Manipulation and mobilization in the treatment of chronic pain.

OBJECTIVE: The purpose of this review was to determine how effective manipulation and mobilization are in the treatment of chronic pain.
METHODOLOGY: The literature search identified three systematic reviews addressing the effectiveness of manipulation and mobilization for low back pain, two systematic reviews addressing chronic neck pain, three randomized controlled trials addressing post-traumatic headache and neck pain, and one systematic review and one randomized controlled trial addressing upper limb (including shoulder) disorders.
RESULTS: Most studies lacked details of the specific interventions, which were often combined with other interventions, and this could have enhanced or masked effectiveness. Subject groups were heterogeneous, and investigators did not indicate effectiveness for subgroups. Systematic reviews of chronic low back pain found evidence of effectiveness compared with placebo and with usual care. Evidence from the systematic reviews for chronic neck pain and from the systematic review and randomized controlled trial for chronic soft tissue shoulder disorders was contradictory. For post-traumatic headache, the randomized controlled trials reported a time-limited positive benefit or no different effects than comparison treatment.
CONCLUSIONS: Manipulation and mobilization are more effective for chronic low back pain than placebos or usual care for up to 6 months (level 2). For chronic post-traumatic headache, evidence of effectiveness of manipulation and mobilization is limited (level 3). Manipulation and mobilization may or may not be effective for either chronic neck pain or chronic soft tissue shoulder disorders (level 4b).