Читать книгу Advanced Osteopathic and Chiropractic Techniques for Manual Therapists - Giles Gyer - Страница 17

This mechanism is based on the effects of spinal manipulation on the pain-modulatory neural circuitry. Manipulation has long been thought to modulate the non-opioid hypoalgesic system by activating the descending pain-modulation circuit, especially serotonin and noradrenaline pathways, from the PAG and rostral ventromedial medulla (RVM) of the brain stem (Pickar 2002; Vernon 2000; Wright 1995). This hypothesis has been supported by both animal model and human studies. In laboratory animal models (Reed et al. 2014; Skyba et al. 2003; Song et al. 2006), objective evidence has been found in support of a central antinociceptive effect that appeared to be mediated by serotoninergic and noradrenergic inhibitory pathways. The findings of human studies (Alonso-Perez et al. 2017; O’Neill, Ødegaard-Olsen and Søvde 2015; Sterling, Jull and Wright 2001) conducted on both symptomatic and asymptomatic subjects are also consistent with the findings of animal models. However, although human research supports a non-opioid form of manipulation-induced hypoalgesic effect through activation of some type of descending inhibitory mechanism, the exact circuit is yet not agreed upon. Because neural responses following spinal manipulation may vary depending on the rate of force application and the location at which the thrust is applied (Cambridge et al. 2012; Downie et al. 2010; Nougarou et al. 2016), it has been assumed that variations in mechanical parameters of manipulation may activate different descending inhibitory pathways (Savva, Giakas and Efstathiou 2014). Therefore, future research should be performed to investigate the exact descending pain-modulatory circuit involved after spinal manipulation, and these studies should also carefully consider the force/time and contact site characteristics of the given intervention.