Journal of Manipulative and Physiological Therapeutics
Naloxone Fails to Antagonize Initial Hypoalgesic Effect of a Manual Therapy Treatment for Lateral Epicondylalgia☆
Introduction
A number of systemic reviews have shown that manual therapy, the skilled application of manual forces to the joint structures, provides effective results in treatment of musculoskeletal pain.2., 3., 4. Much of the research of the neurophysiological effects of manual therapy has focused on spinal techniques and has implicated that mobilization-induced hypoalgesia does not involve endogenous opioid mechanisms.5., 6. This evidence arises from studies that have shown that manual therapy-induced hypoalgesia is not antagonized by naloxone,7., 8. fails to develop tolerance,[9] and occurs in the presence of normal plasma endorphin levels.10., 11. In addition to these findings, several studies of spinal manual therapy have indicated the specificity for techniques to produce mechanical but not thermal hypoalgesia,6., 12., 13. implicating endogenous noradrenergic rather than serotonergic mechanisms.[14]
Mulligan’s Mobilization With Movement (MWM) has been shown to exert a substantial and rapid pain-relieving effect in patients with chronic lateral epicondylalgia.1., 15., 16. It is a recently developed manual therapy treatment technique that involves the application of a sustained glide and active movement across a peripheral joint.[17] The role of endogenous opioid peptides in MWM-induced hypoalgesia has not been investigated and is the aim of this study. This study utilized a widely accepted test of endogenous opioid mechanisms, naloxone antagonism, to evaluate the role of such mechanisms in MWM-induced hypoalgesia.
Section snippets
Methods
This study utilized a randomized, placebo-controlled, crossover, double-blind, repeated measures design to evaluate the hypothesis that MWM-induced hypoalgesia was antagonized by naloxone.
Results
The MWM treatment technique produced a mean hypoalgesic effect of 29% (±5.6, SEM) in PFGS, 18% (±4.3) in PPT, 1.6% (±0.4) in ULTT2b, and 0.2% (±0.7) in TPT across all experimental conditions. Figure 1 shows the percentage changes of pain outcomes for each of the experimental conditions (naloxone, saline, control). There was no statistical difference between naloxone, saline, or control conditions (Table 2).
All 18 participants completed the study, and there were no adverse effects or
Discussion
The findings of this study showed that naloxone did not significantly antagonize the initial hypoalgesic effect of the MWM for the elbow when compared with a placebo saline injection or no-substance injection control. This result is similar to that of Zusman et al.[8] and Vicenzino et al.,[7] who found no effect of naloxone on spinal manual therapy-induced hypoalgesia, suggesting that the manual therapy may mainly induce a nonopioid form of analgesia as part of its effect.5., 7., 8.
The initial
Conclusion
The initial hypoalgesic effect produced by the MWM for the elbow was not significantly antagonized by pretreatment intravenous injection of naloxone, supporting the hypothesis that manual therapy-induced hypoalgesia most likely involves a nonopioid mechanism of action.
Acknowledgements
The authors are grateful to Dr Fiona Mack for performing the cannulations, injecting the substances, and randomly allocating the experimental conditions. The assistance of the participants in this study is also acknowledged.
References (35)
- et al.
Specific manipulative therapy treatment for chronic lateral epicondylalgia produces uniquely characteristic hypoalgesia
Man Ther
(2001) Qualitative review of studies of manipulation-induced hypoalgesia
J Manipulative Physiol Ther
(2000)Hypoalgesia post-manipulative therapy: a review of a potential neurophysiological mechanism
Man Ther
(1995)- et al.
Cervical mobilization: concurrent effects on pain, sympathetic nervous system activity and motor activity
Man Ther
(2001) - et al.
The initial effects of a cervical spine manipulative physiotherapy treatment on the pain and dysfunction of lateral epicondylalgia
Pain
(1996) - et al.
Separate involvement of the spinal noradrenergic and serotonergic systems in morphine analgesia: the difference in mechanical and thermal algesic tests
Brain Res
(1983) - et al.
The initial effects of an elbow mobilization with movement technique on grip strength in subjects with lateral epicondylalgia
Man Ther
(2001) - et al.
Effects of a novel manipulative physiotherapy technique on tennis elbow: a single case study
Man Ther
(1995) - et al.
Adverse tension in the neural system: a preliminary study of tennis elbow
Aust J Physiother
(1993) - et al.
Cardiovascular and respiratory changes produced by lateral glide mobilization of the cervical spine
Man Ther
(1998)
To compare the effects of different rates of application of a cervical mobilization technique on sympathetic outflow to the upper limb in normal subjects
Man Ther
The influence of an AP accessory glide of the glenohumeral joint on measures of peripheral sympathetic nervous system function in the upper limb
Man Ther
Analgesia following transcutaneous electrical stimulation and its partial reversal by a narcotic antagonist
Life Sci
Antagonism of acupuncture analgesia in man by the narcotic antagonist naloxone
Brain Res
The peripheral analgesic effect of meperidine in reducing propofol injection pain is not naloxone-reversible
Reg Anesth Pain Med
Efficacy of manual therapy
Phys Ther
20 years of randomised clinical-trials of manipulative therapy for back pain-a review
Clin Invest Med
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Poster presentation in an abstract form of this study was made at the 10th World Congress on Pain of the International Association for the Study of Pain; August 17_22, 2002; San Diego, Calif.
This study was supported by funding from the Physiotherapy Research Foundation of Australia.