Department of Physical Medicine and Rehabilitation, Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Harvard T.H. Chan Public School of Health, Boston, Massachusetts, USA.
Pain Med. 2019 May 1;20(5):1000-1011. doi: 10.1093/pm/pny261.
To study the impact of therapeutic interventions on pain analgesia and endogenous pain modulation in knee osteoarthritis (KOA).
Systematic review and meta-analysis.
We searched for KOA randomized clinical trials and observational studies with data on therapeutic interventions comparing pain intensity, temporal summation (TS), and conditioned pain modulation (CPM) scores relative to control. These data were pooled as Hedge's g. To study the relationship between pain intensity and TS/CPM, we performed metaregression with 10,000 Monte-Carlo permutations.
We reviewed 11 studies (559 participants). On studying all the interventions together, we found no significant changes in pain modulation, TS, or CPM. Our findings show that this lack of difference is likely because surgical and nonsurgical interventions resulted in contrary effects. Metaregression significantly correlated pain reduction with normalization of TS and CPM.
We demonstrate an association between pain reduction and TS/CPM normalization. Though we cannot directly compare these interventions, the results allow us to draw hypotheses on potential practice schemas. Recovering defective endogenous pain modulation mechanisms may help establish long-term analgesia. However, to validate these paradigms as robust clinical biomarkers, further investigation into their mechanisms would be necessary. The registration number for this review is CRD42017072066.
研究治疗干预对膝骨关节炎（KOA）患者疼痛缓解和内源性疼痛调节的影响。
系统评价和荟萃分析。
我们检索了 KOA 随机临床试验和观察性研究，这些研究提供了关于治疗干预的疼痛强度、时间总和（TS）和条件性疼痛调制（CPM）评分与对照组的比较数据。这些数据汇总为 Hedge's g。为了研究疼痛强度与 TS/CPM 之间的关系，我们进行了 10000 次蒙特卡罗置换的荟萃回归分析。
我们回顾了 11 项研究（559 名参与者）。综合所有干预措施的结果，我们发现疼痛调节、TS 或 CPM 均无显著变化。我们的研究结果表明，这种差异不明显可能是因为手术和非手术干预产生了相反的效果。荟萃回归分析表明，疼痛减轻与 TS 和 CPM 的正常化显著相关。
我们证明了疼痛减轻与 TS/CPM 正常化之间存在关联。虽然我们不能直接比较这些干预措施，但这些结果使我们能够对潜在的实践方案提出假设。恢复内源性疼痛调节机制的缺陷可能有助于建立长期的镇痛效果。然而，要将这些模式验证为可靠的临床生物标志物，需要进一步研究其机制。本研究的注册编号为 CRD42017072066。
