Effectiveness of mobilization with movement on conditioned pain modulation, mechanical hyperalgesia, and pain intensity in adults with chronic low back pain: A randomized controlled trial

Abstract

Background Chronic low back pain is associated with dysfunctions in endogenous analgesia mechanisms, as evaluated through conditioned pain modulation paradigms. Although mobilization with movement has demonstrated enhancements in conditioned pain modulation among patients with conditions such as knee osteoarthritis, its efficacy in chronic low back pain patients has yet to be established. Objectives To investigate the effects of mobilization with movement compared to sham mobilization in conditioned pain modulation, mechanical hyperalgesia, and pain intensity in chronic low back pain patients. Design Randomized controlled trial following CONSORT and TIDieR guidelines. Method Fifty-eight patients with chronic low back pain (mean age 48.77 ± 13.92 years) were randomized into the experimental group, which received real mobilization with movement (n = 29), or the sham mobilization with movement group (n = 29). Only one intervention was performed. Patients were assessed before and after intervention. Conditioned pain modulation, mechanical hyperalgesia and pain intensity were assessed. Results Mobilization with movement resulted in no statistically significant differences compared to sham mobilization for conditioned pain modulation (post-treatment difference: 0.023 [-0.299, 0.345], p = 0.158), mechanical hyperalgesia (post-treatment difference: −0.198 [-0.505, 0.109], p = 0.207), or movement-related pain intensity (post-treatment difference: 0.548 [-0.068, 1.236], p = 0.079) improvements post-intervention. Effect sizes were small for conditioned pain modulation (r = 0.126), mechanical hyperalgesia (r = 0.101), and pain intensity (r = 0.208). Conclusions Mobilization with movement resulted in no significant differences compared to sham mobilization with movement after one intervention for conditioned pain modulation, mechanical hyperalgesia or pain intensity, with small effect sizes. However, the findings should be interpreted with caution due to absence of screening for appropriately eligible patients