Tesarz Jonas, Baumeister David, Andersen Tonny Elmose, Vaegter Henrik Bjarke
Department of General Internal Medicine and Psychosomatics, Medical Hospital, University of Heidelberg, Heidelberg, Germany.
Department of Psychology, University of Southern Denmark, Odense, Denmark.
Pain Rep. 2020 Sep 17;5(5):e849. doi: 10.1097/PR9.0000000000000849. eCollection 2020 Sep-Oct.
Posttraumatic stress disorder (PTSD) is a known risk factor for the development of chronic pain conditions, and almost 1 in 5 individuals with chronic pain fulfills the criteria for PTSD. However, the relationship between PTSD and pain is poorly understood and studies on pain perception in patients with PTSD show inconsistent results suggesting that different sensory profiles exist among individuals with PTSD. Here, we (1) systematically summarize the current literature on experimentally evoked pain perception in patients with PTSD compared to subjects without PTSD, and (2) assess whether the nature of the traumatic event is associated with different patterns in pain perception. The main outcome measures were pain threshold, pain tolerance, and pain intensity ratings as well as measures of temporal summation of pain and conditioned pain modulation. A systematic search of MEDLINE, EMBASE, Web of Science, PsycINFO, and CINAHL identified 21 studies for the meta-analysis, including 422 individuals with PTSD and 496 PTSD-free controls. No main effect of PTSD on any outcome measure was found. However, stratification according to the nature of trauma revealed significant differences of small to medium effect sizes. Combat-related PTSD was associated with increased pain thresholds, whereas accident-related PTSD was associated with decreased pain thresholds. No clear relationship between PTSD and experimentally evoked pain perception exists. The type of trauma may affect pain thresholds differently indicating the presence of different subgroups with qualitative differences in pain processing.
创伤后应激障碍（PTSD）是慢性疼痛疾病发生的一个已知风险因素，近五分之一的慢性疼痛患者符合PTSD的标准。然而，PTSD与疼痛之间的关系尚不清楚，关于PTSD患者疼痛感知的研究结果不一致，这表明PTSD患者存在不同的感觉特征。在此，我们（1）系统总结了目前关于PTSD患者与无PTSD受试者相比实验诱发疼痛感知的文献，（2）评估创伤事件的性质是否与疼痛感知的不同模式相关。主要结局指标为疼痛阈值、疼痛耐受性、疼痛强度评分以及疼痛的时间总和与条件性疼痛调制的测量指标。对MEDLINE、EMBASE、科学网、PsycINFO和CINAHL进行系统检索，确定了21项纳入荟萃分析的研究，包括422名PTSD患者和496名无PTSD的对照者。未发现PTSD对任何结局指标有主要影响。然而，根据创伤性质进行分层显示，效应大小存在显著的中小差异。与战斗相关的PTSD与疼痛阈值升高有关，而与事故相关的PTSD与疼痛阈值降低有关。PTSD与实验诱发的疼痛感知之间不存在明确的关系。创伤类型可能对疼痛阈值有不同影响，表明存在疼痛处理存在质性差异的不同亚组。
