Martínez Pozas, OliverSánchez Romero, EleuterioBeltrán Alacreu, HéctorArribas Romano, AlbertoCuenca Martínez, FerranVillafañe, Jorge HugoFernández Carnero, Josué2023-11-102023-11-102023Martínez-Pozas, O., Sánchez-Romero, E. A., Beltrán-Alacreu, H., Arribas-Romano, A., Cuenca-Martínez, F., Villafañe, J. H., & Fernández-Carnero, J. (2023). Effects of Orthopedic Manual Therapy on Pain Sensitization in Patients With Chronic Musculoskeletal Pain: An Umbrella Review With Meta-Meta-analysis. American Journal of Physical Medicine & Rehabilitation, 102(10), 879–885. https://doi.org/10.1097/PHM.00000000000022390894-91151537-7385http://hdl.handle.net/11268/12361Objective: The aim of this umbrella review with meta-meta-analysis was to assess the effectiveness of orthopedic manual therapy in isolation on pain sensitization in patients with chronic musculoskeletal pain. Design: A systematic search was performed in different databases including systematic reviews with or without meta-analysis. The outcome measures included were pressure pain threshold, temporal summation, and conditioned pain modulation. The results of the different reviews were statistically synthesized through a random-effect meta-analysis, of all standardized mean differences and the corresponding 95% confidence interval reported by each study. Results: For mechanical hyperalgesia, the meta-meta-analysis of three meta-analyses revealed a statistically significant small-moderate effect of orthopedic manual therapy, with no evidence of heterogeneity and moderate-quality evidence. In terms of temporal summation, one meta-analysis revealed a statistically significant small effect of orthopedic manual therapy intervention, with moderate heterogeneity and low quality of evidence. Finally, one review without meta-analysis found that orthopedic manual therapy improved endogenous analgesia with low-quality evidence. Conclusion: Orthopedic manual therapy in isolation improved mechanical hyperalgesia with moderate-quality evidence, as well as temporal summation and conditioned pain modulation with low-quality evidence. However, its effects are limited only to immediate and short-term.engDolor crónicoDolor musculoesqueléticoManipulaciones musculoesqueléticasjournal article10.1097/PHM.0000000000002239restricted accessRehabilitación médicaTratamiento médico