title: Role of osteopathic manipulative treatment in altering pain biomarkers: a pilot study.
abstract: BACKGROUND
  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 beta-endorphin (betaE), 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 betaE 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: A.T. Still Research Institute, Kirksville, MO 63501-1443, USA. bdegenhardt@atsu.edu
authors.forename: Brian F
authors.initials: BF
authors.lastname: Degenhardt
authors.forename: Nissar A
authors.initials: NA
authors.lastname: Darmani
authors.forename: Jane C
authors.initials: JC
authors.lastname: Johnson
authors.forename: Lex C
authors.initials: LC
authors.lastname: Towns
authors.forename: Diana C J
authors.initials: DC
authors.lastname: Rhodes
authors.forename: Chung
authors.initials: C
authors.lastname: Trinh
authors.forename: Bryan
authors.initials: B
authors.lastname: McClanahan
authors.forename: Vincenzo
authors.initials: V
authors.lastname: DiMarzo
mesh_terms: D000328:Adult; D000577:Amides; D001095:Arachidonic Acids / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D063388:Endocannabinoids; D004983:Ethanolamines; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006897:Hydroxyindoleacetic Acid / Q000097:blood; D017116:Low Back Pain / Q000097:blood* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D026301:Manipulation, Osteopathic / Q000379:methods*; D008875:Middle Aged; D010147:Pain Measurement; D010169:Palmitic Acids / Q000097:blood; D010865:Pilot Projects; D053284:Polyunsaturated Alkamides / Q000097:blood; D011446:Prospective Studies; D043885:Receptor, Cannabinoid, CB2; D012701:Serotonin / Q000097:blood; D012720:Severity of Illness Index; D016896:Treatment Outcome; D001615:beta-Endorphin / Q000097:blood
chemical_list: D000577:Amides; D001095:Arachidonic Acids; D015415:Biomarkers; D063388:Endocannabinoids; D004983:Ethanolamines; D010169:Palmitic Acids; D053284:Polyunsaturated Alkamides; D043885:Receptor, Cannabinoid, CB2; D012701:Serotonin; D006897:Hydroxyindoleacetic Acid; D001615:beta-Endorphin; C005958:palmidrol; C078814:anandamide