An overview of systematic reviews examining the quantitative sensory testing-derived hypoalgesic effects of manual therapy for musculoskeletal pain

ABSTRACT

Background

Changes in quantitative sensory testing (QST) after manual therapy can provide insight into pain relief mechanisms. Prior systematic reviews have evaluated manual-therapy-induced QST change. This overview of systematic reviews aims to consolidate this body of literature and critically review evidence on the hypoalgesic effects of manual therapy in clinical populations.

Methods

A comprehensive search was conducted on PubMed, CINAHL, PsycInfo, and Embase. Peer-reviewed systematic reviews with or without meta-analysis were eligible if the reviews examined the effect of manual therapy compared to non-manual therapy interventions on QST outcomes in clinical populations. Methodological quality was assessed with the AMSTAR 2 tool. Meta-analysis results and qualitative (non-meta-analysis) interpretations were summarized by type of manual therapy. Overlap of studies was examined with the corrected covered area (CCA) index.

Results

Thirty systematic reviews, including 11 meta-analyses, met inclusion. There was a slight overlap in studies (CCA of 1.72% for all reviews and 1.69% for meta-analyses). Methodological quality was predominantly low to critically low. Eight (27%) reviews examined studies with a range of manual therapy types, 13 (43%) reviews focused on joint-biased manual therapy, 7 (23%) reviews focused on muscle-biased manual therapy, and 2 (7%) reviews focused on nerve-biased manual therapy. Twenty-nine (97%) reviews reported on pressure pain threshold (PPT). Meta-analytic results demonstrated conflicting evidence that manual therapy results in greater hypoalgesic effects compared to other interventions or controls.

Conclusion

Our overview of QST effects, which has relevance to mechanisms underlying hypoalgesia, shows conflicting evidence from mostly low to critically low systematic reviews.

KEYWORDS:

• Hypoalgesia
• manual therapy
• pressure pain threshold
• pain mechanism
• pain modulation
• systematic review

Acknowledgements

Dr Coronado was supported by a Vanderbilt Clinical and Translational Research Scholars award (grant number KL2TR002245) during the time of this manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary Material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/10669817.2023.2267954

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Logan J. Rodgers

Logan J. Rodgers, PT, DPT, is a PhD student in the Department of Rehabilitation Science at the University of Florida. Logan received his physical therapy degree from The University of St Augustine, Florida. Logan is an orthopedic-certified specialist and a fellow of the American Academy of Orthopedic Manual Physical Therapy.

Joel E. Bialosky

Joel E. Bialosky, PT, PhD is a Clinical Professor in the Department of Physical Therapy at the University of Florida. Dr. Bialosky received his doctoral degree from the University of Florida, an advanced masters degree in musculoskeletal physical therapy from the University of Pittsburgh, and a bachelors degree in physical therapy from Ithaca College.

Sophie A. Minick

Sophie A. Minick is an Undergraduate Research Assistant in the Department of Orthopedic Surgery at Vanderbilt University Medical Center. She is a Junior at Vanderbilt University working towards her double major in Cognitive Studies and Medicine, Health, and Society. She plans to attend medical school after graduation.

Rogelio A. Coronado

Rogelio A. Coronado, PT, PhD is a Research Assistant Professor in the Department of Orthopaedic Surgery and Department of Physical Medicine and Rehabilitation at Vanderbilt University Medical Center. He is core faculty for the Vanderbilt Center for Musculoskeletal Research. Dr. Coronado received his doctoral degree from the University of Florida and physical therapy degree from Texas Tech University Health Sciences Center.