A Randomized Clinical Trial

Irish Journal of Medical Science November 26, 2019; [epub]

Daryoush Didehdar, Fahimeh Kamali, Amin Kordi Yoosefinejad, Mehrzad Lotfi: from Shiraz University of Medical Sciences. This study cites 43 references.

This study is a randomized, double-blinded, clinical trial.


Chronic nonspecific low back pain (LBP) is a prevalent condition affecting a significant portion of the population. A groundbreaking randomized clinical trial, featured in the Irish Journal of Medical Science, explores the profound effects of spinal manipulation on brain neuro-metabolites in patients grappling with this persistent ailment. Led by researchers from Shiraz University of Medical Sciences, the study delves into the neuroplastic changes and neurophysiological mechanisms associated with spinal manipulation.

Understanding Chronic Nonspecific Low Back Pain:

Nonspecific chronic LBP, representing 90% of chronic cases, is characterized by lumbar discomfort without specific neurological signs. The study highlights that chronic pain, even after initial tissue damage has healed, is intricately linked to neuroplastic changes in the central nervous system (CNS).

Key Insights from the Study:

  • Neuroplastic Changes in Chronic Pain:
  • Chronic pain in nonspecific LBP induces neuroplastic changes in different brain regions, emphasizing the role of the central nervous system in the persistence of pain.
  • Central sensitization, increased CNS activity, and hypersensitivity contribute to the transformation of acute pain into chronic pain.
  • Physical Activity and Pain Perception:
  • Physical activity in nonspecific chronic LBP patients increases blood flow in pain-associated brain regions, leading to decreased pain perception.
  • Effectiveness of Spinal Manipulation:
  • Spinal manipulation emerges as a successful, cost-effective, and non-invasive treatment for nonspecific chronic LBP.
  • Previous research confirms the positive impact of manipulation on function improvement and pain reduction.
  • Neurophysiological Mechanism of Manipulation:
  • The study underscores the neurophysiological mechanism of manipulation, involving the CNS’s ability to modulate sensory information.
  • Spinal manipulation activates sensory afferents, influencing the transmission of painful signals and motor function from the spinal cord to the cerebral cortex.
  • Results at 5 Weeks Post-Intervention:
  • Patients undergoing lumbo-pelvic manipulation experienced a significant reduction in both pain and disability compared to the sham group.
  • Positive improvements in brain neuro-metabolites were observed only in the manipulation group, highlighting the specific impact of spinal manipulation on the CNS.
  • Link Between Neuro-Metabolite Changes and Pain Relief:
  • The study establishes a correlation between pain relief, improved functional disability, and positive changes in brain neuro-metabolites.
  • Spinal manipulation induces alterations in CNS processing and sensory-motor integration, contributing to pain reduction and enhanced functional ability.
  • Conclusion and Future Considerations:
  • The findings suggest that spinal manipulation, targeting the CNS, induces changes in brain metabolites, thereby reducing pain and functional disability.
  • While acknowledging the study’s limitations, the authors emphasize the need for further exploration, suggesting that a higher MRI strength could provide more detailed insights.

In conclusion, this study provides valuable evidence supporting the efficacy of spinal manipulation in managing chronic nonspecific low back pain. By unraveling the neuro-metabolic changes associated with this intervention, the research contributes to a deeper understanding of the intricate relationship between spinal manipulation, the central nervous system, and the relief of chronic low back pain.