Jupin Chloé, Beltran Aibar Vicente, Sarhan François-Régis
Physiotherapy School, Centre Hospitalier Universitaire Amiens-Picardie, 80054 Amiens, France.
Institut D'ingénierie de la Santé, Université de Picardie Jules Verne, 80000 Amiens, France.
J Clin Med. 2025 May 29;14(11):3830. doi: 10.3390/jcm14113830.
: Spinal manual therapy (SMT) is widely used in the management of musculoskeletal pain. In addition to mechanical effects, SMT may induce neurophysiological changes at both central and autonomic levels. However, the extent and consistency of these short-term effects remain unclear. : To systematically review the short-term effects of SMT on pain perception, central nervous system (CNS) activity, and autonomic nervous system (ANS) responses in adults with musculoskeletal pain or in healthy controls. : A systematic review was conducted. Three databases (PubMed, ScienceDirect, Embase) were searched up to October 2023, with a final update in March 2025. Randomized controlled trials involving SMT and assessing outcomes related to pain, CNS, or ANS function were included. The methodological quality was assessed using the PEDro scale. The results were synthesized narratively and categorized by outcome domain. Four summary tables were created to present the study characteristics, main findings, methodological quality, and risk of bias. : Eleven trials were included. SMT produced variable effects on pain perception, with more consistent results observed when the treatment was applied frequently and followed standardized protocols. The CNS-related outcomes (e.g., fMRI connectivity, motor-evoked potentials) suggested short-term modulation of brain and spinal excitability in some studies. The ANS responses were heterogeneous, ranging from parasympathetic activation to sympathetic stimulation, depending on the intervention and population. The methodological quality was moderate to high in most studies, although the small sample sizes and limited blinding increased the risk of bias. The effect sizes were not consistently reported. : SMT may induce short-term neuromodulatory effects on pain, CNS, and ANS activity. These effects appear to be context-dependent and require precise, repeated, and purposeful application.
脊柱手法治疗（SMT）在肌肉骨骼疼痛的管理中被广泛应用。除了机械效应外，SMT可能在中枢和自主神经层面诱发神经生理变化。然而，这些短期效应的程度和一致性仍不明确。
系统评价SMT对患有肌肉骨骼疼痛的成年人或健康对照者的疼痛感知、中枢神经系统（CNS）活动和自主神经系统（ANS）反应的短期影响。
进行了一项系统评价。检索了截至2023年10月的三个数据库（PubMed、ScienceDirect、Embase），并于2025年3月进行了最终更新。纳入了涉及SMT并评估与疼痛、CNS或ANS功能相关结局的随机对照试验。使用PEDro量表评估方法学质量。结果进行了叙述性综合，并按结局领域进行分类。创建了四个汇总表来呈现研究特征、主要发现、方法学质量和偏倚风险。
纳入了11项试验。SMT对疼痛感知产生了不同的影响，当频繁应用治疗并遵循标准化方案时，观察到的结果更一致。一些研究中与CNS相关的结局（如功能磁共振成像连接性、运动诱发电位）表明对大脑和脊髓兴奋性有短期调节作用。ANS反应是异质性的，从副交感神经激活到交感神经刺激，这取决于干预措施和人群。大多数研究的方法学质量为中等至高，尽管样本量小和盲法有限增加了偏倚风险。效应大小未得到一致报告。
SMT可能对疼痛、CNS和ANS活动产生短期神经调节作用。这些作用似乎取决于具体情况，需要精确、重复和有目的的应用。
