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).