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Background and Aims This study aimed to evaluate the efficacy of craniosacral therapy (CST) on pain, autonomic dysfunction and symptom management in multiple sclerosis (MS) patients.Methods Twenty MS patients (CST group n=10, control group n=10) were randomised. The CST group received craniosacral therapy in addition to conventional physiotherapy, while the control group received only conventional physiotherapy. Both groups received two sessions of physical therapy per week for eight weeks, while the craniosacral group received an additional 1 session of craniosacral therapy. Pain (VAS), central sensitisation (CSS), fatigue (FSS), sleep quality (PSQI), quality of life (MSQOL-54) and heart rate variability (HRV) parameters were evaluated before and after treatment.Results There were no statistical differences between the groups in terms of age, gender, disease duration, EDSS score and BMI. Pain scores during activity decreased significantly in the CST group (p=0.015) and a significant difference was observed between the groups (p=0.047). In the control group, significant intra-group improvement was found in CSS (p=0.005), FSS (p=0.028) and PSQI (p=0.032) scores. PSQI scores showed a significant difference in favour of control in intergroup comparison (p=0.005). Among the autonomic function parameters, only LF Peak value showed a significant difference between the groups (p<0.001).Abstract OP29 Table 1Data on demographic and clinical characteristics of the participantsAbstract OP29 Table 2Data on the changes in pain and other parameters before and after treatment within and between groupsAbstract OP29 Table 3Data on the changes in HRV parameters before and after treatment within and between groupsConclusions This pilot study reveals that craniosacral therapy shows favourable effects on pain during activity and sleep quality in MS patients. Further studies with larger samples and longer follow-up periods are needed to evaluate the effects of CST on the autonomic nervous system.