Rathbone Michél, Parkinson William, Rehman Yasir, Jiang Shucui, Bhandari Mohit, Kumbhare Dinesh
Department of Medicine, McMaster University, Hamilton, ON, Canada.
School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
Br J Pain. 2016 Aug;10(3):141-55. doi: 10.1177/2049463716642600. Epub 2016 Jul 19.
A systematic review and meta-analysis were performed to estimate the size and variability of the association between chronic pain (CP) and poorer cognitive test performances as a function of individual tests, pain sub-types, and study sources on 22 studies having (1) a control group, (2) reported means and standard deviations (SDs) and (3) tests studied at least 3 times.
CP patients performed significantly poorer with small to moderate effects (d = -.31 to -.57) on Digit Span Backward; STROOP Word; Color and Color-Word; Digit Symbol; Trail Making A and B; Rey Auditory Learning Immediate and Delayed Recall and Recognition. For these 10 measures, single effects (no interaction) were supported (I(2) = 0%-8%) and Random and Fixed models yielded similar results. No group differences were found for Corsi Blocks Forward or Wisconsin Cart Sorting Test Categories Achieved, or Perseveration. Effects for the Rey Complex Figure Immediate and Delayed Recall were significant, but effect size was inconclusive, given moderate to high heterogeneity and lack of consistency between Random and Fixed models. For the Paced Auditory Serial Addition Test, there was a homogeneous (I(2) = 0%) and significantly lower performance in fibromyalgia (d = -.47), but no effect in diagnostically undifferentiated pain samples, and wide variability across studies of whiplash (d = -.15 to -1.04, I(2) = 60%).
The magnitude and consistency of the CP - cognition effect depended on the test, pain subgroup and study source.
Among tests showing a chronic pain (CP) - cognition effect, the magnitude of this association was consistently small to moderate across tests.Effect size estimation was inconclusive for Digit Span Forwards, the Paced Auditory Serial Addition Test and the Rey Complex Figure Test.Variance was too heterogeneous for testing cognitive domain specificity of the CP - cognition effect.
进行了一项系统评价和荟萃分析，以评估慢性疼痛（CP）与较差认知测试表现之间关联的大小和变异性，该关联是个体测试、疼痛亚型和研究来源的函数，涉及22项研究，这些研究具有（1）一个对照组，（2）报告了均值和标准差（SD），以及（3）至少研究了3次的测试。
CP患者在数字广度倒背、斯特鲁普文字、颜色和颜色文字、数字符号、连线测验A和B、雷伊听觉学习即时和延迟回忆及识别等测试中表现显著较差，效应大小为小到中等（d = -0.31至 -0.57）。对于这10项测量，单一效应（无交互作用）得到支持（I² = 0% - 8%），随机模型和固定模型得出相似结果。在顺背科西方块或威斯康星卡片分类测验的完成类别或持续错误方面未发现组间差异。雷伊复杂图形即时和延迟回忆的效应显著，但鉴于中度至高异质性以及随机模型和固定模型之间缺乏一致性，效应大小尚无定论。对于听觉序列加法测试，存在同质性（I² = 0%），纤维肌痛患者表现显著更低（d = -0.47），但在未分化诊断的疼痛样本中无效应，且鞭打损伤研究之间差异很大（d = -0.15至 -1.04，I² = 60%）。
CP - 认知效应的大小和一致性取决于测试、疼痛亚组和研究来源。
在显示慢性疼痛（CP） - 认知效应的测试中，这种关联的大小在各项测试中始终为小到中等。数字广度顺背、听觉序列加法测试和雷伊复杂图形测试的效应大小估计尚无定论。CP - 认知效应的认知领域特异性测试的方差过于异质。
