Short-Term Effects of Spinal Manual Therapy on the Nervous System in Managing Musculoskeletal Pain: A Systematic Review.

: 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.