Pain Modulatory Profiles in Massage for Individuals With Neck Pain

Not Applicable

Completed

Interventions: Other: Pain Inducing Massage
Other: Light Touch Massage
Other: Coldpressor

Brief Summary: One in ten adults experience widespread pain. Neck pain, for example, is a prevalent condition with a high rate of recurrence that affects between 10.4% and 21.3% of the population annually.

Massage is a common manual therapy intervention for individuals with musculoskeletal pain. However, the mechanisms of massage are not well established. Also, the conditioned pain modulation (CPM) paradigm is a dynamic quantitative sensory testing measure of a pain inhibitory process in which pain sensitivity is lessened in response to a remotely applied painful stimulus.

This study will evaluate the association between pain inducing massage and the conditioned pain modulation paradigm in participants with a history of neck pain.

Detailed Description: Conditioned pain modulation (CPM) is the physical manifestation of the diffuse noxious inhibitory control (DNIC), an endogenous pain inhibitory pathway in which pain inhibits pain. Conditioned pain modulation is less efficient in individuals with chronic pain conditions and it is a predictor for the development of chronic pain.

Massage is a common manual therapy intervention for individuals with musculoskeletal pain. Greater changes in pain sensitivity occur following pain inducing massage suggesting a mechanism dependent upon the efficiency of the conditioned pain modulation response. Previous research has indicated pain inducing massage is more effective than pain free massage suggesting a mechanism dependent upon conditioned pain modulation.

The study team will evaluate the association between pain inducing massage and the conditioned pain modulation paradigm. Participants with neck pain will be randomly assigned to receive a pain inducing massage, pain free massage, or a coldpressor task. Pre-and post intervention pain will be assessed. The study team will determine if analgesia induced by pain inducing massage is similar to the conditioned pain modulation paradigm and if baseline conditioned pain modulation predicts responders to pain inducing massage and short term clinical outcomes in patients with a history of neck pain.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

non-English speaking
systemic medical conditions known to affect sensation (e.g. diabetes, hypertension)
history of neck surgery or fracture within the past 6 months
current history of chronic pain condition other than neck pain
diagnosis of cervical radiculopathy or cervical myelopathy
history of whiplash; g) currently using blood thinning medication
any blood clotting disorder such as hemophilia
any contraindication to application of ice, such as: uncontrolled hypertension, cold urticaria, cryoglobulinemia, paroxysmal cold hemoglobinuria, and circulatory compromise.

Arm && Interventions

Group	Intervention	Description
Pain Inducing Massage	Pain Inducing Massage	Participants will receive manual pressure applied to one myofascial trigger point.
Light Touch Massage	Light Touch Massage	Participants will receive light touch applied to one myofascial trigger point.
Coldpressor	Coldpressor	Participants will place hand into water cooled to 6 degrees Celsius (males) or 8 degrees Celsius (females).

Primary Outcome Measures

Name	Time	Method
Change from baseline in Pressure Pain Threshold	2 hours	Pressure in kilograms at which ascending pressure stimulus first changes from pressure to painful

Secondary Outcome Measures

Name	Time	Method
Change from baseline in Ramp and Hold	2 hours	Participants will rate their pain using a 101 point mechanical visual analog scale to thermal stimuli of 45, 47, 49, and 50 degree Celsius each of 5 seconds duration will be applied to the forearm and to the muscle on the side of the neck
Change from baseline in Thermal Pain Threshold and Tolerance	2 hours	Temperature at which ascending thermal stimulus first changes from warm to painful and maximum temperature tolerated
Change from baseline in Pressure Pain Tolerance	2 hours	Pressure in kilograms at which ascending pressure is no longer tolerated
Change from baseline in Temporal Summation	2 hours	Participants will rate their pain using a 0 to 10 numeric rating scale to a train of 10 50 degree Celsius heat pulses will be applied to the skin in the plantar surface of the hand.
Change from baseline in Conditioned Pain Modulation	2 hours	Pressure in kilograms at which ascending pressure stimulus applied to the foot first changes from pressure to painful both prior to and immediately following immersion of the opposite hand in a cold water bath