Department of Human Physiology, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium.
Eur J Pain. 2013 Mar;17(3):299-312. doi: 10.1002/j.1532-2149.2012.00193.x. Epub 2012 Sep 25.
It has been suggested that sensitization of the central nervous system plays an important role in the development and maintenance of chronic (pain) complaints experienced by whiplash patients. According to the PRISMA guidelines, a systematic review was performed to screen and evaluate the existing clinical evidence for the presence of central sensitization in chronic whiplash. DATABASES AND DATA TREATMENT: Predefined keywords regarding central sensitization and chronic whiplash were combined in electronic search engines PubMed and Web of Science. Full text clinical reports addressing studies of central sensitization in human adults with chronic complaints due to a whiplash trauma were included and reviewed on methodological quality by two independent reviewers.
From the 99 articles that were identified, 24 met the inclusion criteria, and 22 articles achieved sufficient scores on methodological quality and were discussed. These studies evaluated the sensitivity to different types of stimuli (mechanical, thermal, electrical). Findings suggest that although different central mechanisms seem to be involved in sustaining the pain complaints in whiplash patients, hypersensitivity of the central nervous system plays a significant role. Persistent pain complaints, local and widespread hyperalgesia, referred pain and (thoracic) allodynia, decreased spinal reflex thresholds, inefficient diffuse noxious inhibitory controls activation and enhanced temporal summation of pain were established in chronic whiplash patients.
Although the majority of the literature provides evidence for the presence of central sensitization in chronic whiplash, underlying mechanisms are still unclear and future studies with good methodological quality are necessary. In addition, international guidelines for the definition, clinical recognition, assessment and treatment of central sensitization are warranted.
有观点认为，中枢敏化在颈性慢性（疼痛）主诉的发生和维持中发挥着重要作用。根据 PRISMA 指南，我们进行了一项系统综述，以筛选和评估现有临床证据，考察慢性颈性疼痛患者中是否存在中枢敏化。
在 PubMed 和 Web of Science 电子搜索引擎中，结合了与中枢敏化和慢性颈性疼痛相关的预设关键词。纳入并由两位独立的审查员根据方法学质量对涉及慢性颈性疼痛主诉的人类成年患者中枢敏化研究的全文临床报告进行了审查。
从确定的 99 篇文章中，有 24 篇符合纳入标准，22 篇文章在方法学质量上得分较高，并进行了讨论。这些研究评估了对不同类型刺激（机械性、热、电）的敏感性。研究结果表明，尽管不同的中枢机制似乎参与维持颈性疼痛患者的疼痛主诉，但中枢神经系统的敏感性起着重要作用。慢性颈性疼痛患者存在持续性疼痛主诉、局部和广泛的痛觉过敏、牵涉痛和（胸）触诱发痛、脊髓反射阈值降低、弥散性伤害性抑制控制作用效率降低以及疼痛的时间总和增强。
尽管大多数文献都为慢性颈性疼痛中存在中枢敏化提供了证据，但潜在的机制仍不清楚，需要进行具有良好方法学质量的未来研究。此外，还需要制定国际指南来定义、临床识别、评估和治疗中枢敏化。
