Alterations in pro-nociceptive and anti-nociceptive mechanisms in patients with low back pain: a systematic review with meta-analysis

Megan E McPhee, Henrik Bjarke Vaegter, Thomas Graven-Nielsen

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Altered pro-nociceptive and anti-nociceptive mechanisms are often implicated in painful conditions and have been increasingly studied over the past decade. For some painful conditions alterations are well-established, but in low back pain (LBP) populations there remains considerable debate whether these mechanisms are altered. The present systematic review aimed to address this issue by identifying studies assessing Conditioned Pain Modulation (CPM) and/or Temporal Summation of Pain (TSP) in LBP patients, comparing to either a healthy control group or using a method with reference data available. Qualitative synthesis and quantitative meta-analysis of group differences were performed. For CPM and TSP, 20 and 29 original articles were eligible, with data for meta-analysis obtainable from 18 (1500 patients, 505 controls) and 27 (1507 patients, 1127 controls) studies, respectively. Most studies were of poor-to-fair quality with significant heterogeneity in study size, population, assessment methodology and outcome. Nonetheless, CPM was impaired in LBP patients compared to controls (standardized mean difference = -0.44 [-0.64, -0.23], P<0.001), and the magnitude of this impairment was related to pain chronicity (acute/recurrent versus chronic, P=0.003), duration (R=-0.62, P=0.006) and severity (R=-0.54, P=0.02). TSP was facilitated in LBP patients compared to controls (standardized mean difference = 0.50 [0.29, 0.72], P<0.001), and the magnitude of this facilitation was weakly related to pain severity (R=0.41, P=0.04) and appeared to be influenced by test modality (P<0.001). Impaired CPM and facilitated TSP was present in LBP patients compared to controls, though the magnitude of differences was small which may direct future research on the clinical utility.

OriginalsprogEngelsk
TidsskriftPain
ISSN0304-3959
DOI
StatusE-pub ahead of print - 1 nov. 2019

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Low Back Pain
Meta-Analysis
Pain
Population Density
Outcome Assessment (Health Care)
Control Groups

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title = "Alterations in pro-nociceptive and anti-nociceptive mechanisms in patients with low back pain: a systematic review with meta-analysis",
abstract = "Altered pro-nociceptive and anti-nociceptive mechanisms are often implicated in painful conditions and have been increasingly studied over the past decade. For some painful conditions alterations are well-established, but in low back pain (LBP) populations there remains considerable debate whether these mechanisms are altered. The present systematic review aimed to address this issue by identifying studies assessing Conditioned Pain Modulation (CPM) and/or Temporal Summation of Pain (TSP) in LBP patients, comparing to either a healthy control group or using a method with reference data available. Qualitative synthesis and quantitative meta-analysis of group differences were performed. For CPM and TSP, 20 and 29 original articles were eligible, with data for meta-analysis obtainable from 18 (1500 patients, 505 controls) and 27 (1507 patients, 1127 controls) studies, respectively. Most studies were of poor-to-fair quality with significant heterogeneity in study size, population, assessment methodology and outcome. Nonetheless, CPM was impaired in LBP patients compared to controls (standardized mean difference = -0.44 [-0.64, -0.23], P<0.001), and the magnitude of this impairment was related to pain chronicity (acute/recurrent versus chronic, P=0.003), duration (R=-0.62, P=0.006) and severity (R=-0.54, P=0.02). TSP was facilitated in LBP patients compared to controls (standardized mean difference = 0.50 [0.29, 0.72], P<0.001), and the magnitude of this facilitation was weakly related to pain severity (R=0.41, P=0.04) and appeared to be influenced by test modality (P<0.001). Impaired CPM and facilitated TSP was present in LBP patients compared to controls, though the magnitude of differences was small which may direct future research on the clinical utility.",
author = "McPhee, {Megan E} and Vaegter, {Henrik Bjarke} and Thomas Graven-Nielsen",
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Alterations in pro-nociceptive and anti-nociceptive mechanisms in patients with low back pain : a systematic review with meta-analysis. / McPhee, Megan E; Vaegter, Henrik Bjarke; Graven-Nielsen, Thomas.

I: Pain, 01.11.2019.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Alterations in pro-nociceptive and anti-nociceptive mechanisms in patients with low back pain

T2 - a systematic review with meta-analysis

AU - McPhee, Megan E

AU - Vaegter, Henrik Bjarke

AU - Graven-Nielsen, Thomas

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Altered pro-nociceptive and anti-nociceptive mechanisms are often implicated in painful conditions and have been increasingly studied over the past decade. For some painful conditions alterations are well-established, but in low back pain (LBP) populations there remains considerable debate whether these mechanisms are altered. The present systematic review aimed to address this issue by identifying studies assessing Conditioned Pain Modulation (CPM) and/or Temporal Summation of Pain (TSP) in LBP patients, comparing to either a healthy control group or using a method with reference data available. Qualitative synthesis and quantitative meta-analysis of group differences were performed. For CPM and TSP, 20 and 29 original articles were eligible, with data for meta-analysis obtainable from 18 (1500 patients, 505 controls) and 27 (1507 patients, 1127 controls) studies, respectively. Most studies were of poor-to-fair quality with significant heterogeneity in study size, population, assessment methodology and outcome. Nonetheless, CPM was impaired in LBP patients compared to controls (standardized mean difference = -0.44 [-0.64, -0.23], P<0.001), and the magnitude of this impairment was related to pain chronicity (acute/recurrent versus chronic, P=0.003), duration (R=-0.62, P=0.006) and severity (R=-0.54, P=0.02). TSP was facilitated in LBP patients compared to controls (standardized mean difference = 0.50 [0.29, 0.72], P<0.001), and the magnitude of this facilitation was weakly related to pain severity (R=0.41, P=0.04) and appeared to be influenced by test modality (P<0.001). Impaired CPM and facilitated TSP was present in LBP patients compared to controls, though the magnitude of differences was small which may direct future research on the clinical utility.

AB - Altered pro-nociceptive and anti-nociceptive mechanisms are often implicated in painful conditions and have been increasingly studied over the past decade. For some painful conditions alterations are well-established, but in low back pain (LBP) populations there remains considerable debate whether these mechanisms are altered. The present systematic review aimed to address this issue by identifying studies assessing Conditioned Pain Modulation (CPM) and/or Temporal Summation of Pain (TSP) in LBP patients, comparing to either a healthy control group or using a method with reference data available. Qualitative synthesis and quantitative meta-analysis of group differences were performed. For CPM and TSP, 20 and 29 original articles were eligible, with data for meta-analysis obtainable from 18 (1500 patients, 505 controls) and 27 (1507 patients, 1127 controls) studies, respectively. Most studies were of poor-to-fair quality with significant heterogeneity in study size, population, assessment methodology and outcome. Nonetheless, CPM was impaired in LBP patients compared to controls (standardized mean difference = -0.44 [-0.64, -0.23], P<0.001), and the magnitude of this impairment was related to pain chronicity (acute/recurrent versus chronic, P=0.003), duration (R=-0.62, P=0.006) and severity (R=-0.54, P=0.02). TSP was facilitated in LBP patients compared to controls (standardized mean difference = 0.50 [0.29, 0.72], P<0.001), and the magnitude of this facilitation was weakly related to pain severity (R=0.41, P=0.04) and appeared to be influenced by test modality (P<0.001). Impaired CPM and facilitated TSP was present in LBP patients compared to controls, though the magnitude of differences was small which may direct future research on the clinical utility.

U2 - 10.1097/j.pain.0000000000001737

DO - 10.1097/j.pain.0000000000001737

M3 - Journal article

JO - Pain

JF - Pain

SN - 0304-3959

ER -