Arthritis Research UK Pain Centre, University of Nottingham, UK.
Osteoarthritis Cartilage. 2012 Oct;20(10):1075-85. doi: 10.1016/j.joca.2012.06.009. Epub 2012 Jul 13.
To systematically review the use of quantitative sensory testing (QST) in pain characterisation (phenotyping) in osteoarthritis (OA).
Six bibliographic databases (Medline, Embase, Amed, Cinahl, PubMed, Web of Science) were searched to identify studies published before May 2011. Data were extracted based on the primary site of OA, QST modalities, outcome measures and test sites. Standardised mean difference (SMD) and 95% confidence intervals (CIs) were calculated if possible. Publication bias was determined using funnel plot and Egger's test. Heterogeneity was examined using Cochran Q test and I2 statistic. Random effects model was used to pool the results.
Of 41 studies (2281 participants) included, 23 were case control studies, 15 case only studies, two randomised controlled trials, and one uncontrolled trial. The majority of studies examined pressure pain with smaller numbers using electrical and/or thermal stimuli. QST was more often applied to the affected joint than distal and remote sites. Of 20 studies comparing people with OA and healthy controls, seven provided sufficient information for meta-analysis. Compared with controls, people with OA had lower pressure pain thresholds (PPTs) both at the affected joint (SMD = -1.24, 95% CI -1.54, -0.93) and at remote sites (SMD = -0.88, 95% CI -1.11, -0.65).
QST of PPTs demonstrated good ability to differentiate between people with OA and healthy controls. Lower PPTs in people with OA in affected sites may suggest peripheral, and in remote sites central, sensitisation. PPT measurement merits further evaluation as a tool for phenotyping OA pain.
系统评价定量感觉测试（QST）在骨关节炎（OA）疼痛表型（表型）中的应用。
检索了 6 个文献数据库（Medline、Embase、Amed、Cinahl、PubMed、Web of Science），以确定 2011 年 5 月前发表的研究。根据 OA 的主要部位、QST 方式、结局测量和测试部位提取数据。如果可能，计算标准化均数差（SMD）和 95%置信区间（CI）。使用漏斗图和 Egger 检验确定发表偏倚。使用 Cochran Q 检验和 I2 统计量检查异质性。使用随机效应模型汇总结果。
共纳入 41 项研究（2281 名参与者），其中 23 项为病例对照研究，15 项为病例报告研究，2 项为随机对照试验，1 项为非对照试验。大多数研究采用压力疼痛测定法，较少采用电和/或热刺激法。QST 更多地应用于受影响的关节，而不是远端和远程部位。在 20 项比较 OA 患者和健康对照组的研究中，有 7 项提供了足够的信息进行荟萃分析。与对照组相比，OA 患者的压痛阈值（PPT）在受影响的关节（SMD=-1.24，95%CI-1.54，-0.93）和远程部位（SMD=-0.88，95%CI-1.11，-0.65）均较低。
QST 的 PPT 能够很好地区分 OA 患者和健康对照组。OA 患者受影响部位的 PPT 较低可能提示外周敏感化，而在远程部位则提示中枢敏感化。PPT 测量值得进一步评估，作为 OA 疼痛表型的一种工具。
