SMI.
Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
Pain Med. 2022 Apr 8;23(4):733-744. doi: 10.1093/pm/pnab155.
The underlying mechanisms for shoulder pain (SP) are still widely unknown. Previous reviews have reported signs of altered pain processing in SP measured with quantitative sensory testing (QST). Evidence suggests that QST might hold predictive value for SP after an intervention, yet it is not known whether QST profiles can be modulated in response to different treatments. Therefore, this systematic review and meta-analysis aimed to assess whether QST parameters can be modified by interventions for patients with SP.
Three databases were searched to identify eligible studies. Eligible studies had a prospective design, with at least one QST variable as an outcome in conjunction with an intervention measured before and after the intervention. Studies that involved SP caused by spinal or brain injury and studies looking at combined chronic neck pain and SP were excluded.
Nineteen studies investigating SP were eligible for inclusion in this review. Pressure pain threshold (PPT) was the most frequently used QST parameter to investigate local and widespread hyperalgesia. A meta-analysis was performed on data from 10 studies with a total of 16 interventions. Results demonstrated an overall acute effect (<24 hours after intervention) of interventions in favor of local decreased pain sensitivity and remote decreased pain sensitivity when PPTs before and after interventions were compared.
This study demonstrates that interventions such as exercise and manual therapy can modulate PPTs acutely, both locally and remotely, in patients with SP. Further research investigating the acute and long-term modulatory ability of these interventions on other QST parameters is needed in patients with SP.
肩部疼痛（SP）的潜在机制仍知之甚少。之前的综述报告了使用定量感觉测试（QST）测量的 SP 中疼痛处理改变的迹象。有证据表明，QST 可能对干预后的 SP 具有预测价值，但尚不清楚 QST 谱是否可以针对不同的治疗方法进行调节。因此，本系统评价和荟萃分析旨在评估 QST 参数是否可以通过干预措施来改变 SP 患者的 QST 参数。
三个数据库被搜索以确定符合条件的研究。合格的研究具有前瞻性设计，至少有一个 QST 变量作为与干预措施相关的结果，在干预前后进行测量。排除了由脊柱或脑损伤引起的 SP 以及同时研究慢性颈部疼痛和 SP 的研究。
19 项研究符合纳入本综述的条件。压力疼痛阈值（PPT）是最常用于研究局部和广泛痛觉过敏的 QST 参数。对 10 项研究共 16 项干预措施的数据进行了荟萃分析。结果表明，与干预前相比，干预后的局部疼痛敏感性降低和远程疼痛敏感性降低，总体急性效应（干预后<24 小时）有利于干预。
本研究表明，运动和手法治疗等干预措施可以在 SP 患者中急性调节 PPT，局部和远程均如此。需要进一步研究这些干预措施对其他 QST 参数的急性和长期调节能力在 SP 患者中。
