• Ion Lascurain-Aguirrebeña, Di J Newham, Xabier Galindez-Ibarbengoetxea, Xabat Casado-Zumeta, Aitana Lertxundi, and Duncan J Critchley.
• Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, King's College London, London, SE1 1UL, United Kingdom; Department of Physiology, Faculty of Medicine & Infirmary, University of the Basque Country UPV/EHU, Leioa, 48940, Spain. Electronic address: ion.lascurain@ehu.eus.
• Musculoskelet Sci Pract. 2019 Jul 1; 42: 90-97.

Backgroundsympathoexcitation observed with passive cervical mobilisations may imply activation of an endogenous pain inhibition system resulting in hypoalgesia. However, research is mostly in asymptomatic participants and there is very limited evidence of a relationship between sympathoexcitation and symptomatic improvement in people with clinical pain.Objectiveto investigate the effects of cervical mobilisations on the sympathetic nervous system in participants with neck pain, and to explore the relationship between symptomatic improvement and sympathoexcitation.Designdouble-blind randomised controlled trial.Method40 participants with neck pain (aged 20-69 years, 25 female) were randomly allocated to either cervical mobilisations or motionless placebo. Skin conductance was measured before, during, and after intervention. After interventions were completed, their credibility was assessed. Participants were classified as responders or non-responders according to global symptom change.Resultsparticipants receiving mobilisations were more likely to be classified as responders (odds ratio: 4.33, p = 0.03) and demonstrated greater change in most outcome measures of sympathoexcitation from baseline to during the intervention but not from during to after the intervention. There was no association between sympathoexcitation and symptomatic improvement. Mobilisations and placebo were equally credible.ConclusionsThese findings suggest sympathoexcitatory changes may be caused by an orienting response unrelated to the activation of an endogenous pain inhibition system Alternatively, the observed lack of an association may be explained by the existence of various mechanisms for pain relief. This study used single outcome measures of sympathoexcitation and symptomatic improvement and other measures may reveal different things. CLINICALTRIALS.Gov NumberM10/2016/095.Copyright © 2019 Elsevier Ltd. All rights reserved.

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