Trigger point manual therapy for the treatment of chronic non-cancer pain in adults: a systematic review and meta-analysis

Publication date: Available online 17 July 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Diarmuid Denneny, Helena C. Frawley, Katrine Petersen, Rebecca McLoughlin, Suzanne Brook, Salma Hassan, Amanda C. de C Williams

Abstract

Objective

To determine the effectiveness of trigger point manual therapy (TPMT) for reducing chronic non-cancer pain and associated problems in adults, by analysing all relevant randomised controlled trials (RCTs).

Data Sources

We searched databases and clinical trials registers from their inception to May 2017.

Study Selection

We included RCTs in any language that recruited patients over the age of 18, with pain of three months duration or more. We assessed pain, function, and patient-reported improvement as outcomes.

Data Extraction

Two authors independently extracted and verified data. Meta-analysis was completed where possible, otherwise data were synthesised narratively.

Data Synthesis

We combined all data using a random-effects model and assessed the quality of evidence using GRADE. 19 trials (involving 1047 participants) met inclusion criteria, representing TPMT treatment for musculoskeletal, pelvic and facial pain. No effect was found for short-term pain relief (mean standardized difference -0.53, 95% CI -1.08 to 0.02). One small study showed a longer-term benefit for pain (mean standardized difference --2.00 (95% CI -3.40 to -0.60) but with low confidence in the effect. Significant gains emerged for function (mean standardized difference -0.77, 95% CI -1.27 to -0.26, and in patient global response (odds ratio 3.79, 95% CI 1.86 to 7.71) from four studies, but not for health-related quality of life.

Conclusions

Evidence for TPMT for chronic non-cancer pain is weak and it cannot currently be recommended.

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