OBJECTIVE: To determine the effectiveness of trigger point manual therapy (TPMT) for reducing chronic non-cancer pain and associated problems in adults, by analysing all relevant randomised controlled trials (RCTs). DATA SOURCES: We searched databases and clinical trials registers from their inception to May 2017. STUDY SELECTION: We included RCTs in any language that recruited patients over the age of 18, with pain of three months duration or more. We assessed pain, function, and patient-reported improvement as outcomes. DATA EXTRACTION: Two authors independently extracted and verified data. Meta-analysis was completed where possible, otherwise data were synthesised narratively. DATA SYNTHESIS: We combined all data using a random-effects model and assessed the quality of evidence using GRADE. 19 trials (involving 1,047 participants) met inclusion criteria, representing TPMT treatment for musculoskeletal, pelvic and facial pain. No effect was found for short-term pain relief (mean standardized difference -0.53, 95% CI -1.08 to 0.02). One small study showed a longer-term benefit for pain (mean standardized difference -2.00 (95% CI -3.40 to -0.60) but with low confidence in the effect. Significant gains emerged for function (mean standardized difference -0.77, 95% CI -1.27 to -0.26, and in patient global response (odds ratio 3.79, 95% CI 1.86 to 7.71) from four studies, but not for health-related quality of life. CONCLUSIONS: Evidence for TPMT for chronic non-cancer pain is weak and it cannot currently be recommended.

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