Manual Therapy for a Chronic Non-Specific Low Back Pain Rat Model
Summary
This study proposes a standardized procedure for manual therapy on chronic low back pain model rats, which will be of reference value for future experimental research on manual therapy.
Abstract
Chronic low back pain (CLBP) is a highly prevalent condition worldwide and a major cause of disability. The majority of patients with CLBP are diagnosed with chronic non-specific low back pain (CNLBP) due to an unknown pathological cause. Manual therapy (MT) is an integral aspect of traditional Chinese medicine and is recognized as Tuina in China. It involves techniques like bone-setting and muscle relaxation manipulation. Despite its clinical efficacy in treating CNLBP, the underlying mechanisms of MT remain unclear. In animal experiments aimed at investigating these mechanisms, one of the main challenges is achieving normative MT on CNLBP model rats. Improving the stability of finger strength is a key issue in MT. To address this technical limitation, a standardized procedure for MT on CNLBP model rats is presented in this study. This procedure significantly enhances the stability of MT with the hands and alleviates common problems associated with immobilizing rats during MT. The findings of this study are of reference value for future experimental investigations of MT.
Introduction
Chronic low back pain (CLBP) is characterized by persistent low back pain lasting more than 3 months, typically between the rib cage and transverse hip line, with or without lower limb pain1,2. It is a highly prevalent disease, with an estimated global annual prevalence of 38% and a lifetime prevalence of 39%, making it a common public health issue3,4. The majority of patients with CLBP, more than 90-95%, cannot be given a definitive pathological and anatomical diagnosis (such as the tumor, fracture, and infection), leading to the classification of Chronic non-specific low back pain (CNLBP)5,6. Due to the non-specific nature of the pathological mechanism, opioid analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) are the main treatment options in Western medicine but are associated with safety concerns7,8. Therefore, there is an increasing demand for complementary and alternative medicines that are both safe and effective.
Manual therapy (MT), commonly referred to as Tui Na in China, is a significant aspect of traditional Chinese medicine (TCM) and encompasses techniques such as bone-setting and muscle relaxation manipulation. Its widespread use in China is attributed to its clinical effectiveness, high safety profile, and non-invasiveness9. In the treatment of CNLBP, MT has been found to be an effective complementary and alternative medicine with proven efficacy demonstrated in previous studies10,11,12. TCM believes that Qi stagnation and blood stasis are the core causes of chronic pain, and Tui Na relieves pain by promoting blood circulation and promoting Qi to muscles and soft tissues. However, despite its efficacy, the precise mechanism underlying its therapeutic effect remains elusive.
In the domain of experimental research on MT, discrepancies exist in the implementation of interventions on animal models. Presently, the majority of researchers opt for machine-based MT, whereas a minority perform MT using human hands13,14,15,16. While machine-based MT is more standardized, MT is more clinically relevant and produces more representative data. However, MT on experimental animals is hindered by the unstable strength of fingers, leading to a crucial challenge in animal experiments and hampering the comparability of experimental results. To overcome this technical challenge, this study proposes an appropriate solution, which enhances the stability of finger strength during MT on CNLBP model rats. The feasibility of this solution is verified, providing valuable guidance for future experimental studies of MT.
Protocol
Representative Results
Discussion
Currently, a consensus on an animal model that accurately replicates chronic non-specific low back pain (CNLBP) is lacking. Multiple animal models of CNLBP exist, such as disc-derived, neurogenic, osteoarticular-derived, and muscle-derived models23. However, these models have limitations due to the heterogeneous nature of CNLBP in clinical practice. The CNLBP model used in this study was modified from Henderson's "external link" model24, which is an osteoarticul…
Disclosures
The authors have nothing to disclose.
Acknowledgements
This work was supported by the General Program of the National Natural Science Foundation of China (81774442, 82274672), the Zhejiang Provincial Natural Science Foundation Project (Q23H270025), the Zhejiang Province Lv Lijiang Famous Old Chinese Medicine Expert Inheritance Studio Construction Project Fund (GZS2021026), and the School-Level Scientific Research Project of Zhejiang Chinese Medicine University (2021RCZXZK03, 2022FSYYZQ13, 2022GJYY045).
Materials
| Automatic Dehydrator | Thermo Fisher Scientific Co.,Ltd | Excelsior AS | |
| Automatic Stainer | Thermo Fisher Scientific Co.,Ltd | Gemini AS | |
| Constant temperature table | Harvard Bioscience (Shanghai) Co.,Ltd | 50-1247 | Heated small animal operating table usually operated at 37 °C–38 °C |
| Digital Slide Scanner | HAMAMATSU Co.,Ltd | C13210-01 | |
| External link fixation system | Shanghai Naturethink life science & Technology CO., Ltd | custom-made | |
| Embedding box | Citotest Labware Manufacturing Co., Ltd | 31050102W | |
| Hargreaves Apparatus | UGO BASILE Co.,Ltd | 37370 | |
| Neutral Resin | ZSGB-BIO Co.,Ltd | ZLI-9555 | |
| Paraformaldehyde | Macklin Co.,Ltd | P804536 | |
| Penicillin | Hangzhou Zhengbo Biotechnology Co.,Ltd | ZSQ-100-160A | |
| Plastic ball toys | Shanghai Huake Industrial Co., Ltd. | HK11029-35503 | |
| SD rats | Shanghai SLAC Laboratory Animal Co.,Ltd | SCXK (HU) 2022-0004 | male, 330-350 g |
| Sodium pentobarbital | Hangzhou Dacheng Biotechnology Co., Ltd. | P3761 | |
| Von Frey filaments | Stoeltingco Co., Ltd. | NC12775 | |
| Weighing table | Shanghai Lichen Bangxi Instrument Technology Co., Ltd. | YP20002B |
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