Spinal manipulative therapy reduces inflammatory cytokines but not substance P production in normal subjects

J Manipulative Physiol Ther. 2006 Jan;29(1):14-21. doi: 10.1016/j.jmpt.2005.10.002.


Objective: To examine the effect of a single spinal manipulation therapy (SMT) on the in vitro production of inflammatory cytokines, tumor necrosis factor alpha, and interleukin (IL) 1beta, in relation to the systemic (in vivo) levels of neurotransmitter substance P (SP).

Methods: Sixty-four asymptomatic subjects were assigned to SMT, sham manipulation, or venipuncture control group. SMT subjects received a single adjustment in the thoracic spine. Blood and serum samples were obtained from subjects before and then at 20 minutes and 2 hours after intervention. Whole-blood cultures were activated with lipopolysaccharide (LPS) for 24 hours. Cytokine production in culture supernatants and serum SP levels were assessed by specific immunoassays.

Results: Over the study period, a significant proportion (P </= .05) of sham and control subjects demonstrated progressive increases in the synthesis of tumor necrosis factor alpha and IL-1beta. Conversely, in a comparable proportion of cultures from SMT-derived subjects, the production of both cytokines decreased gradually. Normalization of the observed alterations to reflect the changes relative to self-baselines demonstrated that, within 2 hours after intervention, the production of both cytokines increased significantly (P < .001 to .05) in both controls. In contrast, a significant (P < .001 to .05) reduction of proinflammatory cytokine secretion was observed in cultures from SMT-receiving subjects. In all study groups, serum levels of SP remained unaltered within 2 hours after intervention.

Conclusions: SMT-treated subjects show a time-dependent attenuation of LPS-induced production of the inflammatory cytokines unrelated to systemic levels of SP. This suggests SMT-related down-regulation of inflammatory-type responses via a central yet unknown mechanism.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cytokines / blood*
  • Cytokines / metabolism
  • Female
  • Humans
  • Inflammation Mediators / blood*
  • Inflammation Mediators / metabolism
  • Interleukin-1 / biosynthesis
  • Lipopolysaccharides / pharmacology
  • Male
  • Manipulation, Chiropractic*
  • Monocytes / metabolism
  • Reference Values
  • Substance P / biosynthesis*
  • Substance P / blood
  • Tumor Necrosis Factor-alpha / biosynthesis


  • Cytokines
  • Inflammation Mediators
  • Interleukin-1
  • Lipopolysaccharides
  • Tumor Necrosis Factor-alpha
  • Substance P