Spine-Adjusting Instrument (Impulse®) Attenuates Nociception and Modulates Oxidative Stress Markers in the Spinal Cord and Sciatic Nerve of a Rat Model of Neuropathic Pain.

OBJECTIVE: Oxidative stress plays an important role in neuropathic pain (NP). Spinal manipulative therapy (SMT) can exert beneficial effects on pain outcomes in humans and in animal models. SMT can also modulate oxidative stress markers in both humans and animals. We aimed to determine the effect of Impulse®-assisted SMT (ISMT) on nociception and oxidative stress biomarkers in the spinal cords and sciatic nerves of rats with NP. METHODS: NP was induced by chronic constriction injury (CCI) of the sciatic nerve. Animals were randomly assigned to naive, sham (rats with sciatic nerve exposure but without ligatures), or CCI, with and without ISMT. ISMT was applied onto the skin area corresponding to the spinous process of L4-L5, three times per week for 2 weeks. Mechanical threshold, latency to paw withdrawal in response to thermal stimulus, and oxidative stress biomarkers in the spinal cord and sciatic nerve were the main outcomes evaluated. RESULTS: ISMT significantly increased mechanical threshold and withdrawal latency after CCI. In the spinal cord, ISMT prevented the increase of pro-oxidative superoxide anion generation and hydrogen peroxide levels. Lipid hydroperoxide levels both in the spinal cord and in the sciatic nerve were attenuated by ISMT. Total antioxidant capacity increased in the spinal cords and sciatic nerves of CCI rats with and without ISMT. CCI and ISMT did not significantly change the total thiol content of the spinal cord. CONCLUSIONS: Our findings suggest that reduced oxidative stress in the spinal cord and/or nerve may be an important mechanism underlying a therapeutic effect of SMT to manage NP nonpharmacologically.

Peripheral oxidative stress blood markers in patients with chronic back or neck pain treated with high-velocity, low-amplitude manipulation.

OBJECTIVE: The purpose of this study was to investigate oxidative-stress parameters in individuals with chronic neck or back pain after 5 weeks of treatment with high-velocity, low-amplitude (HVLA) spinal manipulation. METHODS: Twenty-three individuals aged 38.2 ± 11.7 years with nonspecific chronic neck or back pain verified by the Brazilian Portuguese version of the Chronic Pain Grade, with a sedentary lifestyle, no comorbidities, and not in adjuvant therapy, underwent treatment with HVLA chiropractic manipulation twice weekly for 5 weeks. Therapeutic procedures were carried out by an experienced chiropractor. Blood samples were assessed before and after treatment to determine the activities of the antioxidant enzymes superoxide dismutase (SOD), catalase and glutathione peroxidase (GPx), and the levels of nitric oxide metabolites and lipid hydroperoxides. These blood markers were analyzed by paired Student t test. Differences were considered statistically significant, when P was <.05. RESULTS: There was no change in catalase but an increase in SOD (0.35 ± 0.03 U SOD per milligram of protein vs 0.44 ± 0.04 U SOD per milligram of protein; P < .05) and GPx (7.91 ± 0.61 nmol/min per milligram of protein vs 14.07 ± 1.07 nmol/min per milligram of protein; P < .001) activities after the treatment. The nitric oxide metabolites and the lipid hydroperoxides did not change after treatment. CONCLUSION: High-velocity, low-amplitude spinal manipulation twice weekly for 5 weeks increases the SOD and GPx activities. Previous studies have shown a relationship between pain and oxidative and nitrosative parameters; thus, it is possible that changes in these enzymes might be related to the analgesic effect of HVLA spinal manipulation.

Assessment of oxidative parameters in rat spinal cord after chronic constriction of the sciatic nerve.

Although reactive oxygen species (ROS) are involved in neuropathic pain, the direct relationship between these species and chronic constriction of sciatic nerve (CCI) has not been studied in spinal cord. Thus, this study induced CCI in rats and these animals were sacrificed 3 and 10 days after the surgical procedure to determine the superoxide dismutase (SOD) and catalase activities, as well as ascorbic acid, hydrogen peroxide (H(2)O(2)) and lipid hydroperoxide levels in lumbosacral spinal cord. Von Frey Hair and hot plate tests were performed to assess the degree of mechanical and thermal hyperalgesia at days 0, 3 and 10. The results showed that CCI significantly induced mechanical and thermal hyperalgesia at days 3 and 10. Parallel there was increase in spinal cord lipid hydroperoxide at days 3 and 10 in rats submitted to CCI. In Sham rats a significant increase in this parameter occurred at day 10. H(2)O(2) decreased at day 10 only in CCI group. SOD activity was decreased in Sham and CCI groups at day 3, while catalase activity was increased in CCI rats at days 3 and 10. Ascorbic acid levels were reduced only in CCI rats at day 3. Although the role of such changes is unclear, many were not specific to neuropathic pain and the differences could be related to different degrees of central sensitization in Sham and CCI rats.

Effect of high-velocity, low-amplitude treatment on superoxide dismutase and glutathione peroxidase activities in erythrocytes from men with neck pain.

OBJECTIVE: This study investigates the analgesic effect of high-velocity, low-amplitude (HVLA) manipulation and antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase (GPx) in erythrocytes of men with neck pain. METHODS: Twenty-two men with neck pain of mechanical origin who were aged 20 to 50 years, were nonsmokers, had a sedentary lifestyle, had no comorbidities, and were not in adjuvant therapy underwent 6 sessions of HVLA chiropractic manipulation 3 times a week for 2 weeks. Patients were treated by the same chiropractor and under the same conditions. Blood samples were collected before the beginning of the treatment and at the end of the third and last session. Erythrocytes were separated from blood and then processed to determine SOD and GPx activities. The quadruple visual scale and the Neck Disability Index were used to demonstrate the analgesic effect of treatment. The results were analyzed by repeated-measures analysis of variance followed by Bonferroni posttest. Differences were considered significant when P was less than .05. RESULTS: Despite the tendency to reduction in SOD and increase in GPx activities, there was no significant change after the treatment. CONCLUSION: High-velocity, low-amplitude treatment for 6 sessions in men with neck pain did not affect systemic SOD and GPx activities. Despite the absence of significant changes, this study is important because it is the first to investigate the activities of SOD and GPx in patients with neck pain treated with HVLA spinal manipulation.

Interferential therapy effect on mechanical pain threshold and isometric torque after delayed onset muscle soreness induction in human hamstrings.

This study was undertaken to examine the acute effect of interferential current on mechanical pain threshold and isometric peak torque after delayed onset muscle soreness induction in human hamstrings. Forty-one physically active healthy male volunteers aged 18-33 years were randomly assigned to one of two experimental groups: interferential current group (n = 21) or placebo group (n = 20). Both groups performed a bout of 100 isokinetic eccentric maximal voluntary contractions (10 sets of 10 repetitions) at an angular velocity of 1.05 rad · s(-1) (60° · s(-1)) to induce muscle soreness. On the next day, volunteers received either an interferential current or a placebo application. Treatment was applied for 30 minutes (4 kHz frequency; 125 µs pulse duration; 80-150 Hz bursts). Mechanical pain threshold and isometric peak torque were measured at four different time intervals: prior to induction of muscle soreness, immediately following muscle soreness induction, on the next day after muscle soreness induction, and immediately after the interferential current and placebo application. Both groups showed a reduction in isometric torque (P < 0.001) and pain threshold (P < 0.001) after the eccentric exercise. After treatment, only the interferential current group showed a significant increase in pain threshold (P = 0.002) with no changes in isometric torque. The results indicate that interferential current was effective in increasing hamstrings mechanical pain threshold after eccentric exercise, with no effect on isometric peak torque after treatment.

Effects of high-velocity, low-amplitude manipulation on catalase activity in men with neck pain.

OBJECTIVE: The aim of this study was to identify the influence of high-velocity, low-amplitude (HVLA) manipulation on lipid peroxidation and catalase activity in subjects with neck pain who answered the Neck Disability Index and quadruple visual scale questionnaires. METHODS: Twenty-two men (mean age, 38 years) with neck pain were recruited through radio and newspaper advertisements in the local media. Every patient received 6 sessions of HVLA manipulation, 3 times a week for 2 weeks. Blood samples were drawn from the cubital vein before treatment in the first session and after the third and sixth sessions. The quadruple visual scale was used with the same scheme. The Neck Disability Index questionnaire was applied before the beginning of treatment and after the last session. Catalase activity and lipoperoxidation were measured in erythrocyte samples. RESULTS: Results showed no change in lipid peroxidation. Nevertheless, the catalase activity was increased by HVLA manipulation. The same treatment reduced pain perception and disability in these subjects. CONCLUSION: The present study has shown that catalase activity of the erythrocytes, but not lipoperoxidation, increased after 6 sessions of HVLA manipulation treatment in men with neck pain. The results support the beneficial role of HVLA in the treatment of patients with neck pain.