Trigger Point Manual Therapy for the Treatment of Chronic Noncancer Pain in Adults

A Systematic Review and Meta-analysis

Diarmuid Denneny, Helena C. Frawley, Katrine Petersen, Rebecca McLoughlin, Suzanne Brook, Salma Hassan, Amanda C. Williams

Research output: Contribution to journalReview ArticleResearchpeer-review

1 Citation (Scopus)

Abstract

Objective: To determine the effectiveness of trigger point manual therapy (TPMT) for reducing chronic noncancer pain and associated problems in adults, by analyzing all relevant randomized 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 older than 18, with pain of 3 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 synthesized narratively. Data Synthesis: We combined all data using a random-effects model and assessed the quality of evidence using GRADE. A total of 19 trials (involving 1047 participants) met inclusion criteria, representing TPMT treatment of musculoskeletal, pelvic, and facial pain. No effect was found for short-term pain relief (mean standardized difference −0.53; 95% confidence interval [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, 1.86-7.71) from 4 studies, but not for health-related quality of life. Conclusions: Evidence for TPMT for chronic noncancer pain is weak and it cannot currently be recommended.

Original languageEnglish
Pages (from-to)562-577
Number of pages16
JournalArchives of Physical Medicine and Rehabilitation
Volume100
Issue number3
DOIs
Publication statusPublished - Mar 2019

Keywords

  • Chronic pain
  • Manual therapies
  • Rehabilitation
  • Trigger points

Cite this

Denneny, Diarmuid ; Frawley, Helena C. ; Petersen, Katrine ; McLoughlin, Rebecca ; Brook, Suzanne ; Hassan, Salma ; Williams, Amanda C. / Trigger Point Manual Therapy for the Treatment of Chronic Noncancer Pain in Adults : A Systematic Review and Meta-analysis. In: Archives of Physical Medicine and Rehabilitation. 2019 ; Vol. 100, No. 3. pp. 562-577.
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abstract = "Objective: To determine the effectiveness of trigger point manual therapy (TPMT) for reducing chronic noncancer pain and associated problems in adults, by analyzing all relevant randomized 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 older than 18, with pain of 3 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 synthesized narratively. Data Synthesis: We combined all data using a random-effects model and assessed the quality of evidence using GRADE. A total of 19 trials (involving 1047 participants) met inclusion criteria, representing TPMT treatment of musculoskeletal, pelvic, and facial pain. No effect was found for short-term pain relief (mean standardized difference −0.53; 95{\%} confidence interval [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, 1.86-7.71) from 4 studies, but not for health-related quality of life. Conclusions: Evidence for TPMT for chronic noncancer pain is weak and it cannot currently be recommended.",
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Trigger Point Manual Therapy for the Treatment of Chronic Noncancer Pain in Adults : A Systematic Review and Meta-analysis. / Denneny, Diarmuid; Frawley, Helena C.; Petersen, Katrine; McLoughlin, Rebecca; Brook, Suzanne; Hassan, Salma; Williams, Amanda C.

In: Archives of Physical Medicine and Rehabilitation, Vol. 100, No. 3, 03.2019, p. 562-577.

Research output: Contribution to journalReview ArticleResearchpeer-review

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T1 - Trigger Point Manual Therapy for the Treatment of Chronic Noncancer Pain in Adults

T2 - A Systematic Review and Meta-analysis

AU - Denneny, Diarmuid

AU - Frawley, Helena C.

AU - Petersen, Katrine

AU - McLoughlin, Rebecca

AU - Brook, Suzanne

AU - Hassan, Salma

AU - Williams, Amanda C.

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N2 - Objective: To determine the effectiveness of trigger point manual therapy (TPMT) for reducing chronic noncancer pain and associated problems in adults, by analyzing all relevant randomized 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 older than 18, with pain of 3 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 synthesized narratively. Data Synthesis: We combined all data using a random-effects model and assessed the quality of evidence using GRADE. A total of 19 trials (involving 1047 participants) met inclusion criteria, representing TPMT treatment of musculoskeletal, pelvic, and facial pain. No effect was found for short-term pain relief (mean standardized difference −0.53; 95% confidence interval [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, 1.86-7.71) from 4 studies, but not for health-related quality of life. Conclusions: Evidence for TPMT for chronic noncancer pain is weak and it cannot currently be recommended.

AB - Objective: To determine the effectiveness of trigger point manual therapy (TPMT) for reducing chronic noncancer pain and associated problems in adults, by analyzing all relevant randomized 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 older than 18, with pain of 3 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 synthesized narratively. Data Synthesis: We combined all data using a random-effects model and assessed the quality of evidence using GRADE. A total of 19 trials (involving 1047 participants) met inclusion criteria, representing TPMT treatment of musculoskeletal, pelvic, and facial pain. No effect was found for short-term pain relief (mean standardized difference −0.53; 95% confidence interval [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, 1.86-7.71) from 4 studies, but not for health-related quality of life. Conclusions: Evidence for TPMT for chronic noncancer pain is weak and it cannot currently be recommended.

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KW - Rehabilitation

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