scholarly journals What Are the Predictors of Altered Central Pain Modulation in Chronic Musculoskeletal Pain Populations? A Systematic Review

2017 ◽  
Vol 6 (20;6) ◽  
pp. 487-500
Author(s):  
Jacqui Clark
Keyword(s):  
Systematic Review ◽  
Musculoskeletal Pain ◽  
Predictive Factors ◽  
Primary Outcome ◽  
Acute Stage ◽  
Pain Modulation ◽  
Chronic Musculoskeletal Pain ◽  
Central Pain ◽  
Sensory Sensitivity ◽  
Poor Outcomes

Background: Altered central pain modulation is the predominant pain mechanism in a proportion of chronic musculoskeletal pain disorders and is associated with poor outcomes. Although existing studies predict poor outcomes such as persistent pain and disability, to date there is little consensus on what factors specifically predict altered central pain modulation. Objectives: To review the existing literature on the predictive factors specifically for altered central pain modulation in musculoskeletal pain populations. Study Design: This is a systematic review in accordance with supplemented PRISMA guidelines. Methods: A systematic search was performed by 2 mutually blinded reviewers. Relevant articles were screened by title and abstract from Medline, Embase, PubMed, CINAHL, and Web of Science electronic databases. Alternative sources were also sought to locate missed potential articles. Eligibility included studies published in English, adults aged 18 to 65, musculoskeletal pain, baseline measurements taken at the pre-morbid or acute stage, > 3-month follow-up time after pain onset, and primary outcome measures specific to altered central pain modulation. Studies were excluded where there were concurrent diseases or they were non-predictive studies. Risk of bias was assessed using the quality in prognostic studies (QUIPS) tool. Study design, demographics, musculoskeletal region, inclusion/ exclusion criteria, measurement timelines, predictor and primary outcome measures, and results were extracted. Data were synthesized qualitatively and strength of evidence was scored using the grading of recommendations, assessment, development, and evaluations (GRADE) scoring system. Results: Nine eligible articles were located, in various musculoskeletal populations (whiplash, n = 2; widespread pain, n = 5; temporomandibular disorder, n = 2). Moderate evidence was found for 2 predictive factors of altered central pain modulation: 1) high sensory sensitivity (using genetic testing or quantitative sensory tests), and 2) psychological factors (somatization and poor self-expectation of recovery), at a pre-morbid or acute stage baseline. Limitations: At the times of the article publications, the current definitions and clinical guidelines for identifying altered central pain modulation were not yet available. Careful interpretation of the information provided using current knowledge and published guidelines was necessary to extract information specific to altered central pain modulation in some of the studies, avoiding unwarranted assumptions. Conclusions: Premorbid and acute stage high sensory sensitivity and/or somatization are the strongest predictors of altered central pain modulation in chronic musculoskeletal pain to date. This is the first systematic review specifically targeting altered central pain modulation as the primary outcome in musculoskeletal pain populations. Early identification of people at risk of developing chronic pain with altered central pain modulation may guide clinicians in appropriate management, diminishing the burden of persistent pain on patients and heath care providers alike. Systematic Review Registration no.: PROSPERO 2015:CRD42015032394

scholarly journals Central Hyperexcitability in Chronic Musculoskeletal Pain: A Conceptual Breakthrough with Multiple Clinical Implications

2002 ◽  
Vol 7 (2) ◽  
pp. 81-92 ◽  
Author(s):  
Jan Lidbeck
Keyword(s):  
Musculoskeletal Pain ◽  
Myofascial Pain ◽  
Pain Modulation ◽  
Chronic Musculoskeletal Pain ◽  
Individual Treatment ◽  
Clinical Implications ◽  
Pain Processing ◽  
Central Pain ◽  
Myofascial Pain Syndromes ◽  
Pain Syndromes

Recent investigations of dysfunctional pain processing in the central nervous system have contributed much knowledge about the development of chronic musculoskeletal pain. Many common chronic musculoskeletal pain syndromes - including regional myofascial pain syndromes, whiplash pain syndromes, refractory work-related neck-shoulder pain, certain types of chronic low back pain, fibromyalgia and others - may essentially be explained by abnormalities in central pain modulation. The growing awareness of dysfunctional central pain modulation may be a conceptual breakthrough leading to a better understanding of common chronic pain disorders. A new paradigm will have multiple clinical implications, including re-evaluation of clinical practice routines and rehabilitation methods, and will focus on controversial issues of medicolegal concern. The concept of dysfunctional central pain processing will also necessitate a mechanism-based classification of pain for the selection of individual treatment and rehabilitation programs for subgroups of patients with chronic musculoskeletal pain due to different pathophysiological mechanisms.

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.

scholarly journals Sensory discrimination training for adults with chronic musculoskeletal pain: a systematic review

2020 ◽  
pp. 1-19
Author(s):  
Andrew Graham ◽  
Cormac G. Ryan ◽  
Alasdair MacSween ◽  
Jenny Alexanders ◽  
Nick Livadas ◽  
...  
Keyword(s):  
Systematic Review ◽  
Discrimination Training ◽  
Musculoskeletal Pain ◽  
Chronic Musculoskeletal Pain ◽  
Sensory Discrimination

scholarly journals Effects of aerobic exercise in the treatment of older adults with chronic musculoskeletal pain: a protocol of a systematic review

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Naiane Teixeira Bastos de Oliveira ◽  
Irlei dos Santos ◽  
Gisela Cristiane Miyamoto ◽  
Cristina Maria Nunes Cabral
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Aerobic Exercise ◽  
Musculoskeletal Pain ◽  
Included Study ◽  
Chronic Musculoskeletal Pain ◽  
Current Evidence ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
And Function

Abstract Background Chronic musculoskeletal pain affects the quality of life of older adults by interfering in their ability to perform activities of daily living. Aerobic exercise programs have been used in the treatment of various health conditions, including musculoskeletal disorders. However, there is still little evidence on the effects of aerobic exercise for the treatment of older adults with chronic musculoskeletal pain. Thus, the objective of this study is to assess the effects of aerobic exercise in improving pain and function of older adults with chronic pain as a consequence of different chronic musculoskeletal conditions. Methods The databases to be used in the search are PubMed, EMBASE, CINAHL, PEDro, and Cochrane Central Register of Controlled Trials (CENTRAL). Randomized controlled trials that used aerobic exercise in the treatment of older adults with chronic musculoskeletal pain will be included. Primary outcomes will be pain and function. We will use the PEDro scale to evaluate the methodological quality and statistical description of each included study, and the strength of the recommendations will be summarized using GRADE. Discussion The results of this systematic review will provide a synthesis of the current evidence on the effects of aerobic exercise in the treatment of older adults with chronic musculoskeletal pain. In addition, this information can help health professionals in decision-making about the use of aerobic exercise in the treatment of older adults with chronic musculoskeletal pain. Ethics and dissemination This systematic review was recorded prospectively, and the results will be part of a doctoral thesis to be published in a peer-reviewed international journal and possibly presented at international conferences. Systematic review registration PROSPERO, CRD42019118903.

scholarly journals Central neurobiological effects of physical exercise in individuals with chronic musculoskeletal pain: a systematic review

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e036151
Author(s):  
Rutger M J de Zoete ◽  
Kenneth Chen ◽  
Michele Sterling
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
High Risk ◽  
Physical Exercise ◽  
Clinical Outcomes ◽  
Musculoskeletal Pain ◽  
Exercise Intervention ◽  
Risk Of Bias ◽  
Chronic Musculoskeletal Pain ◽  
Brain Areas

ObjectivePrimary objectives: to investigate the central neurobiological effects (using MRI) of physical exercise in individuals with chronic pain. Secondary objectives: (1) to investigate the associations between central changes and clinical outcomes and (2) to investigate whether different types and dosages of physical exercise exert different central changes.DesignSystematic review searching four electronic databases up to September 2018: AMED, CINAHL, Embase and MEDLINE. Two reviewers independently assessed the methodological quality of included studies using the Cochrane Collaboration’s Risk of Bias in Non-Randomised Studies-I tool. A standardised extraction table was used for data extraction, which was performed by two reviewers.InterventionsStudies reporting any physical exercise intervention in any chronic musculoskeletal pain condition were included. Eligibility of 4011 records was screened independently by two reviewers, and four studies were included in the review.Primary and secondary outcome measuresPrimary outcome: any brain outcome assessed with any MR technique. Secondary outcomes: any self-reported clinical outcomes, and type and dosage of the exercise intervention.ResultsAll four studies had high risk of bias. There was heterogeneity between the brain areas studied and the types of exercise interventions delivered. All studies reported functional MRI changes in various brain areas following an exercise intervention. Insufficient data were available to conduct a meta-analysis or to answer the secondary aims.ConclusionsOnly a limited number of studies were available and all were at high risk of bias. None of the studies was randomised or included blinded assessment. Exercise may exert effects on brain neurobiology in people with chronic pain. Due to the high risk of bias, future studies should use a randomised study design. Investigation of morphological brain changes could be included.PROSPERO registration numberCRD42018108179.

scholarly journals Weight loss interventions for adults with overweight/obesity and chronic musculoskeletal pain: a mixed methods systematic review

2018 ◽  
Vol 19 (7) ◽  
pp. 989-1007 ◽  
Author(s):  
L. Cooper ◽  
C. G. Ryan ◽  
L. J. Ells ◽  
S. Hamilton ◽  
G. Atkinson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Weight Loss ◽  
Mixed Methods ◽  
Musculoskeletal Pain ◽  
Chronic Musculoskeletal Pain ◽  
Weight Loss Interventions
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