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From the A.T. Still Research Institute (Drs Degenhardt and Johnson) and A.T. Still University-Kirksville College of Osteopathic Medicine (Drs Towns and Rhodes, Mr Trinh, Mr McClanahan) in Mo; Western University of Health Sciences College of Osteopathic Medicine of the Pacific in Pomona, Calif (Dr Darmani); and the Institute of Biomolecular Chemistry in Pozzuoli, Italy (Dr DiMarzo).

Address correspondence to Brian F. Degenhardt, DO, A.T. Still Research Institute, 800 W Jefferson St, Kirksville, MO 63501-1443. E-mail: bdegenhardt{at}atsu.edu

Context: Underlying mechanisms explaining the effects of osteopathic manipulative treatment (OMT) are poorly defined. The authors evaluate various nociceptive (pain) biomarkers that have been suggested as important mediators in this process.

Objective: To determine if OMT influences levels of circulatory pain biomarkers.

Methods: In a prospective, blinded assessment, blood was collected from 20 subjects (10 with chronic low back pain [LBP], 10 controls without chronic LBP) for 5 consecutive days. On day 4, OMT was administered to subjects 1 hour before blood collection. Blood was analyzed for levels of ß-endorphin (ßE), serotonin (5-hydroxytryptamine [5-HT]), 5-hydroxyindoleacetic acid (5-HIAA), anandamide (arachidonoylethanolamide [AEA]), and N-palmitoylethanolamide (PEA). A daily questionnaire was used to monitor confounding factors, including pain and stress levels, sleep patterns, and substance use.

Results: Increases from baseline in ßE and PEA levels and a decrease in AEA levels occurred immediately posttreatment. At 24 hours posttreatment, similar biomarker changes from baseline were observed. A decrease in stress occurred from baseline to day 5. The change in PEA from baseline to 24 hours posttreatment correlated with the corresponding changes in stress. Subgroup analysis showed that subjects with chronic LBP had significantly reduced 5-HIAA levels at 30 minutes posttreatment (P=.05) and 5-HT levels at 24 hours posttreatment (P=.02) when compared with baseline concentrations. The increase in PEA in subjects with chronic LBP at 30 minutes posttreatment was two times greater than the increase in control subjects.

Conclusion: Concentrations of several circulatory pain biomarkers were altered after OMT. The degree and duration of these changes were greater in subjects with chronic LBP than in control subjects without the disorder.