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A nice article on pain and massage

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Using manual therapy to treat pain
by Dr Julie Eastgate

Laboratory and clinical studies have started to identify the physiological changes that occur in individuals undergoing manual therapy. Manual therapy results in a rapid-onset, localised analgesia, increases limb mobility and effects autonomic changes. Animal models have been developed to inform on neuronal mechanisms, and suggest a local action on nociceptors and modulation of central pain-inhibition mechanisms.

Manual therapy is a commonly used treatment modality for managing musculoskeletal pain that has been shown to promote rapid recovery. Localised, manipulation-induced analgesia is routinely seen following manual therapy and is proposed to occur via a number of mechanisms:

· A local action on nociceptors.
· Modulating the activity of both descending and segmental pain inhibitory systems.
· Exerting psychological effects, probably as a result of treatment expectations.

The mechanical hypoalgesic effect occurs within minutes of manipulation, and meta-analysis of clinical studies has confirmed that it is associated with an increase in pressure-pain threshold and limb mobility. In contrast manual therapy does not modulate sensitivity to thermal pain.

In addition to the demonstrable analgesic effects, manual therapy also induces a number of autonomic changes such as increased skin conductance and cutaneous blood flow, increased pulse and respiration rate, and changes in skin temperature. This indicates that, in addition to changes in pain perception, manual therapy modulates central nervous system function in a sympathoexcitatory manner (promoting mobility).

The local analgesia and systemic autonomic changes in response to manipulation have been demonstrated in healthy individuals and those with pain. Manual therapy also achieves motor function benefits; cervical mobilisation in individuals with insidious-onset cervical pain has been shown to promote increased deep neck flexor muscle activity and improve pain-free grip. However, motor function benefit tends to be restricted to individuals with a clinical condition.

These patterns of effect are suggestive of activation of the descending supra-spinal pain systems. Further evidence of a role for descending pain modulation pathways has been generated using animal models. A rat model has been developed in which capsaicin injection induces hyperalgesia in the hind-paw; ipsi-lateral knee joint manipulation subsequently exerts an anti-algesic effect in the entire limb. The model has shown that the analgesic effect of joint mobilisation is inhibited by the intrathecal administration of serotonin antagonists and is partially modulated by a₂2-noradrenergic receptor inhibitors; in contrast opioid antagonists and gamma-aminobutyric acid inhibitors have no effect. This suggests that manual therapy affects the activity of the supra-spinal, descending pain-inhibitory systems that involve seratogenergic and noradrenergic pathways.

A nice article on pain and massage

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