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Abstract
Recent research has indicated that the analgesia provided by manual therapy may be caused not only through the improvement of pathomechanics of the affected structure, but also through the activity of descending pain inhibitory pathways. Analgesia associated with this descending neural circuitry has been classified as opioid or non-opioid in nature, and the pathways activated appear to be highly dependent on the parameters used to induce analgesia. A characteristic of opioid system activation is the development of tolerance to analgesia produced by both endogenous and exogenous mechanisms. This paper will review the possible mechanisms by which tolerance develops. A discussion of the literature pertaining to stimulation and stress-induced analgesia will indicate the possible relationship between tolerance and physiotherapy inverventions such as manual therapy, electrotherapy and exercise. Implications for physiotherapy research and practice will be discussed.