Effectiveness of physical and rehabilitation techniques in reducing pain in chronic trapezius myalgia: A systematic review and meta-analysis

Background: Neck pain is highly prevalent in the general population. Chronic trapezius myalgia (CTM) is a common cause of neck pain. Methods: Systematic review and meta-analysis to evaluate the clinical effectiveness of physical and rehabilitation techniques in reducing CTM pain in short, intermediate and long term periods. A comprehensive search strategy identified relevant research from 8 electronic databases covering January 1990 to November 2013. Principal keywords were trapezius myalgia, trapezius pain, neck and shoulder pain, myofascial pain syndrome, trigger points and treatment. Only randomised controlled trials examining the clinical effectiveness of physical modalities in the treatment of CTM in adults (>18 years) with pain for more than 3 months, were included in this review. Methodological quality was assessed by two reviewers with the criteria developed by the Cochrane Back Review Group and inter-reviewer reliability reported using Kappa values. Effect sizes and 95% CI were reported for pain in the three stages of the follow up. A cut off point of 15 points change in pain (scale 0-100) was considered for minimal clinically important change (MCIC). Evidence quality was assessed using the GRADE approach. Results: Seventeen articles met the inclusion criteria (n = 944 patients); 7 exercise therapy, 5 acupuncture/dry needling, 3 laser therapy, 1 TENS and 1 from manual therapy. Methodology quality revealed that 11 studies had high risk of bias and 6 low risk of bias. Meta-analysis revealed the following effect sizes: a significant MCIC for acupuncture/dry needling (MD: -24.88, 95% Cl: -40.20 to -9.56), no MCIC effect for exercise (MD: -8.84 95% Cl: -20.20-2.51), for laser (MD: -12.89, 95% CI: -16.38 to -9.39), for TENS (MD: -2.60, 95% CI: -25.76-20.56) and manual therapy (MD: 2.00, 95% CI -13.07-17.07). There was no effect from one laser trial at the intermediate time point (MD: -5.70, 95% CI: -24.10-12.70), and at the long term time point stress management had superior outcomes to exercise therapy (MD: 16.00, 95% CI 2.26-29.73). Conclusion: The quality of evidence ranged from very poor to poor in short term with acupuncture/dry needling having the largest effect size. This review found no evidence of effective treatment to reduce pain in the intermediate and long term periods. (C) 2015 Elsevier Ltd. All rights reserved.