Comparative effectiveness of non-invasive therapeutic interventions for myofascial pain syndrome: a network meta-analysis of randomized controlled trials

Abstract

Background: Myofascial pain syndrome (MPS) has an impact on physical health and quality of life for patients, with various non-invasive methods used for relieving myofascial pain. We aimed to compare the effectiveness of different non-invasive therapeutic interventions for MPS. Materials and Methods: We searched PubMed, Embase, CINAHL Complete, Web of Science, Cochrane, and Scopus to identify randomized controlled trials (RCTs) describing the effects of any non-invasive treatments in patients with MPS. The primary outcome was pain intensity, while pressure pain threshold and pain-related disability were secondary outcomes. Results: The analysis included 40 studies. Manual therapy (MD of pain: -1.60, 95% CI: -2.17 to -1.03; MD of pressure pain threshold: 0.52, 95% CI: 0.19 to 0.86; MD of pain-related disability: -5.34, 95% CI: -8.09 to -2.58), laser therapy (MD of pain: -1.15, 95% CI: -1.83 to -0.46; MD of pressure pain threshold: 1.00, 95% CI: 0.46 to 1.54; MD of pain-related disability: -4.58, 95% CI: -7.80 to -1.36)，extracorporeal shock wave therapy (MD of pain: -1.61, 95% CI:-2.43 to -0.78; MD of pressure pain threshold: 0.84, 95% CI: 0.33 to 1.35; MD of pain-related disability: -5.78, 95% CI: -9.45 to -2.12), and ultrasound therapy (MD of pain: -1.54, 95% CI: -2.24 to -0.84; MD of pressure pain threshold: 0.77, 95% CI: 0.31 to 1.22) were more effective than no treatment. Conclusion: Our findings support that manual therapy, laser therapy, and extracorporeal shock wave therapy could effectively reduce pain intensity, pressure pain threshold, and pain-related disability with statistical significance when compared with placebo. This finding may provide clinicians appropriate therapeutic modalities for patients with myofascial pain syndrome among different scenarios.