Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy.
Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Clin J Pain. 2020 Feb;36(2):124-134. doi: 10.1097/AJP.0000000000000775.
Somatosensory abnormalities are linked to clinical pain outcomes in individuals with spinal pain. However, a range of factors might confound the relationship between altered somatosensory function and clinical pain outcomes. This systematic review aimed to evaluate the literature to assess the level of evidence of associations between psychological, social, physical activity, and sleep measures and somatosensory function (assessed via sensory psychophysical testing) among individuals with spinal pain.
A comprehensive literature search was performed in 6 electronic databases from their inception to June 2018. Two reviewers independently assessed the methodological quality using a modified Quality in Prognostic Studies (QUIPS) tool and supplemented with recommendations from the Critical Appraisal and Data Extraction for the Systematic Review of Prediction Modelling Studies (CHARMS) checklist and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The level of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. Data were pooled to evaluate the strength of the relationships of interest.
Among the 17 factors identified in the included studies, pain catastrophizing, depression, and pain-related fear have significant negative (small to fair) associations with pain thresholds. A "very low" to "moderate" quality of evidence was found for all the investigated factors. Subgroup analysis showed a smaller effect size for pain catastrophizing/fear of movement and pain thresholds in individuals with low back pain.
Psychological factors are associated negatively with pain thresholds and they need to be adjusted when establishing predictive relationships between somatosensory function and pain outcomes in individuals with spinal pain.
躯体感觉异常与脊柱疼痛患者的临床疼痛结果相关。然而，一系列因素可能会混淆感觉功能改变与临床疼痛结果之间的关系。本系统评价旨在评估文献，以评估心理、社会、身体活动和睡眠测量与脊柱疼痛患者躯体感觉功能（通过感觉心理物理学测试评估）之间关联的证据水平。
从 6 个电子数据库的创建开始，对 6 个电子数据库进行了全面的文献检索，检索时间截止到 2018 年 6 月。两位审稿人使用改良的预后研究质量（QUIPS）工具独立评估方法学质量，并辅以预测模型研究系统评价的批判性评价和数据提取（CHARMS）清单和诊断准确性研究质量评估（QUADAS-2）工具的建议。使用推荐、评估、制定和评估（GRADE）系统评估证据水平。对感兴趣的关系进行了数据汇总以评估其强度。
在纳入研究中确定的 17 个因素中，疼痛灾难化、抑郁和与疼痛相关的恐惧与疼痛阈值呈显著负相关（小到中等）。所有研究因素的证据质量均为“极低”到“中度”。亚组分析显示，在腰痛患者中，疼痛灾难化/运动恐惧和疼痛阈值的效应大小较小。
心理因素与疼痛阈值呈负相关，在建立脊柱疼痛患者躯体感觉功能与疼痛结果之间的预测关系时，需要对其进行调整。
