An assessment of the efficacy of physical therapy and physical modalities for the control of chronic musculoskeletal pain

An analysis of review articles and controlled clinical trials for temporomandibular disorders and similar chronic musculoskeletal pain disorders was carried out. Although little evidence was found that any specific therapy had long-term efficacy greater than placebo, we did find strong evidence that symptoms improve during treatment with most forms of physical therapy, including placebo. When the frequency of significant between-group differences in trials that used placebo and waiting list control (i.e., no treatment) groups were compared, it was found that treatment was better than placebo in only 7/22 trials, whereas treatment was almost always better than no treatment (15/16), This difference was highly significant (P = 0.001), A similar analysis of trials that included more than one treatment group showed that while equal amounts of treatment were usually associated with equal outcome (9/10), unequal treatment regimes led to unequal outcome (10/15; P = 0.012). The group that received the most therapy appeared to do best. In conclusion, it seems that patients are helped during the period that they are being treated with most forms of physical therapy. However, most of these therapies have not been shown to be more efficacious than placebo. (C) 1997 International Association for the Study of Pain.