TITLE:
The Effect of Treatment-Related Outcome Expectations on Pain Perception after Spinal Manipulation in Patients with Non-Specific Low Back Pain: A Cohort Study
AUTHORS:
Nikolaos Zampetakis, Nektarios Martzoukos, Danai Paleta, Georgios Krekoukias, Stefanos Karanasios, George Gioftsos
KEYWORDS:
Expectations, Low Back Pain, Pressure Pain Threshold, Spinal Manipulation
JOURNAL NAME:
Open Journal of Therapy and Rehabilitation,
Vol.14 No.3,
June
29,
2026
ABSTRACT: Purpose: This cohort study aimed to investigate the effect of treatment-related outcome expectations on pressure pain thresholds (PPTs) immediately after a thrust manipulation in the lumbar spine in patients with chronic non-specific low back pain (NSLBP). Methods: Treatment-related outcome expectations were assessed using the Expectations for Treatment Scale (ETS). Pressure pain thresholds (PPTs) were measured at local and remote sites before and immediately after a lumbar thrust manipulation. The primary analysis examined the association between ETS scores and changes in PPTs using Spearman’s rank correlation. Sensitivity analyses explored differences between groups with high and low treatment expectations. Results: A total of 56 patients were enrolled. No significant associations were observed between ETS scores and changes in PPTs at any measurement site. Sensitivity analyses using different ETS categorization thresholds produced similar findings. Statistically significant differences in PPTs pre- and post-intervention were observed only at the upper trapezius muscle bilaterally. Conclusion: The findings of this cohort study indicate that there is no discernible association between treatment-related outcome expectations and changes in mechanical sensitivity in individuals with chronic NSLBP undergoing a single lumbar thrust manipulation.