OBJECTIVES To systematically assess the evidence of Craniosacral Therapy (CST) for the treatment of chronic pain. METHODS PubMed, Central, Scopus, PsycInfo and Cinahl were searched up to August 2018. Randomized controlled trials (RCTs) assessing the effects of CST in chronic pain patients were eligible. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for pain intensity and functional disability (primary outcomes) using Hedges' correction for small samples. Secondary outcomes included physical/mental quality of life, global improvement, and safety. Risk of bias was assessed using the Cochrane tool. RESULTS Ten RCTs of 681 patients with neck and back pain, migraine, headache, fibromyalgia, epicondylitis, and pelvic girdle pain were included. CST showed greater post intervention effects on: pain intensity (SMD = -0.32, 95%CI = [- 0.61,-0.02]) and disability (SMD = -0.58, 95%CI = [- 0.92,-0.24]) compared to treatment as usual; on pain intensity (SMD = -0.63, 95%CI = [- 0.90,-0.37]) and disability (SMD = -0.54, 95%CI = [- 0.81,-0.28]) compared to manual/non-manual sham; and on pain intensity (SMD = -0.53, 95%CI = [- 0.89,-0.16]) and disability (SMD = -0.58, 95%CI = [- 0.95,-0.21]) compared to active manual treatments. At six months, CST showed greater effects on pain intensity (SMD = -0.59, 95%CI = [- 0.99,-0.19]) and disability (SMD = -0.53, 95%CI = [- 0.87,-0.19]) versus sham. Secondary outcomes were all significantly more improved in CST patients than in other groups, except for six-month mental quality of life versus sham. Sensitivity analyses revealed robust effects of CST against most risk of bias domains. Five of the 10 RCTs reported safety data. No serious adverse events occurred. Minor adverse events were equally distributed between the groups. DISCUSSION In patients with chronic pain, this meta-analysis suggests significant and robust effects of CST on pain and function lasting up to six months. More RCTs strictly following CONSORT are needed to further corroborate the effects and safety of CST on chronic pain. PROTOCOL REGISTRATION AT PROSPERO CRD42018111975.

中文翻译：

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慢性疼痛的颅骶疗法：随机对照试验的系统评价和荟萃分析。

目的 系统评估颅骶疗法 (CST) 治疗慢性疼痛的证据。方法 检索截至 2018 年 8 月的 PubMed、Central、Scopus、PsycInfo 和 Cinahl。评估 CST 对慢性疼痛患者效果的随机对照试验 (RCT) 符合条件。使用小样本的 Hedges 校正计算疼痛强度和功能障碍（主要结果）的标准化均值差 (SMD) 和 95% 置信区间 (CI)。次要结果包括身体/精神生活质量、整体改善和安全。使用 Cochrane 工具评估偏倚风险。结果 纳入了 681 名颈背痛、偏头痛、头痛、纤维肌痛、上髁炎和骨盆带疼痛患者的 10 项随机对照试验。与相比，CST 对以下方面的干预后效果更大：疼痛强度（SMD = -0.32，95%CI = [- 0.61，-0.02]）和残疾（SMD = -0.58，95%CI = [- 0.92，-0.24]）照常治疗；与手动/非手动假手术相比，疼痛强度（SMD = -0.63，95%CI = [- 0.90，-0.37]）和残疾（SMD = -0.54，95% CI = [- 0.81，-0.28]）；与主动手法治疗相比，疼痛强度（SMD = -0.53，95%CI = [- 0.89，-0.16]）和残疾（SMD = -0.58，95% CI = [- 0.95，-0.21]）。六个月时，CST 对疼痛强度 (SMD = -0.59, 95%CI = [- 0.99,-0.19]) 和残疾 (SMD = -0.53, 95%CI = [- 0.87,-0.19]) 的影响更大假。除了六个月的心理生活质量与假手术组相比之外，CST 患者的次要结果均比其他组有显着改善。敏感性分析揭示了 CST 对大多数偏倚领域风险的强大影响。10 项随机对照试验中有 5 项报告了安全性数据。没有发生严重不良事件。轻微不良事件在各组之间平均分布。讨论 对于慢性疼痛患者，这项荟萃分析表明 CST 对疼痛和功能的显着而强大的影响可持续长达六个月。需要更多严格遵循 CONSORT 的随机对照试验来进一步证实 CST 对慢性疼痛的效果和安全性。PROSPERO CRD42018111975 上的协议注册。