Chronic pain is a prevalent and disabling problem for society. The National Institute of Neurological Disorders and Stroke (NINDS, 1997) has succinctly summarized chronic pain's impact on public health with the following statement, """"""""Chronic pain is the most costly health problem in America."""""""" Carpal tunnel syndrome (CTS) is a commonly occurring example of upper extremity chronic pain that causes disability. Conservative treatment of CTS involves medication, splinting, and exercise and is frequently prescribed for patients with mild to moderate CTS. Given that conservative treatment of CTS has demonstrated unsatisfactory outcomes and limited efficacy, investigation of alternative and complementary approaches seems warranted. Neural mobilization technique (NMT) for the median nerve is a manipulative and body- based method that has been used to treat CTS. Clinical studies have indicated favorable outcomes are associated with median nerve NMT when treating patients with CTS. Anatomical studies have demonstrated the median nerve is specifically stressed with NMT and improvements in motor function have also been reported when using median nerve NMT. These studies provide initial support for NMT, but rigorous clinical studies regarding NMT efficacy have not been performed and NMT mechanisms have not been elucidated. The purpose of this grant proposal is to investigate the impact a manipulative and body-based method has on the nervous system. Specifically, we will investigate median nerve NMT for its effect on a neurophysiological mechanism involved in the development and maintenance of chronic pain (ie, central sensitization of pain). Our first specific aim is to determine if patients with CTS demonstrate excessive central sensitization of pain, when compared to healthy control subjects. Our second specific aim is to determine if the median nerve NMT's effect on the nervous system is a reduction in central sensitization of pain. This study will use novel measures of pain sensitivity to investigate one aspect of the underlying neurophysiology of manipulative and body-based methods. These data may also provide support for a future clinical trial investigating the efficacy of median nerve NMT for patients with CTS. ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Center for Complementary & Alternative Medicine (NCCAM)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21AT002796-02
Application #
7296128
Study Section
Special Emphasis Panel (ZAT1-JH (13))
Program Officer
Khalsa, Partap Singh
Project Start
2006-09-30
Project End
2009-08-31
Budget Start
2007-09-01
Budget End
2009-08-31
Support Year
2
Fiscal Year
2007
Total Cost
$176,601
Indirect Cost
Name
University of Florida
Department
Other Health Professions
Type
Schools of Public Health
DUNS #
969663814
City
Gainesville
State
FL
Country
United States
Zip Code
32611
Anderson, R J; Craggs, J G; Bialosky, J E et al. (2013) Temporal summation of second pain: variability in responses to a fixed protocol. Eur J Pain 17:67-74
Bialosky, Joel E; Bishop, Mark D; Robinson, Michael E et al. (2011) Heightened pain sensitivity in individuals with signs and symptoms of carpal tunnel syndrome and the relationship to clinical outcomes following a manual therapy intervention. Man Ther 16:602-8
Alappattu, Meryl J; Bishop, Mark D; Bialosky, Joel E et al. (2011) Stability of behavioral estimates of activity-dependent modulation of pain. J Pain Res 4:151-7
Bishop, Mark D; Craggs, Jason G; Horn, Maggie E et al. (2010) Relationship of intersession variation in negative pain-related affect and responses to thermally-evoked pain. J Pain 11:172-8
Bialosky, Joel E; Bishop, Mark D; Robinson, Michael E et al. (2010) The relationship of the audible pop to hypoalgesia associated with high-velocity, low-amplitude thrust manipulation: a secondary analysis of an experimental study in pain-free participants. J Manipulative Physiol Ther 33:117-24
Robinson, Michael E; Bialosky, Joel E; Bishop, Mark D et al. (2010) Supra-threshold scaling, temporal summation, and after-sensation: relationships to each other and anxiety/fear. J Pain Res 3:25-32
Beneciuk, Jason M; Bishop, Mark D; George, Steven Z (2010) Pain catastrophizing predicts pain intensity during a neurodynamic test for the median nerve in healthy participants. Man Ther 15:370-5
Jansen, J A C G; Mens, J M A; Backx, Frank J G et al. (2009) Changes in abdominal muscle thickness measured by ultrasound are not associated with recovery in athletes with longstanding groin pain associated with resisted hip adduction. J Orthop Sports Phys Ther 39:724-32
Bialosky, Joel E; Bishop, Mark D; Price, Don D et al. (2009) The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Man Ther 14:531-8
Beneciuk, Jason M; Bishop, Mark D; George, Steven Z (2009) Clinical prediction rules for physical therapy interventions: a systematic review. Phys Ther 89:114-24

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