Developing Manual Therapy Frameworks for Dedicated Pain Mechanisms

OBJECTIVE: To create a consensus-based framework of manual therapy treatment approaches for the major mechanisms-based pain classifications established by the International Association for the Study of Pain (IASP) nociceptive, nociplastic, and neuropathic pain. DESIGN: The hybridized consensus survey included experts who participated in working groups and a survey of external stakeholders. METHODS: Eighteen working group members created theoretical treatment frameworks for nociceptive, nociplastic, and neuropathic pain mechanisms. The treatment frameworks were then sent to manual therapists and/or pain experts (stakeholders), who rank ordered the frameworks for each mechanism. The mean/median/mode of the rank ordered results was tabulated, and a single framework was identified for each pain mechanism. RESULTS: Fifteen theoretical frameworks were created for nociceptive (3), nociplastic (6), and neuropathic (6) pain mechanisms. Ninety-six stakeholders rank ordered the framework options, and 1 framework was identified for each pain mechanism. Four of the 10 framework constructs were consistent across each mechanism, whereas notable differences in recommendations were promoted in the other six. CONCLUSION: There were notable differences across the recommended frameworks, suggesting endorsement modification of manual therapy approaches based on the individual’s dominant pain mechanism. Understanding dominant pain mechanisms may help clinicians tailor care for precision musculoskeletal medicine. JOSPT Open 2023;1(1):48-62. Epub 10 July 2023. doi:10.2519/josptopen.2023.0002