Cerebral Metabolic Changes in Men After Chiropractic Spinal Manipulation for Neck Pain

Ogur3. DC Manahu ',ashil\l. Mil, I'h ll: Mehl'tii M:ISll(i, \-tn. Phil: $hoirhi Wat:1I1111..i: Katsllhiko Shibuya. \IS:
K(.'ii(' hiro "';:I1I1:lgllChi . M)), I'hP", Masatoshi ltoh , loll), I'hD: Hiroshi Fuklld:l, M PhI), Kawhiko Y'!lwi. MIl,li l)) D,

Ablllract

8ackground Chiropractic spinal manipulation (CSM) is an treatment for back pain. The autonomic nervous system is often involved in spinal dysfunction. Ahhough sludit's (m thl" effects of CSM han' brell performed. IlUchiropractic study has examined regional cerebral llll'taboliSITI posiIroll emission tomography (PET). Objective The aim of thE' present study was tll itwcstigatr th(' elTccts of CSM OIL brain responses in terms of cerebral metabolic changes measured by positron emiS$ion tomography (FOG-PET), Methods . Twelve male volun teers were recruiloo, Brain PET scanning W35 performed twice 011 {,3ch participant, at Il'l'ting and after CSM, were used for evaluations. A visual an310gue scale (VAS) was rated by p.1rtidpallts

before and after chiroprarti<' tr('<ltment , lind musclr IOlle and salivary amyl3se were ml'aSllret!. RUlIlt.\ Increased gllK(}SC !netabolisHi was observtd in th(' inferior pr{'(ronlal cortex. anterior cingulaled l'orll'X, and middle temporal gyrus, and glucose metabolism found in Ii'll' I'rn'bdla r vrnnh and \'hual assod atio n cortex, in the treatment condition (P<.OOI). COll1pariwm of < Iueslionnairt'S a lower wess levt"l and beller quality in the Ireatlnelll condifion, A signifirantly 1 0\\,I'r \'AS was lIotrd after CSM. Cervical muscle (one and were after CSM . Conclusion The results of this study suggi'SI thai CSM regional cerebral giu("osl' ult'tabolism rel31ed 10 and pain (AIMII TIler I/N/llh M('d,
2011:17(6):12-17.)

Thkeshi Ogllra, IX, PhI>, is a research in the Dh'ision of Cytlotron Nuclear Medidnc, Cyclotron and Center, Tohoku University, St'llclai, Japan, and II director .. t the Japall Chiropractic Ocelor College, Sendai. Manabll Tashiro, MU, I'hO, an associate professo r and a l'hief nuclear medidnc ph)'sidan; Mehedi Masud, is a Celie:lN:h (ellm.. Shoichi Walanuki is a radiological tedllloiogisl in the Dh'biol! ofCydotron Nuclear Medicine., Cyclotron :lIld Radioisotopt Center. Masatoshi Itnh, MD, "hll, is a speciallyapproved professor in the Division of Cyclotron Nuclear Medicine, C)'t:lOltOn and Radioisotope Cenler, and a dirN.'lor at Selldai Medical Imaging Clinic, Sendai, Japan. Keiichlro Yama!!ut."hi, MD, PhD, is a visiting professor in the Division ofCydotron Nuriear Medicine, Cyclotron and Radioisotope (enter, and II dirC'flor at the Advanced Image Medical Center, Sendai Welfare Hospilal. Katsuhlko Shibuya., MS, is a rf'Searrh(,r and Kazuhiko Ya.n ai, MO, PbU, is a profesin the Depa rt ment of Pharmacology, Graduate School of Medicine, Tohoku Universily. Hiroshi Fukuda, MI), PbD, 3 pmfessor at the DeparlllwlIl of Radioing)' alld Nuclear Medicine, the imtitule ofDevclopmcllt, Aging and Cancer, Tuhoku Univrrsily.
Corrc.lpolldi,lg Author: iHal!(I!1I/ "{(/.IlIiro. ;\-1/ ). Ph!)

f -mllil: wl(lshiro@qriunhokll.llcjfJ

m,lIlipuhlli(ltl (CS\1) is an Ireatrn('l1\ ti) f as JH ba(k Hnd .'l'k. lower back pain. Fllr > ]flO years, chirtlpr.ll"tOfS have lwalth ran be imp rol'cd sjl1l1al manrpulallvt" Ih!'fapy.'' Rese:m: h on (SM hus been l'xlensi\'rl r l>er(orm<'d wOfldwide, and its e!limc)' " II lIl\JsculClskele.tal has been well donJnwTltetl, Thl' <llItolllllllir rwr I"OUS system has been imokeu in construrti ug mt,('hunislils Iha l at'COUlll ((If tlw dfet{ of.\piua l studit'S (1\1('11rl1t'ntecl ;1 pottlltiiil rdati()nship hl't\'\"t'l'll tIl(' vnt e!md sublux;J tioll ('omplex aud thl' fmlftion of the ;1Il1UIlf)mi( TI,ese mainly disl"Il.'Iw(\ til t" .lItlo!lornir on ('ular tilll('lion in rellllioll 1 CS1>P:O 1.< A recellt 0 ht':lrt r"le \':lliabHit)' an"lysis do("u mented chiropractic ;,djU$llIIem affects the autonomic SYSh'l1 l,I:' Ilowt'I'(.'l". litr rClt uT(' no stud}' using pl)Silron emission tOJ)lography (I'ET) !(l rxallliJle rt'giollal ('rff'\)rJI m<'l abolic r hanges rdatl'tl 10 from CSM. Only one availahl(' ll(.'uroiUlaging on (SM u\illg singh, photon ('om pU led tomography (SPH.T) indiraH'l1 deneasrd l"e!!iOllal ('erehral blood flo\'\" in thl' lei! n'll'Ix.' ]Jurn to adVI'r.;I' fear1 iolls "lier t!l.'tllment. H Sinn' stlllly fnl"uS('(j (\\1 tIll' reKlions, the bra in ami II\(' diniral efle.r{s of (S.'-' h;lye unkllowll. chirupr:lclir fl'St',irdl do(umrnled the n(>Cd lor a fUI!l1ionai neumimaging study ["('garding Ihp for t!t.'{'l wr 0'_1 _'" _ ' _" _ _ "_ ,,'

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using singlt' OCT) indiu.u'd n'Odlum relatNi ludy fo(uM'ti on linical df('('fs of

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dy rtgarding the ,ding of lh(' Ill'u-

hlminn) in Ihe hr:Jin as.<;(Jciatt"(1 with ;ml ollomir nervous Trealmenl condilion (unctions in ""'llOn.".(' 10 ( SM inll'l"\'l'fltioTl: thr limbic anet p'LI'lilil llbir H"' .... .. such as prefront al (ortex, urbjlofrorltal rortl':\:, ringulalr gyms, slliatutn and lfft'bellrrm, :Jnd brain stem, trt;atmenl 11 F[Xj uptake timt' (resl) 1 PET rUlIct ionalllt'uroi magi ng I('chniclue!. an' powerful l!Xlls to l' ilWtsligiltl' Ilcllmnal aCli\'ity in Ihe human brain,L'I 'n it' PET scan has lwen IIsrd for rnra,uring fl'gional n:rtbral hlood flow and rt'gional feft- hral tnt'tabolk ralt' rauiulabdrd mU!f('ulr\. Conlrol II'llich are l'ithrr inj<'Cled illtl'Jvellu(lsly or ('Ol1lilluotisly in/wll'll h)' condition H){: "',.... , ... . thr In the [,("S<'3n'h .-.eHing. functional bt't'll ill shlilirs of !lcule bmin ani\'3lioll, alill for Ihis pur1)l1St', fUIlclinnal1Llagnr lic n-wnanrr im3gi.ng (fMIl.!) has rt-plact'l1 1 FOG uptake lime(rest)jPET scanning PET with 1'10 ]lIP \wt'3use uf its prrfrrrt'll resolulion, avoilJ. , II 11 " I' anre (If l'3c\i();I(tivl' mat('rials, and operating j>er inv(',tigilT tion,'\'I0,'" Ilow<'\'rr, PE wilh '"F-labeICt1 UuorudeoxyglucOS(' (FIX ;) has bl't'JI Tl'gardcd as an rlCcd ll'JlI imaging mar'wr t}fb railllllrlahol" l>iagn1l11 u,:mllllstnrting Ih,' pr'''il1lt pnlh"'''\, In 1I11'ln',1\1I1t'111 tlr ic aftivil), (gluw,'\( 'J1w lTlulffult' 1''1)(" a Tadio3r' ,'UllIfI)l (rf'lin):, II<) IrNlllM ll) ('<,ud'linl!, tin' analogue of glumse, is tr<tpp('d metai'loijeally into ,H'Tivated !iuonll.WlllC)W 'I('USI' (Ft X:) Ifa' illjt'<'.rd afl/Of III(' (hirllpr:lrtK' in brain allo fa n 1lC' Il'ot'll fur p h)'sjolugi' tfl'alON'o Il .)r rrslhl)! flI"rkxl. AJditiunallllC".... \Ucl l as n IUsrir COIl aud hillllle(:hankaltilTlclion" in \'i\'o." Initially. tt'chlliqU\' M itfill"''o. 5;lli\'ary am),IMsc, and hrfiln' used in hl"althy \'olUlltl'l'rs who perfomwd a natural running ilml [Ilt' In'alml'tll nr n'Sling pffillcl. 11K dtlr:l1ilm III :'10min\l11':< ' in upright poslUrl',:' bter, this h'fhnigut' was applit'li lo liaily a!h'f FI)( ; inj..<.1 iUIi IIX: uplakt"imr' in thl' movt"rnenl" and alte rnali\'t' therapy arnmatherap),!' An .:mb,Uoo TOIIJCW3tKl), 0'101) lnulling ]1) OIinUIl'll imp<lrtal1t advalllagr of Iht File; Irchniqur is tlmt tht rrgitll1;t1 injf<1ion con tinUE'll for 111 milmlo:..ln IlT.lInlnll (I>nrnlion, brain aClivlty duri ng :m minlllrs aller injrction is ;i\'rfagt'o :lIul I IX; inpnoo:.hvniy :tnrr fhl' tf\';tlnlnll. Addit i'M lal Tl'ronlrti hilsed on Ihr hiodu?mical property of M mt'laholic IrapllW';!.\Un, nents IOlIsd r stiilill.'S), aillyl3St, and wbj','l1hT ,",lirlS ....m .. :Utl't till' trf'atUIl111 , 11lf> whl'rt' the ph:lst's for FIX; uptake and for PET measurt'dur"tillll ofJO minU1l'lo FIX; ill;""'1ioll nx; Ujll..kt IInll' in men! ta n 1 se paratrd (I;igure I), "nulher ariv'1U 13ge of lC' Ihfl m li'l/!. PI!1' startt-d :iO 1-\)(; injrt111111 tcchnique is radial ion exposu", achil','ed hy a S<!llsitive :kiim('n 2(1millUll"i, sinn;t! dfll fl acquisition moot',"1 L WI' Ih:11 3 CS\1t realnll'nl misht induc(> mNshO iucrl.':lS(' or dCCfl':IM' ('Klivalinll or dracli\o'l ltion) in the brain p.'1nf Q "'ith diSC' prohll"lIIs w('r<' rxdudl'd from Ihe stuO)', Ml'dical lie regions 3ssori;ttt'l1 with iltltunomic nervous functinns in 10 sl'fcenillR was prrforllJl'u to conti rm of allY or CSM intl'rvl'Tllion : tht' limbic and parillimbir regions such as prt'- lOt'tliration th;t( might aOLTt brain fun('tio!l, Thl'rt'fMr, 12 men rrontal ('ort t'.:.:, {lrbh"ffOlll;tj w rt('x. ringulat{" gym s. striatum ;tud vo[ unH'('rs aged :t l to 4() }'t'ars (mr:m agcSlJ, 28 1-7 y) wrrt Ih;ll;ul\l1s. ccr('lx'Uum, anll brain Strlll. The aim oflhe pr{";CIII st udy indudrrt in Iht' study. \YO!Ut'1i Iwre nnl illdllded 01 the W:IS 10 the of (;-;M on brain T{'!oiPUl1:;t!i or hi8her risk orr"di,ltioll til thl' o\'al'y till' l'l.'rrhro l met"bolir rhanges PET and FDC;, III addiClfthe hmin artivity assl)riatcd with till' 1llrnstruul tion, we t'\'illuatw the relation hclwt'E'1l rhe n.><;ulls of PET c)'c lt, The stud), proww l W;lS appro\'l'd hy tht tion ant.llhl' dl3nges ill :llllmlOmic function :lI1d l':Jill itlit'llsilY (I)nllllillt't' of To hoku UllivrrsilY Gradualr Sd lU()1 of MIdkinc. induced by ehiroprnnic trealmrnt . 20mH 15), Srndai, Japan Th(' Jl!'('!ienl Sludy (lmdnrlrd ill C TOSSlWt'r in MlIHOI)S whi('h rach partiripant was f'lCa m il!t'd t\\i((' (once in Ihl' 1I\t't11" ;lnd IlIl' olhre tilllt' in thr c.mlml" romiitillns) 10 I'<lrtidl>ants and men wllh ('Cf\ical p;tin and shouldrr stiifnt"o.' W('rt' ronlpJrt' rr:-ting regional hrain :Kthily in the:.! CQndilions (I re(rllitl'tt :Ifler rt'SC'; lrcht'rx placetl :1poslrr on Ihe ofTohoku I), In the lr('atmrnl fOlltlil ion, m :t'i\'('ll a sillgle (S,\ Cnivt'I'\jly. Induded were men agrtl 20 10 40 years wilh ('Cr"ical inlr n 'ention including a eMS pmcCfIIlrt' lin InIal 20 pain dnd shoulder who did lIot m:rl\"e :111)' kind of lII<1nipu- minUT Short I)' 3fter the l."\M lft'illmcn1. H X;;:'Olltaining :ooa[il'l(' f'S). lath"!' Irralment fOf mOllth hrfoil.' thl' l'xllC'rimell!. (ri- solulion iujcC'trti into lhl' 1 )'1rticipanl Ihnmgh dlf' Irft antecv It'ria W {" ( 1) th r CI' "f di.'iC pTlJblrlll\ SIKh disc ht'OIiation biUI \II'in (37 ,\.lI\q) ill :t qlli('l, diml y Iii room, or signitirJul (li,'iC degenerafion ,lilt! (2) any Olht'r ph)'sical ur mrll"it in :l rt'laxl'd mannrr with !hrir for :1O min30 aft" lal disorders or ml'l.lication th,1I migtll afJff\ broin fr ll)(1ioll or pt'I'- utes hefort' tht' Sl'an. The hrain scan gi\'ill J; iJuormrd runst'llt, ,II! 15 l'I't'rr first Ihr illjrction us.ing;) PEr stanllrr (SET2100W, Shi!ll:Ld/,u Inc, for MIU l'X1Hninatiot1 ofthc rrrvit'al rrgion, J pnl'tid Kyoto, Jop3n), Thl' I'll (,()Wfl'(llh r t'n tirt' ill 1

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HG URR2 (Irli) ami dtadiv:Jli o]) (Iif!;hl) ;.lil'r l'hi mpr:l<'til' spinal Inal1iplllulioll. Hr.,in r'4';o!)s .ll J(M"ill/j a I giunal k JUPlllboli(' Jl'fftaM'(ri&hl) inlhl" condition. nulh images shoo" a '.,uhs 1){luwl.hy-1'Ul'.t1 HlInpari.'io.:>lI ()f imJ,,""" Ihll'Sh" ld: 1'<.(1)]. ex1Nlt Ihre,hold: lOvuXt"1 minimum),

in rrt'us<> (irfi)

lC1 unl'il' 1l'1l1aholk

ing III fl\f tilt' em ission s(":lll and 5 minu t('s for the transmission fo r attl'l1uation rOrrt'(:t ioll (Figur(' 1). In the scan lor th" ('ontw l l'())Iu itioll, Fl K; was illjl"t'teu into til(' an !'r a 20 minute resting phase instead oH X".1 intr rven(i(HI: the scannin g pron'du.rr /(lliowiTig was ii.lent ic:iI (() that fo r Iht' trl'ntmrnt rondilillll (Figurt' 1). Thf' mdi<ltioll eXjlIlsufr from I PET ."ran

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1 5f.-labdled l-1uorodcoxyglucose Positron lilllis.', io n Tomograpt at approxilrl Ol tt'ly 0.9 illS\,: this {"(j illThe PET br.lin images ""t'fl' ,lIIalyu-d 10 identity regilll parable to thr rrom a chest ractiogr.lph (Oll mS\' prr te.\t) ch31 1gel> ill glucosr melabolk ralt IIsing a .\nft wa rl' and than a1lnual environmental (2.'1 The ordC'r tht' 2 alld ,sl:llistk al I'aralllt'lric 2 (W,"' 2. FUliflional llll<lgi l.abQra tory. 1,(Jlldo n, U,lilelJ Kin gt]om)."t".l> I'osi ti onal ern "tTt'atmcnt--("lmt ro l"- was (otHltrrbalallced \(J minimize an dti'tt." Ordn (Xcurs study pn rti ripant" It'nd to 1(-(,1 between thr tWD S(:am werl' l"Onwtcd li )r each par ticipant. t he ft'alignnH'1I1 fl1l1("l ioll of tlw The H)( ; lmlin II mp!; stress mOl"(' in the IlL"t s{an tha n in (Mmlt rt':1 :\'t'ur(llogira l hlstilute. Mc(; iI! Urli'ersity, 1 I' scans. lht' pro wcol wns prepart'd to minimil.C' thh ()fdt'r ol t a",",or iated etti'r \. As n result . tlw first sra n wa" pt' rfo rmr d ill the IJM'(J fM <\ lIatmnlral standardil.atioll Irt'almr nl cOlldi li()11 ill half Ilf thc pa rticipants :mJ vicr V f'Nn. TIlt' PET i.m ugl's by applying linear and non linear Ir;msform:lIilJl inh'W.l1 brtw{'('n the rtrs! and second was wcck to I'limi- which minilOi7.tod lh(' inl(,L"Subjl'<1 diHcft nt'('S in gyr.l l and timeti( naIr rrsid ua l erft'fls tlft rralmem; the inlewJI bt'tw('('11 ("QIUJitiom. al anatomy. nlr Si1e of earh wu:ri com(,rt('(l il ,to 2 min (for ;>, (scnm) rangt'tl rr011l I to Ii intervalSI), 22 ):I J). alld 7 ;4 I.'S ) in till' normaliled imag\'o Till' lIormaliud X \\'\ The CSM was pn fun ned by th e rhiropractnr. usin)\ isotl"Opir b 'Tlw! of 12 IlUIl (for x. } niH '. axl's) In illueaSt' thr siglli\!-Io-lioist' rali f! by suppressing high f pmficiency-ral(,d drll.tur ofacli valor Ilwlilolls. Q ue slionn a i l('s use d fo r subj t t"t ivt' t' va li13 Ii o ll. qu ell!"}" n()bc ill the illlagl's. (such as l'araFIIl' \ wp r{' fl'qUl'stt'U 10 answ\, r qU ions relatcd In th t l'st Respilllsl' Sca le (S RS-l/i) and Enro pt:all ti)r Mapping) the stand:ml tou! for df tl'l"ling regional rh angrs Research and Treallllelll of Callc('T Quality of Lifl' q llcsl iOlUI<l.lre- fadioal'livi ty levels in fl'rtain hraill rrgi(liis. 11,(> mosl popular ({ UI these hl'"('lI 10 contrast "ilh ("ore :{O ([(l RT( QLQ-GO immM iatdy aftl'r the rSM ) aUVtlxc! wert' normalb ;lIId hefort' nx; injeclioll. ofSR$-i8 and 101('1'( q L Q-OO slim ulus." for st:lI istiral , Wfre t'xam ined using WillmOIL tl'sl for statistical analy- to 311 arbilr.lry global mean vallll' of!"() IIIg/100 ml/mill b)' allaly to Ihr efTerb o f in t('l"suhj rrl variahility sis. In addition, in tl'm it)' of suLj t'Ctive pa in .<;('lIsaL ion evalua ted of glohal glut"OS<.' 1I1l'lnholi$ui. A p:lin'J t trst lI'ilS ilpplitd using a visual analoglH' wale ( Vi\$) (0, no pain ; HI, 111a.. ifllum x rnain til int'd with voxt b (or ble paill) befor(, and :lfl ('T(S,\II illterwllt iOIl. Wilcoxon signed-rank t'arh vowl: only I'uxt'] dust.rrs test was p<'dim nH] fiJr of thr VAS I"l,:,uits. as wcll. ("erviral to 1' <.001 in a lest (hright th reshold liJ]" vtl;.;rl I 1;.maUy, signiflfiHl t voxl.'b IO ll r bHat('rally ar tile sU pt'rior part of lhl' tra- lit'S) ill 2 pt'l iu)' m uscle (Museit' Meter PEK 1, imo lu hlf, Kyoto, Jap.)II). apprar in a gwup sinn' ('at'h nfu r.J! suhslnJclllfl' has a rt-rtai n \. Salivary amylase was dl' t('TmillW (Amylase Moui tor, Nipm Inc. utne in human hrain (tog anl rrinr t'l ngu.iatl' roft l'x). nlt' \i;r.t' of t is d('M"riht'd h)' thl' of vox Osaka, J<l pan) as a mra\ure of l"lmnges in alltollom.ic lIer\'OIl.\ S}OS- \'{u:cls group (duster tl)OJ l'lhl'r. & lsed HIT thl' f:l("l lllat lt' m fuuclion. Ib e IlIl'aSnrrllltuts of muscle tont' :Uld amy- showillg in Ihis study IVJS

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RE.'iUl;rs '/lIt' H1G-Pl:;1' anaJrsis f{'\'ea ll,<i dlangcs in r{'gional c!tn'ural t:K'tW('en and trr:atm('nl. (I' <.(01). In the treatme!\! ('1)nciilio ll , gl ucose rne\;lI)(1lism was obsl'rvrd in the inrerior prrrrollwi cortl'x (IJA 47). 8I1teri()\' ringulatr (Ortell. (SA 32). and llliJdlf' temporal gyrus (St\ 21); decrea'5ai glu('{)S(' was ob.'\t'T\'rd in the c{'re/)('ijar vl'nllis and aSSlx iation rol1ell. (M 19)(Table 1), of frve;)led di!lcfrl1('l'!'\ b(>twet'll the rrsli ng ;]nd trealmrnl rnndHioni'>. TJw mean SRS-18 .score WIlS signifi('alltiy JOWd in Ihe treallllClit Ihan Ihr mnditiull (Tahlp 2). Thr n'leaIlI!OI(I'(' qJ,Q-OO SI.-ore was also silJnificantly lower in the Irf'atll1rnt than resting condition n O 2). ahlr of menn VAS showrd thnl pain was signiflcantl), improvrd nftrr tre.1tlnt'nt (Table 2). of cervi"'I! mus-

llw lahle indifatn ot'wl.wl.opxD;t'1 aualy.'ii\ pilr.Ullt'lrir IlUipping 2 Region_ uf aClhlltion aud d(:iclh..tiuu all' 11 K: ofth" .,,' staristic in tach fl'gi<)f]S Q<.,lcs.:rihe.! by y, and 'I in hrain space anti hy flU' I art'l. (JU,<trf Sil,l' i!,diratl's rhe num!",'r or,., ).wl, in ('adl I\-gioll ,'Ulistira! "im(lh"!lool(,I)" .J1ll' I. st'Ilr,' inuiratrs si,fl niliralKc if II >3,0, ('(lrn-sponding to /'<-0111 (without Olffl1:tiollS 1'1)1' multiple ('nnlpari"'lIls). I Ahbr<:l'iatiolls; II'C ill/frio!' jll\'lr,lUtal nlrtu: z,.,H(;. miJdl"

gyrus: ACe. ;,mwrior dngula!!' ('oT!n: (\',

L _ _ _ __

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clC' 1(lilt signiliGl11 t impn.lVemenls from Ihl:' resling til treiltmenl (Table 2). A ul1:rrasc in nwa n salivary amyl:lse was (liJserved aCier clliropractir trealmrnt (Tank 2). m SC(JSSION In the study, participnllts had C1:rvical pail! at fhe lime or the l"lI.:lrTIinatiol1 as ('o!l1!11o!)ly l'xpt'ri('Il('r-d by Inall)' (hirnpraftic patients, lIlay ht a caUSt of fervical pain . and and loon;I!,'("tnC'ut of Ct,..yil"al p.lil1 routinely includes psyl'hological lllanagt'lllt'nt n l ' becallsr psychological strl'SS

lionx, y,
Wl're

e- I TAB1 2 Results ofQo,testioJlMire!

in SuiJ;t'\.'{s Haling Chiruprartir Spinal Mallipulalinu

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-j, Dar;! reported as mtan :tSD, ,\hhrt'viations: SRS-IS. SII\'SS Respoll'i('Sca.le-18: EOKl(' Qt.Q<"'..JO, EUropfan for Rf"S{',1rth ,1tl{1 TttJtltlrnl ofCanl't'r Quality ofUfc QUe:;tiollllairt'-<':or(' 30: VA'\. ;lOalogut" sc31" htlwlX'l belorE'aoU alil'r Kight: fl':'it ing. n,f.2.9 nun: trt'atmL'lt, 0.1 14.:1 tnt)l: f.'< ,00'<;, Idt: n'.'ling, Ut LJI mill: lreatml"llL 5.1 mill; P< .001. Sali,'llry amylase: clif!i-n>nt'M bt'twt'1:n th.. bt'fijr(> and a!il'l' 10.1:11 19.$ trealm("lLt, 7St 17.0 KIIJ/L: 1-'<.05.

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51.14.8

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"

A1.TERNAT1VI' T!lfRAl'l fS. NOV/ mc lOll. VOL 17. NO. 0

15

hm'(' shown Ihal rhronil' activation or the sympalhrtir ncrwus sys telll in chronic stress I;,cilit<llrs tonic and painful ll1usc\(' l'Olltrac' tions. as has bren snggl'Sl!'d for rhrollic lellsi(ln-I},Pl' hr;Jtiachrs and work-rrlatt.'d In the presl'llI IIIraSUrl'me11l of mllM'l(' IOnr indiratet\ a lower \';) 111(' after CSM at which poinl tllc cere\.X'!Iar vc;rmis IV;)S TIl('[rkre, Wl' suggesl Ihal dE'ani\'at iOli of the f!'rl.'helbr vermis may be prerrd('d by in s),lllpatJI(,tic Ionl'. tOIH'. paill . '111(, lingulatl' cnrtrx. infl'rior pr{'rwlI!;)1 rortl'x, :md middle temjx)ral gyrus were al'livalcd in tl\(' lreatml'llt('()ndilion ill Ilw prt'sent study. The ringulale rorlrx i" vlI'olw d in Ill(' geller-Ilion liliollC!rs.'''1I III additioll, in vC!lI'ligatiol1s Oil Activah)r Adjustillg of autonomic .;.1:" :llId p('lillTlllaIlCe of relaxatioll tas b Instnl1l1cllh haw' lx'rn tx'rfonlloo Ix-falt'it' ufs.,fety rolltl:01S rd ntl'd ma), elicil maximal artivation in Ihl' alllrnllr ringulall' rcg;on....This til Aellt"ral f('f\"ical ": in one stud)" Activator r('gion of the limuic COrll'X b('CH implicnt('d in rogllitive and Adjusting Instnml('nts lIl:\ximil.M t!u;r.lpeutic eff('(ts and belll'fits rmoljonal aJld as p;!rl of lhr midlinr ililentional s)'MeHl lhn! involves Iht' dor.'iQlatt'ral preiroutal Tht' lateral pre.mlidarra.'it'd thr III previous aiming sfientilk ('xamination of Ill(> fWllta] regions arc dt'arth'at('d during various ('ognitiw comthat Ihe !:Iteral prefrontal auloliomic dfl'rls Ilf('SM illh'CI'l'ntiOl I, ('ardiova."\l'ular ti.J!l('tiou and pined to H's ting. ,'I ,,< It is fl'I;ling had hrt'll thr maiu ou tClJfJH' measurrs. l!>.12-" arc :lrlh'atro dunn!; the relaxrd ('(u\(litillll. Artil':lliOIl of the iufl'rior Iluw(,v('r, il would ])(' u.\('rulto rX3] uiJl(' til(' St,ltus of region'll brain prt'fmnta! in the Trr:ttlllrilt (Olnditi(Hl mil}' indkatr a rebxtill' of the prl'S('nt 5uggt:'S1 th:1I arli:lctivil), immrdiatl'ly alier the (SM ilHcHenlioll. We first applirti arillll ejf('l'1. the 1'1)(; te('hniqul' till' <I ]ollg-Irrm a('tivaljon study ill Iwalth}' 1'01 of the anterinr ('orte;>; and inferior pn'frolllnl corll'X tll(' rt'gional brain al'tivit)' during 30 rninutC'S iJftrr FOG may arisr from syrnpathetk relaxali(1 n. injc('tioll W<I$ avt'ragl'd and Tenmled base<:! nn lit!' biodl!'llIkal of.'i<lliviJl)' amyl:t.se iu the [t'waled property of"mrtalM,lir In thr study. Ihr rt'gion significant]}' lower vnlues ;Iftrr lX'" and in the reslalmPlabour chang<'s ill the limhic ;tUd parJlimbic n'H'ncl ing fondition, SauI'ar)' 1 ')('{'lI!OP inue3singJy lmpor1:lIIt in psychOlwuwend()crino\()giral f('warrh on slrpss."' 1 \ IUIII , and brain werl' t'Xpe('1IU. thought tll reflect In the present PET illve,,( iS:llion. tht' rhallh't' param('(er of S:llivary d,'trtted in thQ which W.1S rn';lftivated in the Ch.. ill tll(' !xxly isth!, sali\<lry 1117)'mt :Ilpha-arnylase.oio "" Author.! trraltlwn/ wndi/iOIl compared 10 the rf'Sting rouditioll. The eerv- haw J OC\JlTIMtt:'d all incrt'JSf' in salivary ,1myJa<;l' in J.ll'oplt under},'\)str(".;s.o.I":'; il is Ihat :I dcrrea* ill salincl!ar vermis may l)t, important in pain pct('cptioll. Nt'uroim:lgillf1 ing stutii/:s han' ShO\\'Il a paLicrtl ill cerebellar actival ioll during The vary amyhw obscneJ in p('1Jplc in a r('\axed "!lIldilioll. Regarding pain rt'Sl)(lnse.,. t!o (;]u('()se metabolic rhanges h;jl'l' be!'n noll'<l in rhe of PET illlnipis. the rrdurtion ill :(31ivary illllyl,,:';!' in thr the ('rrebella of U of 18 suffcring rcgiollal pnin sYlltiroml',''' prt'...... nt tre;ltment condilinll ma)' !Jt. rrlated to adi\'att.'d ;Ul'as and and (1tlwr have noted a similar al'liva tiol1 pnttem in lh(' ('fl. deacti\'aled :!re:lS Ill:!}' be relatt'i] rdax,llioll. rbeUum.'1M In th(' present study. all p.1rtidpauts had tll.'('k p.ain at The indudr the limited Ilumlx:r ofJXl!1ici the timr (If,lw expt'rimelll , :lnd the rl'Mlits of VAS indicatl-d a signif. and (;f:l ('(mlror f1rottp, though many d inic;11 PEl' studies 011 tt'Sl-I\'te.\l rqmxhll'" icalltly lower ail:er C'.SM , 'Ibus, dractil'a tioll ofth{' cerebellar halt' \)('('n dOlle wilhout ('ontrol groups vtrrnis ill this may be TelMOO 10 pain rrdurlioll ill the p<1l'tici- ihilit}','" !'trr1hi'mIUlY!. sOIflOOftl!P in Ihis al'r ba."l'd 1m suo. pnlllS. 111!' cerrbellar is aJso l'OIlCCnLt'U with lll{'nt<tJ SlI'l"S.\. j1ivc t'\',lluatil)ll!i of Ih(' pOlrtidlxHlIS. All alillitio)uallimilatiou i.\ lhat I'ainfi.il hra t a(!ivates th e antrriur nrOllJld Ihe \'!'rmis, the dliropracti( trc:Jtmcnt was pl'rtormed hy a single pl':Il'litionrr. and a .";t'1lllory t'1I(, Ihal an ticipates Ihe painful slimulalitln results in r\noliler of Ibi\ loXhlli'lue wl.\uld he rildiali')11 exp051l1't'. of tht' JXlsterim rerei")(.'l!ar vrrmis. 1:"." In addition, Ih(' cer- thcugh tht't'Xposurl' was as low as arhit".:tblc. ebellar vermis is itwolvrd wi lh the autonomic ne rvous s}'lI'tr m. studies have sllggeS!Ni thai the rr rebelillm involv/'d in CONCWSION Ihr fegulnti('11 of autonomic r('spolls!':' ill aV!'rsi\< condition l' In summary. the pl'e.'it'nl study oellU'llstral,'d RCllloval ufthe crrdwllum impairs pt'rformant't' oJ ilU!o- re!ax:tlion and rl'gion:l1 brain TIlItabolir changt'S. uom ir fUllrtions inrludillg salivary. fa rd iac. and respiratory well as rNh lCl'{l nlUscir 10m and dffrc:1St'l1 l'lilin illlt'llsil), f(!linll'iHg cond it ioning.' ,j!',., rfft'l'b nn aVl'rsiw cotltiitionillg (3 111)(' a chiropr:Il'lic spinal m:mipul:nion , FlX;-PET 10 be ;) \'t.'ry 10 the C{'rcheUar \'ennis:" Stimulatiou ofille cCflueJlal' promisillg IlK)j (or ducidlting the undl'rlying lI1t'l'h:mism of clinical not the inhibits tOllr o(,hl.' dliropwclk In'<1tlllellt . Furthn Ileumimaging studirs ill{'tras;.'il by pt'riphernl stimulation.OI.:;' Thus. lieacli wltion (If Ihe an' needed to supporl rhe results !x'(:auS(' the tlItlllber of pal'tidrrrebdlar wrmis in the pr!'selll study may have \)1.'1'11 rt,latl'd ;1 was small in tIll' study. dr<Teasr in sympalh!'tk lOll('. M('IU;I] S)111 p;lIhrtk a('tivatioll,'''''' and arc frfquently al'('()mpanird Acknowlt'(lgrments would like to thank Kawko 'l':Imb . of Iho' l)topartnlem artivily and Illusde Wile:'" Somr studirs by inr('f;lsetl
tllUS!'S symp'!IIW'lif arlivalion. "'l< Theft-fore. il is 10 rom-

P."IT(, autollomic function ill lhe trl'arm('ul ('ondil ions ill wll() ha\'l: rrrYkalpain. 1I0\\,('\,er, !Irr UM'fuint'SS ofCS.'1 for ct:rvir.lI1J<lin is ('ontmwrsial hecause of possible "dverS(' fractions of l'l'n'iGl] "djusrml111, inrhKlhlg a ill nff!.: pain and ;md headache's or radiatint: pnin.';, i/< Therr(\)rl', I-'It s('kdoo Methods as Iht' rn'alJll('11t procrtluf{' in lhe preselll study. ar<' a /onn manipulati\'(' lhrrapF' in which high-velocity and rrlalivl'ly low fi.nrt'-imp.1(1 iuslrlllllt'nts k,now1\ Activator Adjusting arc US('(/:i(1 are in Iko;(' by >50% chiropraltic pnl('-

rc
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1(,

AlTFRNAT IV( TII[RAI'1 [ S, Nov/m e lOll VOL 17, NO, ()

u('r....
m nU;I("-

l'urf'lllt'llI

or

of( yd ()l.ron Nuclear Medicine, Cyclotron and Radioisotope ( enltr, Tohoku lJ!liveThil),. for her (<<hnical support un rhis 1111' authors would likt' 1 thank the- Jilpan Chiropr:ar tic D(H.'lUr 0 (ollt,!-'t' filr ils fOlI)lrihution nffundillg 1 ,his study. 0
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