Conditioned Pain Modulation in Populations With Chronic Pain: A Systematic Review and Meta-Analysis

2012 ◽  
Vol 13 (10) ◽  
pp. 936-944 ◽  
Author(s):  
Gwyn N. Lewis ◽  
David A. Rice ◽  
Peter J. McNair
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Meta Analysis ◽  
Pain Modulation ◽  
Conditioned Pain Modulation

Modulation of offset analgesia in patients with chronic pain and healthy subjects – a systematic review and meta-analysis

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Dennis Boye Larsen ◽  
Xenia Jørgensen Uth ◽  
Lars Arendt-Nielsen ◽  
Kristian Kjær Petersen
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Subgroup Analysis ◽  
Healthy Subjects ◽  
Meta Analysis ◽  
Pain Modulation ◽  
Cochrane Library ◽  
Conditioned Pain Modulation ◽  
Qualitative Synthesis ◽  
Current Systematic Review

Abstract Objectives Offset analgesia (OA) induces a brief pain inhibition and studies suggest OA impairment in patients with chronic pain when compared to healthy subjects. Conditioned pain modulation remains the most studied descending pain inhibitory control mechanism and is modulated by centrally-acting analgesics. Since OA may be mediated by similar neural substrates as conditioned pain modulation, understanding if OA is a peripheral or central proxy of pain modulation is important. The modulatory effect of centrally-acting drugs on OA in healthy and chronic pain populations has not yet been systematically reviewed and meta-analyzed, and this systematic review and meta-analysis aimed to identify studies employing interventions for modulating OA magnitude. Methods A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library yielded 146 records of which 11 (172 healthy pain-free subjects, 106 chronic pain patients) were eligible for qualitative synthesis, and 10 for meta-analysis on overall modulatory effect of interventions on OA, and subgroup analysis of patients and healthy pain-free subjects. Results Risk of bias was evident for study participation and study confounding in the included studies. Several different methods for assessing and calculating OA magnitude were identified, which may affect interpretability of findings and warrants standardization. The meta-analysis showed no modulatory effects on OA overall (standardized mean difference (SMD) [95%CI]: 0.04 [−0.22, 0.30], Z=0.29, p=0.77), or in the subgroup analysis for patients (SMD [95%CI]: −0.04 [−0.63, 0.71], Z=0.13, p=0.90) or healthy pain-free subjects (SMD [95%CI]: 0.01 [−0.21, 0.24], Z=0.11, p=0.91). Moderate to substantial heterogeneity was found for the overall analysis (I2=47%, p=0.03) and patient subgroup analysis (I2=75%, p=0.003). Conclusions The current systematic review and meta-analysis conclude that centrally-acting drugs and exercise do not influence OA. Evidence on the peripheral contribution to OA response requires further investigations. Preclinical models of OA should be established to identify the neurophysiology and -biology behind OA.

Systematic review with meta-analysis: conditioned pain modulation in patients with the irritable bowel syndrome

2018 ◽  
Vol 48 (8) ◽  
pp. 797-806 ◽  
Author(s):  
Ahmed Albusoda ◽  
James K. Ruffle ◽  
Kathrine A. Friis ◽  
Maximilian R. Gysan ◽  
Asbjørn M. Drewes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Irritable Bowel Syndrome ◽  
Meta Analysis ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Irritable Bowel

REPRINTED WITH PERMISSION OF IASP – PAIN 160 (2019) 2679–2690: Conditioned pain modulation as a biomarker of chronic pain: a systematic review of its concurrent validity

Ból ◽  
2020 ◽  
Vol 21 (3) ◽  
pp. 1-15
Author(s):  
Carina Fernandes ◽  
Marina Pidal-Miranda ◽  
Noelia Samartin-Veiga ◽  
María T. Carrillo-de-la-Peña
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Concurrent Validity ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Experimental Pain ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Pain Mechanisms ◽  
Chronic Pain Conditions

Conditioned pain modulation (CPM) is a promising psychophysical biomarker of central pain mechanisms because it significantly discriminates patients with chronic pain from healthy controls. Nevertheless, it is unclear in what extent CPM assessed experimentally is correlated with clinical manifestations of pain. To assess the concurrent validity of CPM, we performed a systematic review of the literature reporting correlations between CPM responses and pain intensity, disability, duration, and area in patients with different chronic pain conditions. We included 32 studies that altogether encompassed data from 1958 patients and provided 62 correlations. The majority of the results (69%) reported nonsignificant correlations between CPM efficiency and clinical manifestations of pain, whereas the remaining results showed a correlation between CPM reduction and worse clinical symptoms of pain. The modality of stimulation, the type of pain, and the stimulation site appear to be critical variables that influenced the pattern of results. Given that most of the studies were conducted with highly heterogeneous methodologies and unclear risk of bias, the findings highlight the need for future studies using standardized measures of clinical and experimental pain before considering CPM as a valid biomarker of pain. We discuss some guidelines to overcome the constraints in this promising line of research.

Mo1559 - Conditioned Pain Modulation in Painful Functional Gastrointestinal Disorders: Systematic Review and Meta-Analysis

2018 ◽  
Vol 154 (6) ◽  
pp. S-752-S-753
Author(s):  
Ahmed Albusoda ◽  
Kathrine Abildskov Friis ◽  
Maximilian R. Gysan ◽  
Qasim Aziz ◽  
Adam D. Farmer
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Functional Gastrointestinal Disorders ◽  
Pain Modulation ◽  
Gastrointestinal Disorders ◽  
Conditioned Pain Modulation

scholarly journals Exploring the pain in patellofemoral pain: A systematic review and meta-analysis examining signs of central sensitization

2020 ◽  
Author(s):  
Kemery J. Sigmund ◽  
Marie K. Hoeger Bement ◽  
Jennifer E. Earl-Boehm
Keyword(s):  
Systematic Review ◽  
Central Sensitization ◽  
Temporal Summation ◽  
Meta Analysis ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Pain Thresholds ◽  
Pressure Pain ◽  
Pressure Pain Thresholds ◽  
Pain Mapping

Objective: Patellofemoral pain has high recurrence rates and minimal long-term treatment success. Central sensitization refers to dysfunctional pain modulation that occurs when nociceptive neurons become hyper responsive. Research in this area in PFP has been increasingly productive in the past decade. The aim of this review is to determine whether evidence supports manifestations of central sensitization in individuals with PFP. Data sources: MeSH terms for quantitative sensory testing (QST) pressure pain thresholds, conditioned pain modulation, temporal summation, sensitization, hyperalgesia, and anterior knee pain or PFP were searched in PubMed, SportDiscus, CINAHL, Academic Search Complete, and Ebscohost. Study Selection: Peer reviewed studies written in English, published between 2005–2020 which investigated QST and/or pain mapping in a sample with PFP were included in this review. Data Extraction: The initial search yielded 140 articles. After duplicates were removed, 78 article abstracts were reviewed. Full-text review of 21 studies occurred, with 11 studies included in the meta-analysis and eight studies included in the systematic review. Data Synthesis: A random-effects meta-analysis was conducted for four QST variables (local pressure pain thresholds, remote pressure pain thresholds, conditioned pain modulation, temporal summation). Strong evidence supports lower local and remote pressure pain thresholds, impaired conditioned pain modulation, and facilitated temporal summation in individuals with PFP compared to pain-free individuals. Conflicting evidence is presented for heat and cold pain thresholds. Pain mapping demonstrated expanding pain patterns associated with long PFP symptom duration. Conclusions: Signs of central sensitization are present in individuals with PFP, indicating altered pain modulation. PFP etiological and treatment models should reflect the current body of evidence regarding central sensitization. Signs of central sensitization should be monitored clinically and treatments with central effects should be considered as part of a multi-modal plan of care. Registration Number: This review is registered with Prospero (CRD42019127548) Registration URL: https://www.crd.york.ac.uk/PROSPERO Key Points:

Conditioned pain modulation in elite athletes: a systematic review and meta-analysis

2020 ◽  
Vol 20 (3) ◽  
pp. 429-438 ◽  
Author(s):  
Jessica McDougall ◽  
Catherine R. Jutzeler ◽  
Alex Scott ◽  
Peter R.E. Crocker ◽  
John L.K. Kramer
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Elite Athletes ◽  
Meta Analysis ◽  
Experimental Studies ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Cochrane Central Register ◽  
Healthy Controls ◽  
Significant Difference

AbstractBackground and aimsElite athletes reportedly have superior pain tolerances, but it is unclear if results extend to conditioned pain modulation (CPM). The aim of our study was to synthesize existing literature in order to determine whether CPM is increased in elite athletes compared to healthy controls.MethodsA systematic review and random-effects meta-analysis was conducted. Cochrane Central Register of Controlled Trials, SPORTDiscus, PsycINFO, CINAHL, Web of Science, and PubMed were searched for English-language studies that examined CPM in adult elite athlete populations.ResultsSeven studies were identified; all were of poor to fair methodological quality. There was no overall difference in CPM between elite athletes and controls (Hedges g = 0.37, CI95 −0.03−0.76; p = 0.07). There was heterogeneity between studies, including one that reported significantly less CPM in elite athletes compared to controls. An exploratory meta-regression indicated that a greater number of hours trained per week was associated with higher CPM.ConclusionsThe overall number and quality of studies was low. Despite nominally favoring higher CPM in elite athletes, aggregate results indicate no significant difference compared to healthy controls. A possible factor explaining the high degree of variability between studies is the number of hours elite athletes spent training.ImplicationsBased on available evidence, athletes do not have remarkable endogenous pain modulation compared to controls. High quality experimental studies are needed to address the effect of hours trained per week on CPM in athletes.

Efficacy of Physical Therapy on Nociceptive Pain Processing Alterations in Patients with Chronic Musculoskeletal Pain: A Systematic Review and Meta-analysis

Pain Medicine ◽  
2020 ◽  
Vol 21 (10) ◽  
pp. 2502-2517 ◽  
Author(s):  
Alberto Arribas-Romano ◽  
Josué Fernández-Carnero ◽  
Francisco Molina-Rueda ◽  
Santiago Angulo-Diaz-Parreño ◽  
Marcos José Navarro-Santana
Keyword(s):  
Systematic Review ◽  
Physical Therapy ◽  
Musculoskeletal Pain ◽  
Manual Therapy ◽  
Temporal Summation ◽  
Meta Analysis ◽  
Pain Modulation ◽  
Chronic Musculoskeletal Pain ◽  
Conditioned Pain Modulation ◽  
Slight Improvement

Abstract Introduction Chronic musculoskeletal pain is a major health, social, and economic problem. Most of the subjects who suffer from chronic musculoskeletal pain present processes of central sensitization. Temporal summation and conditioned pain modulation are the two most commonly used clinical measures of this. The objective of this review is to evaluate the effects of physical therapy on temporal summation (TS) and conditioned pain modulation (CPM) in patients with chronic musculoskeletal pain. Methods This is a systematic review and meta-analysis. We searched the MEDLINE, EMBASE, CINAHL, EBSCO, PubMed, PEDro, Cochrane Collaboration Trials Register, Cochrane Database of Systematic Reviews, and SCOPUS databases. Different mesh terms and key words were combined for the search strategy, with the aim of encompassing all studies that have used any type of physical therapy treatment in patients with chronic musculoskeletal pain and have measured both TS and CPM. Results Eighteen studies remained for qualitative analysis and 16 for quantitative analysis. Statistically significant differences with a 95% confidence interval (CI) were obtained for TS (–0.21, 95% CI = –0.39 to –0.03, Z = 2.50, P = 0.02, N = 721) and CPM (0.34, 95% CI = 0.12 to 0.56, Z = 2.99, P = 0.003, N = 680) in favor of physical therapy as compared with control. Manual therapy produces a slight improvement in TS, and physical therapy modalities in general improve CPM. No significant differences between the subgroups of the meta-analysis were found. The methodological quality of the studies was high. Conclusions Physical therapy produces a slight improvement in central sensitization (CS)–related variables, with TS decreased and CPM increased when compared with a control group in patients with CMP. Only significant differences in TS were identified in the manual therapy subgroup.

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