TRIGGER POINT MANUAL THERAPY FOR THE TREATMENT OF CHRONIC NONCANCER PAIN IN ADULTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

BACKGROUND & OBJECTIVE

The estimated incidence of myofascial trigger points (TrPs) is somewhere between 30% and 93% in adults. This large range may be because the definition and assessment of myofascial pain syndrome (MPS) is not agreed upon. The identification and diagnosis of TrPs may be confused with the presence of allodynia and hyperalgesia.

Many treatments of MPS are based on peripheral and tissue techniques similar to those described by Travell and Simons utilizing local ischemia to eliminate the TrP. Others (D’Ambrogio and Roth) describe the changes as due to modulation in the pain threshold in the spinal cord following trigger point manual therapy (TPMT).

The authors note that this is the first systematic review comparing the effects of TPMT with other forms of treatment (or no treatment) for noncancer pain in adults. This review aimed to identify if there is significant effectiveness with the use of TPMT for the treatment of chronic noncancer pain in adults.

METHODS

The authors published a protocol prior to the study. They followed the Cochrane guidelines for systematic review of interventions. The study excluded treatments that penetrate the skin, or that did not specifically address TrP treatment as using ischemic compression techniques. This excludes techniques such as dry needling, acupuncture, muscle energy techniques, massage, manipulation, and mobilizations.

2692 initial records were initially identified. Following established screening and eligibility protocols, 19 studies were included in the review (1047 participants).

The review assessed pain, function, and patient-reported improvement as outcomes.

RESULTS

Pain Relief: 11 studies with 548 participants found an insignificant effect. Adding in studies that had a high risk of bias did not significantly change the results.

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