thoracic region, fascial mobilization and placebo on cardiac SNA musculoskeletal pain in patients with any body segment in both acute and chronic. As well as to verify the action of the descending inhibitory pain control mechanism and its relationship with cardiac ANS. Methods: A parallel clinical trial of treatment with a blind, randomized, placebo controlled, three-arm examiner was performed to investigate the acute effect, in 58 individuals with musculoskeletal pain, of the Manipulative Manual Therapy (TMM) techniques (n = 20), Fascial Mobilization Technique (TMF) (n = 19) and placebo (PL) (n = 19) on Cardiac ANS. Autonomic activity was monitored indirectly through heart rate variability (HRV) and the difference in blood pressure (BP) with the modulation of conditioned pain during the cold pressure test (CPT). HRV and BP response to coldinduced pain were measured before and after the interventions. Parasympathetic autonomic activity was verified by HRV through the analysis of the mean square root (RMSSD), the standard deviation of RR intervals (SDRR), the high frequency component (HF) and the sympathetic activity by the difference in systolic BP (SBP) and diastolic (DBP) to CPT. Conditioned pain modulation was also used to verify the response of the descending nociceptive inhibitory system (DNIS). Results: Both groups were similar for baseline variables except for BP, which had higher values in the MFT group. Two-way repeated ANOVA revealed that MMT induced immediate improvement on the parasympathetic response elicited by HF (nu) as compared to PL [mean difference = 9.8, (95% confidence interval 0.7 to 19.0), p = 0.033] or MFT [mean difference = 8.2, (95% confidence interval 0.4 to 16.1), p = 0.039]. One-way ANCOVA showed a significant effect of intervention for RMSSD (P = 0.028), HF (ms2) (P = 0.013), and HF (nu) (P = 0.019), after controlling for BP at baseline. There were no significant differences in sympathetic responses between the three treatments. Most
of the patients were women (60%) and had chronic pain (75%). The groups had similar demographic characteristics. Patients with impaired DNIS showed lower HRV [RMSSD (P = 0.020), SDRR (P = 0.009), HF (ms2) (P = 0.027), LF (ms2) (P = 0.004), and total
power (P = 0.002)]. The blood pressure response to CPT was similar between groups (systolic pressure, P = 0.813; diastolic pressure, P = 0.709). Conclusion: In patients with musculoskeletal pain, the MMT on upper thoracic spine leads to immediate improvement in cardiac vagal modulation as compared with placebo or MFT. There were no effects on cardiac sympathetic function after the three interventions. These results support the effectiveness of the MMT on cardiac parasympathetic function in musculoskeletal pain. Patients with impaired DNIS presented lower resting HRV, indicating an altered vagal control of the heart. In contrast, the blood pressure response to a sympathoexcitatory stimulus was preserved.

Published

2025-05-20

How to Cite

Immediate effect of manual therapy on the cardiac autonomic nervous system in individuals with musculoskeletal pain. (2025). Sistema De Submissão De Trabalhos De Conclusão De Curso, 6(1), 89. https://sstcc.unisuam.edu.br/index.php/ppgcr/article/view/113

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