Impact of Physiotherapy on Autonomic Nervous System Function in Spinal Pain: A Systematic Review and Meta-analysis.

BACKGROUND

Spine pain conditions, such as low back pain (LBP) and neck pain, are prevalent musculoskeletal disorders. The autonomic nervous system (ANS) has been implicated as a potential contributor to pain. However, research investigating the impact of physiotherapy interventions on ANS function in patients with spinal pain disorders remains limited.

OBJECTIVE

This review aims to examine the influence of physiotherapy interventions on the ANS in patients with spinal pain conditions.

METHODS

A comprehensive literature search was conducted in PubMed, CINAHL, Web of Science, Ovid, and the Cochrane Controlled Trials Register to identify eligible randomized clinical trials. For meta-analysis, a random-effects model was used to compare the effects of physiotherapy interventions on ANS outcomes to comparison interventions.

RESULTS

A total of 16 studies were included in the systematic review, of which 11 were eligible for meta-analysis. Nine studies focused on participants with LBP, while seven studies focused on neck pain. The included studies investigated a variety of physiotherapy interventions compared to various control interventions. The meta-analysis revealed no statistically significant difference in ANS-related parameters between physiotherapy and comparison groups for LBP (pooled standardized mean difference [SMD] = 0.12; 95% CI: -0.10, 0.32; I2 = 55%) or neck pain (SMD = 0.09; 95% CI: - 0.29, 0.46; I2 = 74%).

CONCLUSIONS

This systematic review and meta-analysis found no evidence that physiotherapy interventions induce ANS modulation compared to other interventions.

FUNDING: None.

REGISTRATION: PROSPERO (registration no.: CRD42023460760).