The Effectiveness of Noninvasive Interventions for Musculoskeletal Thoracic Spine and Chest Wall Pain: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

• Published in: Journal of manipulative and physiological therapeutics 2015-09, Vol.38 (7), p.521-531
• Main Authors: Southerst, Danielle, DC, Marchand, Andrée-Anne, DC, MSc, Côté, Pierre, DC, PhD, Shearer, Heather M., DC, MSc, Wong, Jessica J., DC, Varatharajan, Sharanya, MSc, Randhawa, Kristi, MPH, Sutton, Deborah, MEd, MSc, Yu, Hainan, MBBS, MSc, Gross, Douglas P., PhD, Jacobs, Craig, DC, MSc, Goldgrub, Rachel, BHSc, Stupar, Maja, DC, PhD, Mior, Silvano, DC, PhD, Carroll, Linda J., PhD, Taylor-Vaisey, Anne, MLS
• Format: Article
• Language: English
• Subjects: Acupuncture; Acupuncture Therapy - methods; Adult; Aged; Case-Control Studies; Cohort Studies; Cooperative Behavior; Exercise Therapy - methods; Female; Humans; Male; Middle Aged; Musculoskeletal Manipulations; Musculoskeletal Manipulations - methods; Musculoskeletal Pain; Musculoskeletal Pain - diagnosis; Musculoskeletal Pain - rehabilitation; Ontario; Pain Management - methods; Pain Measurement; Patient Education as Topic; Physical Medicine and Rehabilitation; Physical Therapy Modalities; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Review Literature as Topic; Severity of Illness Index; Spinal Diseases - diagnosis; Spinal Diseases - rehabilitation; Thoracic Vertebrae; Thoracic Vertebrae - physiopathology; Thoracic Wall; Treatment Outcome
• ISSN: 0161-4754; 1532-6586
• DOI: 10.1016/j.jmpt.2015.06.001

Abstract Objective The purpose of this study was to critically appraise and synthesize evidence on the effectiveness of noninvasive interventions, excluding pharmacological treatments, for musculoskeletal thoracic pain. Methods Randomized controlled trials (RCTs), cohort studies, and case-control studies evaluating the effectiveness of noninvasive interventions were eligible. We searched MEDLINE, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials accessed through Ovid Technologies, Inc, and CINAHL Plus with Full Text accessed through EBSCOhost from 1990 to 2015. Our search strategies combined controlled vocabulary relevant to each database (eg, MeSH for MEDLINE) and text words relevant to our research question and the inclusion criteria. Random pairs of independent reviewers screened studies for relevance and critically appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with a low risk of bias were synthesized following best evidence synthesis principles. Results We screened 6988 articles and critically appraised 2 studies. Both studies had a low risk of bias and were included in our synthesis. One RCT compared thoracic spinal manipulation, needle acupuncture, and placebo electrotherapy for recent thoracic spine pain. There were statistically significant but clinically nonimportant short-term reductions in pain favoring manipulation. There were no differences between acupuncture and placebo electrotherapy. Another RCT compared a multimodal program of care and a session of education for recent musculoskeletal chest wall pain. The multimodal care resulted in statistically significant but clinically nonimportant short-term reductions in pain over education. However, participants receiving multimodal care were more likely to report important improvements in chest pain. Conclusions Quality evidence on the management of musculoskeletal thoracic pain is sparse. The current evidence suggests that compared to placebo, spinal manipulation is associated with a small and clinically nonimportant reduction in pain intensity and that acupuncture leads to similar outcomes as placebo. Furthermore, a multimodal program of care (ie, manual therapy, soft tissue therapy, exercises, heat/ice, and advice) and a single education session lead to similar pain reduction for recent-onset musculoskeletal chest wall pain. However, patients who receive multimodal care are more likely to report pain improvements.