Integrated manual therapies: IASP taskforce viewpoint.

Introduction: Manual therapy refers to a range of hands-on interventions used by various clinical professionals, such as osteopaths, osteopathic physicians, chiropractors, massage therapists, physiotherapists, and physical therapists, to treat patients experiencing pain.

Objectives: To present existing evidence of mechanisms and clinical effectiveness of manual therapy in pain.

Methods: This Clinical Update focuses on the 2023 International Association for the Study of Pain Global Year for Integrative Pain Care.

Restoration of normal central pain processing following manual therapy in nonspecific chronic neck pain.

Objective: To determine if a 4-week manual therapy treatment restores normal functioning of central pain processing mechanisms in non-specific chronic neck pain (NSCNP), as well as the existence of a possible relationship between changes in pain processing mechanisms and clinical outcome.

Design: Cohort study.

Methods: Sixty-three patients with NSCNP, comprising 79% female, with a mean age of 45.

Virtual Rehabilitation and COVID-19: Varied Adoption and Satisfaction Among Patients and Providers Participating in a Multi-Site Survey Study.

The COVID-19 pandemic compelled rapid healthcare adaptations including increased use of telehealth (TH) and virtual care (VC) to provide rehabilitation services. This multi-site cross-sectional survey study examined rehabilitation patients' and providers' experiences with service delivery during the COVID-19 pandemic, including the use of TH/VC. Patients and providers who received or provided rehabilitation services were recruited from 1 of 3 large, post-acute rehabilitation systems located in the Southeastern and Midwestern United States during the COVID-19 pandemic.

Biopsychosocial contributors to irritability in individuals with shoulder or low back pain.

Objectives: Irritability is a foundational clinical reasoning concept in rehabilitation to evaluate reactivity of the examination and treatment. While originally theorized to reflect tissue damage, a large body of evidence supports pain is a biopsychosocial experience impacted by pain sensitivity and psychological factors. Therefore, the purpose of this study was to examine biopsychosocial contributors to irritability.

An overview of systematic reviews examining the quantitative sensory testing-derived hypoalgesic effects of manual therapy for musculoskeletal pain.

Background: Changes in quantitative sensory testing (QST) after manual therapy can provide insight into pain relief mechanisms. Prior systematic reviews have evaluated manual-therapy-induced QST change. This overview of systematic reviews aims to consolidate this body of literature and critically review evidence on the hypoalgesic effects of manual therapy in clinical populations.

An international consensus definition for contextual factors: findings from a nominal group technique.

Objective: Emerging literature suggests contextual factors are important components of therapeutic encounters and may substantially influence clinical outcomes of a treatment intervention. At present, a single consensus definition of contextual factors, which is universal across all health-related conditions is lacking. The objective of this study was to create a consensus definition of contextual factors to better refine this concept for clinicians and researchers.

The Biology of Placebo and Nocebo Effects on Experimental and Chronic Pain: State of the Art.

(1) Background: In recent years, placebo and nocebo effects have been extensively documented in different medical conditions, including pain. The scientific literature has provided strong evidence of how the psychosocial context accompanying the treatment administration can influence the therapeutic outcome positively (placebo effects) or negatively (nocebo effects). (2) Methods: This state-of-the-art paper aims to provide an updated overview of placebo and nocebo effects on pain.

Characteristics and Outcomes of Patients Receiving Physical Therapy for Low Back Pain with a Nociplastic Pain Presentation: A Secondary Analysis.

Introduction: Individuals with low back pain (LBP) may be classified based on mechanistic descriptors, such as a nociplastic pain presentation (NPP). The purpose of this secondary analysis was to examine the frequency and characteristics of patients with a NPP referred to physical therapy with LBP. Additionally, we characterized patients with LBP meeting the criteria for NPP by demographic, clinical, psychological, and pain sensitivity variables.

Pain phenotyping and investigation of outcomes in physical therapy: An exploratory study in patients with low back pain.

Phenotypes have been proposed as a method of characterizing subgroups based on biopsychosocial factors to identify responders to analgesic treatments. This study aimed to, first, confirm phenotypes in patients with low back pain receiving physical therapy based on an a priori set of factors used to derive subgroups in other pain populations. Second, an exploratory analysis examined if phenotypes differentiated pain and disability outcomes at four weeks of physical therapy.

A Sneak Peek at Collections: Coming Soon for Subscribers.

has published scientifically rigorous, clinically-relevant musculoskeletal rehabilitation- and sports-related content for over 40 years. The benefit of so many years of is a rich back catalogue of quality musculoskeletal rehabilitation and sports content. To harness the back catalogue, the Journal is launching Collections-designed as a bundle of quality, clinically-focused content related to a core musculoskeletal rehabilitation theme.

Expectations affect pain sensitivity changes during massage.

Background: Pain-inducing massage produces comparable changes in pain sensitivity as a cold pressor task, suggesting shared neurophysiological mechanisms of conditioned pain modulation. Manual therapy and conditioned pain modulation are influenced by positive and negative expectations. Therefore, the purpose of this study was to examine the effects of positive and negative expectations on pain-free and pain-inducing massage.

Resident Case Series: Blood Flow Restriction as an Adjunct to Strengthening Exercises in Two Patients with Subacromial Impingement and High Irritability.

Introduction: Evidence informed management of individuals presenting with subacromial impingement syndrome (SAIS) includes strengthening exercises directed at the shoulder musculature. Patients with subacromial impingement syndrome (SAIS) can present with pain during and after completion of heavy resistance training limiting the applicability of this recommended treatment approach. Blood flow restriction (BFR) training is indicated for patients who have pain while completing heavy resistance training and may represent an important treatment modification for patients with SAIS unable to fully participate in a strengthening exercise program.

Experimental Pain Phenotype Profiles in Community-dwelling Older Adults.

Objectives: Pain sensitivity and the brain structure are critical in modulating pain and may contribute to the maintenance of pain in older adults. However, a paucity of evidence exists investigating the link between pain sensitivity and brain morphometry in older adults. The purpose of the study was to identify pain sensitivity profiles in healthy, community-dwelling older adults using a multimodal quantitative sensory testing protocol and to differentiate profiles based on brain morphometry.

The healthcare buffet: preferences in the clinical decision-making process for patients with musculoskeletal pain.

The preferences a person has for care are associated with outcomes for patients presenting with musculoskeletal pain conditions. These include preferences for differing levels of involvement in the decision-making process, preferences for the provider attributes, and preferences for particular interventions. In this paper, we discuss these various forms of preference, as well as how they influence clinical care within shared decision-making frameworks.

Age Differences in Multimodal Quantitative Sensory Testing and Associations With Brain Volume.

Background And Objectives: Somatosensory function is critical for successful aging. Prior studies have shown declines in somatosensory function with age; however, this may be affected by testing site, modality, and biobehavioral factors. While somatosensory function declines are associated with peripheral nervous system degradation, little is known regarding correlates with the central nervous system and brain structure in particular.

A psychophysical study comparing massage to conditioned pain modulation: A single blind randomized controlled trial in healthy participants.

Introduction: Pain-inducing massage results in greater pain inhibition than pain free massage, suggesting a mechanism dependent on conditioned pain modulation (CPM). The purpose of this study was to test the hypothesis that pain inducing massage produces similar magnitude of reduction in pain sensitivity as a cold pressor task and that baseline conditioned pain modulation efficiency predicts pain inducing massage related hypoalgesia.

Methods: Sixty healthy participants were randomly assigned to receive either pain inducing massage to the neck, cold pressor task to the hand, or pain free massage to the neck.

Patient-centered outcomes: Domain importance predicts health care use following physical therapy.

Introduction: Identifying patients with musculoskeletal pain who are at risk for additional health care use is important for improving the value of physical therapists' services. We previously identified three subgroups based on the importance attached by patients to improvements in outcome domains including a (1) Pain and Function Outcomes Important subgroup; (2) Pain Important subgroup; and (3) Multiple Outcome Domains Important subgroup.

Objective: The primary aim was to determine whether subgroups based on patient-determined outcomes of importance predicted any additional pain-related health care use after an episode of physical therapy.

Can Patient Expectations Modulate the Short-Term Effects of Dry Needling on Sensitivity Outcomes in Patients with Mechanical Neck Pain? A Randomized Clinical Trial.

Objective: Dry needling is commonly used for the management of patients with musculoskeletal pain. However, the effects of patient expectations are uncertain. Our aim was to determine the effect of patient expectations on short-term clinical outcomes after the application of a single session of dry needling in individuals with neck pain.

Musculoskeletal pain stakeholder engagement and partnership development: determining patient-centered research priorities.

Background: Musculoskeletal (MSK) pain is a global public health problem with increased societal burden. Increased attention has focused toward patient and other stakeholder perspectives when determining future MSK pain research priorities, however infrastructure and capacity building within the community are needed for individuals and organizations to participate in patient-centered outcomes research. The purpose of this manuscript is to describe our collaborative experiences with several MSK pain stakeholders and processes to identify a top priority research topic.

Patient-defined outcomes for pain, fatigue, emotional distress, and interference with activities did not differ by age for individuals with musculoskeletal pain.

Introduction: Age impacts the prevalence and experience of musculoskeletal pain; however, it is unknown whether this factor impacts patient's anticipated outcomes after treatment.

Objective: Using the Patient-Centered Outcomes Questionnaire (PCOQ), the primary purpose was to determine whether there are age-related differences in desired, successful, expected levels, and importance of improvement in pain, fatigue, emotional distress, and interference with daily activities. As a secondary purpose, anatomical location and sex were then included in the model to examine for interaction effects.

Importance of Outcome Domain for Patients With Musculoskeletal Pain: Characterizing Subgroups and Their Response to Treatment.

Background: Patient-centered care models allow for the ability to tailor treatment to outcomes of importance to patients.

Objective: The purposes of this study were to (1) define patient subgroups based on outcomes of importance; (2) determine whether patient subgroups based on outcomes of importance differed in demographic, clinical, and psychological measures; and (3) determine whether outcome domain subgroups differed in treatment responses.

Design: This was a prospective, longitudinal observational study.

Are Changes in Fear-Avoidance Beliefs and Self-efficacy Mediators of Function and Pain at Discharge in Patients With Acute and Chronic Low Back Pain?

Objective: To examine the mediating role of changes in fear-avoidance beliefs and self-efficacy on pain and physical functioning at discharge in patients with acute and chronic low back pain (LBP).

Design: Retrospective study.

Methods: Baseline and discharge data from 418 participants with acute and chronic LBP were analyzed.

Riding a Tiger: Maximizing Effects of Manual Therapies for Pelvic Pain.

Manual therapy interventions are frequently used during the management of pelvic pain conditions. Pain relief after any intervention results from effects unrelated to the intervention, effects specific to the intervention, and effects of context in which the intervention is provided. Understanding these multiple mechanisms allows providers of manual therapy to maximize outcomes by deliberately harnessing each of these core elements of pain relief.