title: Analgesic effects of manual therapy in patients with musculoskeletal pain: a systematic review.
abstract: BACKGROUND
  Current evidence shows that manual therapy elicits analgesic effect in different populations (healthy, pain inflicted and patients with musculoskeletal pain) when carried out at the spinal column, although the clinical significance of these effects remains unclear. Also the analgesic effects of manual therapy on peripheral joints have not been systematically reviewed.
  
  
  METHODS
  A systematic review was carried out following the PRISMA-guidelines. Manual therapy was defined as any manual induced articular motion with the aim of inducing analgesic effects. Outcome measure was pain threshold.
  
  
  RESULTS
  A total of 13 randomized trials were included in the review. In 10 studies a significant effect was found. Pressure pain thresholds increased following spinal or peripheral manual techniques. In three studies both a local and widespread analgesic effect was found. No significant effect was found on thermal pain threshold.
  
  
  CONCLUSIONS
  Moderate evidence indicated that manual therapy increased local pressure pain thresholds in musculoskeletal pain, immediately following the intervention. No consistent result was found on remote pressure pain threshold. No significant changes occured on thermal pain threshold values. The clinical relevance of these effects remains contradictory and therefore unclear.
authors.affiliation: Master Program in Manual Physiotherapy, Rotterdam University of Applied Sciences, The Netherlands; Pain in Motion Research Group, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium; Department of Neuroscience, Erasmus MC, University Medical Centre Rotterdam, The Netherlands; Departments of Human Physiology and Physiotherapy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium. Electronic address: l.p.voogt@hr.nl.
authors.forename: Lennard
authors.initials: L
authors.lastname: Voogt
authors.affiliation: Master Program in Manual Physiotherapy, Rotterdam University of Applied Sciences, The Netherlands; Department of Neuroscience, Erasmus MC, University Medical Centre Rotterdam, The Netherlands.
authors.forename: Jurryt
authors.initials: J
authors.lastname: de Vries
authors.affiliation: Pain in Motion Research Group, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
authors.forename: Mira
authors.initials: M
authors.lastname: Meeus
authors.affiliation: Pain in Motion Research Group, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium.
authors.forename: Filip
authors.initials: F
authors.lastname: Struyf
authors.affiliation: Department of Orthopaedic Surgery, Erasmus MC, University Medical Centre Rotterdam, The Netherlands.
authors.forename: Duncan
authors.initials: D
authors.lastname: Meuffels
authors.affiliation: Pain in Motion Research Group, Belgium; Departments of Human Physiology and Physiotherapy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium.
authors.forename: Jo
authors.initials: J
authors.lastname: Nijs
mesh_terms: D000698:Analgesia / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D026201:Musculoskeletal Manipulations / Q000379:methods*; D059352:Musculoskeletal Pain / Q000175:diagnosis / Q000628:therapy*; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D017288:Pain Threshold / Q000502:physiology*; D063868:Patient Outcome Assessment; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index
keywords: Manual therapy; Pain modulation; Pain threshold; Systematic review