Nonpharmacological treatments for musculoskeletal pain.
BACKGROUND
Several types of physical therapy are used in the management of painful musculoskeletal disorders. These treatment modalities can be broadly categorized as electrotherapy modalities (e.g., transcutaneous electrical nerve stimulation), acupuncture, thermal modalities (e.g., moist heat, ultrasound), manual therapies (e.g., manipulation or massage), or exercise. Within each of these broad categories significant variations in treatment parameters are possible.


OBJECTIVE
To consider the evidence base for each of these main categories of physical therapy in the management of musculoskeletal pain.


METHODS
To consider the available evidence related to clinical effectiveness and then to review evidence from basic science studies evaluating potentially therapeutic effects of the various therapies.


RESULTS
There seems to be evidence from basic science research to suggest that many of the therapies could have potentially therapeutic effects. However, there appears to be limited high-quality evidence from randomized clinical trials to support the therapeutic effectiveness of several of the therapies.


CONCLUSIONS
There is some preliminary evidence to support the use of manual therapies, exercise, and acupuncture in the management of some categories of musculoskeletal pain. Limitations of the existing research base are discussed and recommendations for areas of future research are provided.
Wright
A
A
School of Medical Rehabilitation, University of Manitoba, Winnipeg.
Sluka
K A
KA
D015670:Acupuncture Therapy; D000818:Animals; D004599:Electric Stimulation Therapy; D005081:Exercise Therapy; D006358:Hot Temperature / Q000627:therapeutic use; D006801:Humans; D009140:Musculoskeletal Diseases / Q000628:therapy*; D059408:Pain Management; D010166:Palliative Care / Q000379:methods*; D026741:Physical Therapy Modalities