What does this research mean for the field?

Short-term pain intensity and lumbar pressure pain threshold after spinal manipulation are associated with verbal framing rather than cognitive-affective variables. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

This analysis aimed to explore the impact of verbal framing on pain outcomes following spinal manipulation in young adults.

March 7, 2026

Verbal framing, rather than measured cognitive-affective variables, is associated with short-term outcomes after spinal manipulation: a secondary analysis of a randomized controlled trial

Puntos clave

This analysis aimed to explore the impact of verbal framing on pain outcomes following spinal manipulation in young adults.
Randomized participants into three groups based on verbal framing: positive, neutral, and negative.
Measured pain intensity using the NPRS-11 and pressure pain threshold (PPT) pre-treatment and at two post-treatment intervals.
Conducted correlation analyses and multiple linear regression to examine relationships between variables.
Found sparse and inconsistent associations between expectations, attitudes, and pain outcomes.
In the positive verbal framing group, higher expectations were linked to improved PPT immediately post-treatment.
Overall, verbal framing was a significant factor in short-term pain outcomes, but cognitive-affective variables were not.

Resumen

BACKGROUND: Pre-treatment communication may influence short-term responses to spinal manipulation. This secondary analysis examined associations between expectations, attitude toward manual therapy, expectation fulfillment, and pain intensity (NPRS-11) and lumbar pressure pain threshold (PPT) across verbal framings. METHODS: Sixty-six young adults with chronic nonspecific low back pain were randomized to positive, neutral, or negative verbal framing delivered before lumbar spinal manipulation. NPRS-11 and lumbar PPT (L3-L5) were assessed at baseline (t0), immediately post-intervention (t1), and 24 hours post-intervention (t2). Group-specific correlation analyses and multiple linear regression were performed. RESULTS: Associations were sparse and inconsistent. Expectation fulfillment assessed at t2 showed no consistent associations with NPRS-11 or PPT at t1 or t2. In the positive group, higher expectations correlated with higher immediate PPT at t1 L4 ( CONCLUSIONS: Short-term NPRS-11 and lumbar PPT were associated with verbal framing rather than with cognitive-affective variables. CLINICAL TRIAL REGISTRATION: The ClinicalTrial.gov identifier is NCT06537739. We looked again at data from a study in young adults with long-lasting low back pain with no clear cause. Everyone received the same hands-on treatment to the lower back (spinal manipulation). Before treatment, people were randomly assigned to hear one of three short messages: positive, neutral, or negative. We asked whether three things were linked to results 24 hours later: what people expected before treatment, how they felt about hands-on therapy in general, and whether they thought the treatment met their expectations. We compared these factors with two short-term outcomes: how much pain people reported and how sensitive they were to pressure. Overall, expectations, attitude, and feeling that expectations were met were not clearly linked to pain or pressure sensitivity. When we tested what best explained pain after 24 hours, the type of message said before treatment was the only factor that helped explain differences in pain. The other factors did not add useful information. In this group, short-term pain changes seemed to depend more on what was said just before treatment than on what people believed beforehand.

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