Craniosacral therapy and chronic pain
New Research supports craniosacral therapy as a viable option for chronic pain sufferers. Here is my interpretation of the study results and its clinical relevance in plain English.
Title
Craniosacral therapy for chronic pain: a systematic review and meta-analysis of randomised controlled trials (RCTs)
Summary
A review of 10 RTCs involving 681 patients with neck and back pain, migraine, fibromyalgia, epicondylitis and pelvic girdle pain who underwent CST treatments for up to 6 months. The intervention compared the effectiveness of CST in terms of pain intensity and disability to sham, treatment as usual and other manual treatment.
Results
- Compared to treatment as usual: small to medium effect favouring CST after intervention
- Compared to sham: medium to large effect favouring CST after intervention and at 6 months
- Compared to other manual therapies: medium size effect after intervention
(for detailed statistics see annex -forest plots on pain intensity and disability)
Conclusion
CST has significant and robust effects on pain and function in patients with chronic pain, lasting up to six months.
Clinical relevance
A pioneering trial. The first systematic review (SR) and meta-analyses (MA) done on CST (to my knowledge). SR & MA are considered to rank at the top of the evidence-based hierarchy not only because they systematically evaluate top evidence, i.g. RCTs but also because they include statistical analyses that give the data a weight (significance).
In short, the present trial:
- validates CST as an effective modality for patients in chronic pain
- adds scientific rigor to the benefits of CST. Compared to previous SR, it includes only RCT- top quality studies, with targeted population- chronic pain patients and provides a meta-analysis- NEW!
- has a sound statistical methodology. To quantify the pooled effects of available evidence, it employs pairwise meta-analyses and the random-effects model. Standardised mean differences (SMDs) with 95% confidence intervals (CI) are calculated and Chi statistics and sensitivity analyses are used to explore statistical heterogeneity. This compares to previous studies based on patient reported outcomes only (where the risk of bias is high).
- it has a large sample size (681 patients) which speaks for the level of confidence in the observed results (i.e. effects did not happen by chance or placebo).
- provides good patient stratification, e.g. 90% women, median age of 43 years old and median number of treatments to 7 with a maximum of 25.
- limitations: since it is impossible to blind the therapist and/or patient, pure distinction between effect or placebo cannot be made, which is a limitation of all manual therapy studies.
- clinically relevant as chronic pain is the leading cause of disability. Because of the side effects of pharmacological treatment for chronic pain, CST can be a valid option.
References
Haller, H., Lauche, R., Sundberg, T., Dobos, G. and Cramer, H., 2019. Craniosacral therapy for chronic pain: A systematic review and meta-analysis of randomized controlled trials. BMC Musculoskeletal Disorders, 21(1) (online) https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-019-3017-y
Photo by Luis Galvez on Unsplash
Annex
Forest plots of pain intensity and disability. Note the black diamond represents the pooled effects of CST trials.
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