Does Mobilization of the Upper Cervical Spine Affect Pain Sensitivity and Autonomic Nervous System Function in Patients With Cervico-craniofacial Pain?: A Randomized-controlled Trial
Abstract
Objectives The aims were to investigate the effects of anterior-posterior upper cervical mobilization (APUCM) on pain modulation in craniofacial and cervical regions and its influence on the sympathetic nervous system. Methods Thirty-two patients with cervico-craniofacial pain of myofascial origin were randomly allocated into experimental or placebo groups. Each patient received 3 treatments. Outcome measures included bilateral pressure pain thresholds assessed at craniofacial and cervical points preintervention, after the second intervention and after the final treatment. Pain intensity and sympathetic nervous system variables (skin conductance, breathing rate, heart rate, and skin temperature) were assessed before and immediately after each intervention. Results The pressure pain thresholds in the craniofacial and cervical regions significantly increased (P Discussion This study provided preliminary evidence of a short-term hypoalgesic effect of APUCM on craniofacial and cervical regions of patients with cervico-craniofacial pain of myofascial origin, suggesting that APUCM may cause an immediate nociceptive modulation in the trigeminocervical complex. We also observed a sympathoexcitatory response, which could be related to the hypoalgesic effect induced by the technique, but this aspect should be confirmed in future studies.
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Only 6 studies accomplished more than 60% of the items listed in eTable 2.
“Only 6 studies accomplished more than 60% of the items listed in eTable 2. 57,66,67, 76 -78”
From Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis (2016) · cites this paper as [67]
A recent RCT by La Touche et al tested a more specific approach directed to the cervical spine to treat patients with cervico-craniofacial pain of myofascial origin.
“A recent RCT conducted by La Touche et al 67 testing a more specific approach directed to the cervical spine to treat patients with cervico-craniofacial pain of myofascial origin was performed.”
From Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis (2016) · cites this paper as [67]
Eight of the trials reported no adverse events with the treatments.
“Eight of the trials 57,65,67,74,75,77,87,88 reported no adverse events with the treatments.”
From Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis (2016) · cites this paper as [67]
Publication bias for pain versus sham was difficult to determine visually and could not be quantified using Egger regression because of the small number of trials.
“Publication bias was difficult to determine visually (figure 3B) and could not be quantified using Egger regression because of the small number of trials.44,45”
Compared with sham intervention, manual therapy did not significantly increase pressure pain threshold of the temporalis muscle (MD: 0.37 kg/cm2, 95% CI: -0.03 to 0.77, P=.07).
“Compared with sham intervention, MT did not significantly increase PPT of the masseter (MD: 0.45 kg/cm2, 95% CI: -0.21 to 1.11, P=.18; figure 5A)38,44,45 or temporalis muscle (MD: 0.37 kg/cm2, 95% CI: -0.03 to 0.77, P=.07; figure 6A).38,44, 45, 46”
Compared with sham intervention, manual therapy did not significantly increase pressure pain threshold of the masseter (MD: 0.45 kg/cm2, 95% CI: -0.21 to 1.11, P=.18).
“Compared with sham intervention, MT did not significantly increase PPT of the masseter (MD: 0.45 kg/cm2, 95% CI: -0.21 to 1.11, P=.18; figure 5A)38,44,45 or temporalis muscle (MD: 0.37 kg/cm2, 95% CI: -0.03 to 0.77, P=.07; figure 6A).38,44, 45, 46”
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- Authors
- La Touche, R., París-Alemany, A., Mannheimer, J. S., Angulo-Díaz-Parreño, S., Bishop, M. D., Lopéz-Valverde-Centeno, A., von Piekartz, H., & Fernández-Carnero, J.
- Affiliations
- Columbia University (US)
- University of Florida Health (US)
- ORCID
- Bishop, Mark D.
- Venue
- The Clinical Journal of Pain
- Published
- 2013-03
- Volume
- 29
- Issue
- 3
- Pages
- 205-215
- ISSN
- 0749-8047 (ISSN-L)
- OpenAlex
- W2156862303
- Cited by
- 112
- References
- 72
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 7 · 2023: 12 · 2022: 7 · 2021: 6 · 2020: 16 · 2019: 12 · 2018: 13 · 2017: 7 · 2016: 9 · 2015: 11 · 2014: 3 · 2013: 2
- FWCI
- 2.42
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- ABACUS. Repositorio de Producción Científica (Universidad Europea) (submittedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Myofascial pain diagnosis and treatment
- Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Keywords
- myofascial pain, pain modulation, pressure pain threshold, sympathetic nervous system, skin conductance, trigeminocervical complex, hypoalgesia, cervical manipulation
- MeSH terms
- Adult, Autonomic Nervous System, Cervical Vertebrae, Facial Pain, Female, Heart Rate, Humans, Male, Skin Temperature, Spain, Respiratory Mechanics, Treatment Outcome, Musculoskeletal Manipulations, Pain Perception
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