Department of Rehabilitation Sciences, University of Wisconsin-Milwaukee.
Department of Health and Human Performance, Athletic Training Program, Concordia University Wisconsin, Mequon.
J Athl Train. 2021 Aug 1;56(8):887-901. doi: 10.4085/1062-6050-0190.20.
Patellofemoral pain (PFP) has high recurrence rates and minimal long-term treatment success. Central sensitization refers to dysfunctional pain modulation that occurs when nociceptive neurons become hyperresponsive. Researchers in this area of PFP have been increasingly productive in the past decade.
To determine whether evidence supports manifestations of central sensitization in individuals with PFP.
We searched MeSH terms for quantitative sensory testing (QST) pressure pain thresholds (PPTs), conditioned pain modulation (CPM), temporal summation, sensitization, hyperalgesia, and anterior knee pain or PFP in PubMed, SPORTDiscus, CINAHL, Academic Search Complete, and EBSCOhost.
Peer-reviewed studies that were written in English and published between 2005 and 2020 and investigated QST or pain mapping in a sample with PFP were included in this review.
The initial search yielded 140 articles. After duplicates were removed, 78 abstracts were reviewed. The full text of 21 studies was examined, and we included 15 studies in our evaluation: 6 in the meta-analysis, 4 in the systematic review, and 5 in both the meta-analysis and systematic review.
A random-effects meta-analysis was conducted for 4 QST variables (local PPTs, remote PPTs, CPM, temporal summation). Strong evidence supported lower local and remote PPTs, impaired CPM, and facilitated temporal summation in individuals with PFP compared with pain-free individuals. Evidence for heat and cold pain thresholds was conflicting. Pain mapping demonstrated expanding pain patterns associated with long duration of PFP symptoms.
Signs of central sensitization were present in individuals with PFP, indicating altered pain modulation. The etiologic and treatment models of PFP should reflect the current body of evidence regarding central sensitization. Signs of central sensitization should be monitored clinically, and treatments with central effects should be considered as part of a multimodal plan of care.
髌股疼痛（PFP）的复发率高，长期治疗效果甚微。中枢敏化是指伤害感受神经元变得过度反应时发生的功能失调性疼痛调节。在过去十年中，该领域的研究人员在这方面的研究越来越多。
确定 PFP 患者是否存在中枢敏化的表现。
我们在 PubMed、SPORTDiscus、CINAHL、Academic Search Complete 和 EBSCOhost 中使用定量感觉测试（QST）的压痛阈值（PPT）、条件性疼痛调制（CPM）、时间总和、敏化、痛觉过敏和前膝痛或 PFP 的 MeSH 术语进行了搜索。
纳入本综述的研究为同行评议、英文发表、发表时间在 2005 年至 2020 年之间、且对 PFP 样本进行 QST 或疼痛图研究的研究。
最初的搜索产生了 140 篇文章。在去除重复项后，有 78 篇摘要进行了审查。检查了 21 项研究的全文，并将 15 项研究纳入我们的评估：6 项 meta 分析、4 项系统评价和 5 项 meta 分析和系统评价。
对 4 个 QST 变量（局部 PPT、远隔 PPT、CPM、时间总和）进行了随机效应荟萃分析。与无痛个体相比，PFP 个体存在明显的局部和远隔 PPT 降低、CPM 受损和时间总和增强的证据。冷热痛阈值的证据存在冲突。疼痛图显示了与 PFP 症状持续时间较长相关的疼痛模式扩展。
PFP 患者存在中枢敏化的迹象，表明疼痛调节发生改变。PFP 的病因和治疗模型应反映当前关于中枢敏化的证据。应在临床上监测中枢敏化的迹象，并考虑具有中枢作用的治疗方法作为多模式护理计划的一部分。
