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Review
. 2025 Apr 10:18:1923-1933.
doi: 10.2147/JPR.S517869. eCollection 2025.

Manipulative Treatment of Myofascial Pain Syndrome: A Network Meta-Analysis Based on Randomized Controlled Trials

Jing Chen #  1   2 , Linyu Yin #  1   2 , Qing Hu  1   2 , Songtao Liu  1   2 , Lirong Zeng  3
Affiliations
Review

Manipulative Treatment of Myofascial Pain Syndrome: A Network Meta-Analysis Based on Randomized Controlled Trials

Jing Chen et al. J Pain Res. .

Abstract

Objective: Myofascial pain syndrome (MPS) is a common condition. Manual therapy is preferred over other invasive treatments due to its noninvasiveness and safety, but evidence for its effectiveness is lacking. We here conducted a comprehensive search of randomized controlled trial studies related to manipulative therapy for MPS and conducted a network meta-analysis to provide a basis for clinical applications and experimental studies.

Methods: Reports on randomized controlled trials of noninvasive therapy for MPS deposited in the China National Knowledge Infrastructure database, Chinese Science Citation Database(CSCD), Chinese Citation Database(CCD), Chinese Biomedical Database, PubMed, Embase, Cochrane Library, and Web of Science from their respective inception dates until November 10, 2024, were retrieved. A network meta-analysis was performed using Rv4.2.0 software.

Results: Fourteen studies involving 588 patients overall were included. The interventions included pain point compression, massage, and ischemic compression. Visual analogue scale scores were reported in 12 studies and the pressure pain threshold was reported in five studies. The outcomes demonstrated that manipulation had a notable effect, although not statistically significant, as compared with conventional treatment and placebo. Overall, the effect of pain-point compression was favorable. The results were stable, with no significant publication bias.

Conclusion: Manipulation was an effective treatment for MPS, but the effects were not statistically significant, based on the findings of this study. Owing to issues such as uneven methodological quality and the small sample size of the included studies, further high-quality multicenter, large-sample, randomized double-blind controlled trials are required to verify the reliability of this conclusion.

Keywords: comparative effectiveness research; musculoskeletal manipulations; myofascial pain syndromes; network meta-analysis; systematic review.

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Conflict of interest statement

The authors declare no conflicts of interest regarding the publication of this paper. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Literature screening process.
Figure 2
Figure 2
Risk-of-bias graph.
Figure 3
Figure 3
Risk-of-bias summary.
Figure 4
Figure 4
Mesh correlation graph (visual analogue scale score for pain) among different techniques.
Figure 5
Figure 5
Forest plot of the effectiveness of different techniques compared to conventional treatment (visual analogue scale score for pain).
Figure 6
Figure 6
Forest plot of the effectiveness of different techniques compared with placebo (visual analogue scale score for pain).
Figure 7
Figure 7
Network association diagram of different techniques (pain-pressure threshold).
Figure 8
Figure 8
Forest graph of the effectiveness of different techniques compared to conventional treatments (pain-pressure threshold).
Figures 9
Figures 9
Forest plot of the effectiveness of different techniques compared with placebo (pain-pressure threshold).
See this image and copyright information in PMC

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