基于力的操纵(FBM),包括轻触,压力,按摩,动员,推力操纵,和针刺技术被用于跨几个学科提供临床镇痛。这些常用技术证明了改善疼痛相关结果的能力;然而,这些动手干预措施导致镇痛发生的机制尚未得到充分研究.神经学,神经免疫,生物力学,神经血管,神经递质,和上下文因素相互作用已经被提出来影响反应;然而,与临床疼痛结局的具体关系尚未得到很好的确定.这项研究的目的是确定与FBM相关的基于机制的研究中存在的差距。进行了国际多学科名义组技术(NGT),并确定了八个领域的37个建议空白。这些差距中有23个在支持FBM的复杂多系统机制响应的领域达成共识。生物力学领域内间隙的支撑强度比其他支撑的整体支撑要少。评估情境因素影响的差距得到了强有力的支持,与临床结果相关的机制也得到了强有力的支持(转化研究)。研究FBM与不同疼痛表型(疼痛机制表型和临床表型)的个体之间的差异的文献的重要性也与通过使用疼痛表型朝向患者特异性疼痛管理(精准医学)的其他镇痛技术保持一致。
Force-Based Manipulation (FBM) including light touch, pressure, massage, mobilization, thrust manipulation, and needling techniques are utilized across several disciplines to provide clinical analgesia. These commonly used techniques demonstrate the ability to improve pain-related outcomes; however, mechanisms behind why analgesia occurs with these hands-on interventions has been understudied. Neurological, neuroimmune, biomechanical, neurovascular, neurotransmitter, and contextual factor interactions have been proposed to influence response; however, the specific relationships to clinical pain outcomes has not been well established. The purpose of this study was to identify gaps present within mechanism-based research as it relates to FBM. An international multidisciplinary nominal group technique (NGT) was performed and identified 37 proposed gaps across eight domains. Twenty-three of these gaps met consensus across domains supporting the complex multisystem mechanistic response to FBM. The strength of support for gaps within the biomechanical domain had less overall support than the others. Gaps assessing the influence of contextual factors had strong support as did those associating mechanisms with clinical outcomes (translational studies). The importance of literature investigating how FBM differs with individuals of different pain phenotypes (pain mechanism phenotypes and clinical phenotypes) was also presented aligning with other analgesic techniques trending toward patient-specific pain management (precision medicine) through the use of pain phenotyping.