Adamczyk Wacław, Luedtke Kerstin, Saulicz Edward
Department of Kinesiotherapy and Special Methods in Physiotherapy, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland.
Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Clin J Pain. 2018 Jan;34(1):82-94. doi: 10.1097/AJP.0000000000000499.
Diminished tactile acuity in chronic non-neuropathic pain syndromes has been attributed to central pain processing and cortical reorganization. The latter was recently targeted in clinical trials that demonstrated no clear advantages over traditional approaches for the reduction of nonspecific low back pain (LBP). The aim of this systematic review and meta-analysis was to summarize the current evidence on tactile acuity in LBP and pain-free controls.
Six databases were independently searched by 2 researchers. Nineteen studies with either case-control, cross-sectional, or baseline lumbar tactile acuity data collected before an intervention were included in the qualitative and quantitative synthesis. All pooled analyses were based on random effects models. Risk of bias was assessed using the Downs and Black scale and selection criteria were verified independently by 2 assessors.
Data on patients (n=547) and controls (n=346) were summarized. Studies on patients included data on nonspecific chronic LBP only; no data on acute LBP were identified. There was a significant mean difference between patients and controls for lumbar tactile acuity including (11.74 mm; 95% confidence interval, 8.61-14.87) and excluding (9.49 mm; 95% confidence interval, 3.64-15.34) higher risk of bias studies.
A gap of knowledge regarding tactile acuity in populations with acute and chronic non-neuropathic LBP needs to be addressed in future research as this may significantly help the understanding of the causality of tactile acuity alterations.
慢性非神经性疼痛综合征中触觉敏锐度下降被认为与中枢性疼痛处理和皮质重组有关。最近,针对皮质重组进行的临床试验表明,在减轻非特异性下背痛(LBP)方面,与传统方法相比并无明显优势。本系统评价和荟萃分析的目的是总结目前关于LBP患者和无疼痛对照者触觉敏锐度的证据。
两名研究人员独立检索了六个数据库。定性和定量综合分析纳入了19项在干预前收集了病例对照、横断面或基线腰椎触觉敏锐度数据的研究。所有汇总分析均基于随机效应模型。使用唐斯和布莱克量表评估偏倚风险,选择标准由两名评估者独立核实。
总结了患者(n=547)和对照者(n=346)的数据。关于患者的研究仅包括非特异性慢性LBP的数据;未发现急性LBP的数据。患者和对照者在腰椎触觉敏锐度方面存在显著的平均差异,包括高偏倚风险研究在内为(11.74毫米;95%置信区间,8.61 - 14.87),排除高偏倚风险研究后为(9.49毫米;95%置信区间,3.64 - 15.34)。
未来研究需要解决急性和慢性非神经性LBP人群中触觉敏锐度方面的知识空白,因为这可能有助于显著理解触觉敏锐度改变的因果关系。