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

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2 Citations (Scopus)


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
Issue number3
Publication statusPublished - Mar 2019


  • Chronic pain
  • Manual therapies
  • Rehabilitation
  • Trigger points

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