Impact of Therapeutic Interventions on Pain Intensity and Endogenous Pain Modulation in Knee Osteoarthritis: A Systematic Review and Meta-analysis.
Impact of Therapeutic Interventions on Pain Intensity and Endogenous Pain Modulation in Knee Osteoarthritis: A Systematic Review and Meta-analysis.
复制标题
治疗干预对膝骨关节炎疼痛强度和内源性疼痛调节的影响：系统评价和荟萃分析。
DOI：
10.1093/pm/pny261
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Fregni,Felipe
中科院分区：
文献类型：
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作者：
O'Brien,AnthonyTerrence;El-Hagrassy,MirretM;Rafferty,Haley;Sanchez,Paula;Huerta,Rodrigo;Chaudhari,Swapnali;Conde,Sonia;Rosa,Gleysson;Fregni,Felipe
目的研究疼痛镇痛和内源性疼痛调制在膝骨关节炎（KOA）的治疗干预措施的影响DesignSystematic review and meta-analysis.MethodsWe搜索KOA随机临床试验和观察性研究的数据比较疼痛强度，时间总和（TS），和条件性疼痛调制（CPM）分数相对于控制的治疗干预措施。将这些数据合并为Hedge g。为了研究疼痛强度和TS/CPM之间的关系，我们进行了荟萃回归与10,000蒙特-卡罗permutations.ResultsWe审查了11项研究（559名参与者）。在一起研究所有干预措施时，我们发现疼痛调制，TS或CPM没有显着变化。我们的研究结果表明，这种缺乏差异可能是因为手术和非手术干预导致相反的效果。荟萃回归显着相关疼痛减少TS和CPM.ConclusionsWe的正常化表现出疼痛减少和TS/CPM正常化之间的关联。虽然我们不能直接比较这些干预措施，但结果使我们能够对潜在的实践模式提出假设。恢复有缺陷的内源性疼痛调节机制可能有助于建立长期镇痛。然而，为了验证这些范例作为稳健的临床生物标志物，有必要对其机制进行进一步研究。本综述的注册号为CRD 42017072066。
ObjectiveTo study the impact of therapeutic interventions on pain analgesia and endogenous pain modulation in knee osteoarthritis (KOA).DesignSystematic review and meta-analysis.MethodsWe searched for KOA randomized clinical trials and observational studies with data on therapeutic interventions comparing pain intensity, temporal summation (TS), and conditioned pain modulation (CPM) scores relative to control. These data were pooled as Hedge’s g. To study the relationship between pain intensity and TS/CPM, we performed metaregression with 10,000 Monte-Carlo permutations.ResultsWe reviewed 11 studies (559 participants). On studying all the interventions together, we found no significant changes in pain modulation, TS, or CPM. Our findings show that this lack of difference is likely because surgical and nonsurgical interventions resulted in contrary effects. Metaregression significantly correlated pain reduction with normalization of TS and CPM.ConclusionsWe demonstrate an association between pain reduction and TS/CPM normalization. Though we cannot directly compare these interventions, the results allow us to draw hypotheses on potential practice schemas. Recovering defective endogenous pain modulation mechanisms may help establish long-term analgesia. However, to validate these paradigms as robust clinical biomarkers, further investigation into their mechanisms would be necessary. The registration number for this review is CRD42017072066.