Spinal manipulation for fibromyalgia: a narrative review.

Objective: The purpose of this review was to summarize the available literature on the use of spinal manipulative therapy for the management of fibromyalgia. Methods: A narrative review of the literature was performed through February 29, 2024, using keywords and Boolean operators, such as "manipulation AND fibromyalgia." Databases searched include MEDLINE, ICL, PEDro, the Cochrane Library, Google Scholar, as well as clinical trials registries. Online literature mapping was also used to identify relevant studies. All publications involving spinal manipulation for fibromyalgia management were included, excluding editorials, commentaries, conference proceedings, and trade magazine articles. Results: A total of 38 publications met the inclusion criteria. These results consisted of nine case reports, three case series, four pilot studies, four randomized controlled trials, 14 systematic reviews, and four clinical practice guidelines with publication dates ranging from 1997 to 2023. Conclusion: Higher-quality controlled studies are limited and report mixed results for treating fibromyalgia with spinal manipulation, while lower-quality studies are more likely to report benefit following treatment. Systematic reviews report a lack of established efficacy or inconclusive evidence, while clinical practice guidelines vary widely from strong recommendations against its use to suggesting that it be considered as a component of multi-modal treatment.