Effects of neural mobilization in disorders associated with chronic secondary musculoskeletal pain: A systematic review and meta-analysis

Purpose: To evaluate the effect of neural mobilization (NM) in people with disorders associated with chronic secondary musculoskeletal pain due to persistent inflammation or diseases of the nervous system. Methods: A database search was conducted to select randomized controlled trials where NM, alone or within a multimodal protocol, was the main intervention for patients with neurological, autoimmune, or autoinflammatory disorders. The risk of bias and the certainty of evidence were assessed using the Cochrane Risk of Bias Tool for Randomized Trials and the GRADE approach. The primary outcome was pain intensity. Secondary measures were inflammatory biomarkers, range of motion and the level of spasticity. Results: Eleven studies were included (360 participants; 57% females). The most reported condition was arthritis, and the overall risk of bias was high in more than half of the studies. Pooled data showed a significant effect of NM, based on very low quality of evidence, on reducing pain intensity in people with systemic disorders (three studies: SMD = − 0.58; 95% CI = − 0.98, − 0.18; p = 0.005), and the level of spasticity in individuals with brain or spinal cord injury (two studies: SMD = − 0.85; 95% CI = − 1.70, 0.00; p = 0.05). Conclusions: There is scant and very low certainty of evidence to support that NM, compared to control interventions, may improve pain intensity and spasticity in patients with disorders associated with chronic secondary musculoskeletal pain. Further research with high methodological quality is needed to recommend for or against the use of NM in this population.