Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón, Madrid, Spain.
Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Madrid, Spain.
Phys Ther. 2021 Aug 1;101(8). doi: 10.1093/ptj/pzab131.
The presence of altered nociceptive pain processing in patients with upper extremity tendinopathy/overuse injury is conflicting. Our aim was to compare pressure pain thresholds (PPTs) in symptomatic and distant pain-free areas between patients with upper extremity tendinopathy/overuse injury and controls.
Five databases were searched from inception to October 15, 2020. The authors selected case-control studies comparing PPTs between individuals with upper extremity tendinopathy/overuse injury and pain-free controls. Data were extracted for population, diagnosis, sample size, outcome, and type of algometer. Results were extracted by 3 reviewers. The methodological quality/risk of bias (Newcastle-Ottawa Quality Assessment Scale) and evidence level (Grading of Recommendations Assessment, Development and Evaluation approach) were assessed. Meta-analyses of symptomatic, segment-related, and distant pain-free areas were compared.
The search identified 807 publications with 19 studies (6 shoulder, 13 elbow) eligible for inclusion. The methodological quality ranged from fair (48%) to good (37%). Patients exhibited lower bilateral PPTs than controls at the symptomatic area (affected side: MD = -175.89 kPa [95% CI = -220.30 to -131.48 kPa]; nonaffected side: MD = -104.50 kPa [95% CI = -142.72 to -66.28 kPa]) and the segment-related area (affected side: MD = -150.63 kPa [95% CI = -212.05 to -89.21 kPa]; nonaffected side: MD = -170.34 kPa [95% CI = - 248.43 to -92.25]) than controls. No significant differences in PPTs over distant pain-free areas were observed.
Low to moderate quality evidence suggests bilateral hypersensitivity to pressure pain at the symptomatic and contralateral/mirror areas in patients with upper extremity tendinopathies/overuse injury. Moderate quality of evidence supports bilateral pressure pain sensitivity in the segment-related area (neck) in lateral epicondylalgia, but not in subacromial impingement syndrome. No evidence of widespread pressure pain hyperalgesia was reported.
Early identification of people with altered pain modulation could guide clinicians in treatment strategies. This review shows that there is a complex interplay between peripheral and central pain mechanisms in upper extremity tendinopathies/overuse injuries and that there likely are different subgroups of patients with upper extremity conditions.
患有上肢肌腱病/过度使用损伤的患者存在疼痛处理改变的情况存在争议。我们的目的是比较上肢肌腱病/过度使用损伤患者和对照组在症状部位和远处无痛部位的压痛阈值（PPT）。
从创建到 2020 年 10 月 15 日，我们在 5 个数据库中进行了搜索。作者选择了比较上肢肌腱病/过度使用损伤患者和无痛对照组之间 PPT 的病例对照研究。提取了人口统计学、诊断、样本量、结局和压力计类型的数据。由 3 位评审员进行结果提取。使用纽卡斯尔-渥太华质量评估量表（Newcastle-Ottawa Quality Assessment Scale）评估方法学质量/偏倚风险（Newcastle-Ottawa Quality Assessment Scale）和证据水平（Grading of Recommendations Assessment, Development and Evaluation approach）。比较了症状部位、节段相关部位和远处无痛部位的荟萃分析。
搜索结果确定了 807 篇出版物，其中有 19 项研究（6 项肩部，13 项肘部）符合纳入标准。方法学质量从差（48%）到好（37%）不等。与对照组相比，患者在症状部位（患侧：MD = -175.89kPa[95%CI=-220.30 至-131.48kPa]；非患侧：MD = -104.50kPa[95%CI=-142.72 至-66.28kPa]）和节段相关部位（患侧：MD = -150.63kPa[95%CI=-212.05 至-89.21kPa]；非患侧：MD = -170.34kPa[95%CI=-248.43 至-92.25kPa]）的双侧 PPT 值较低。在远处无痛区域，没有观察到压痛阈值的显著差异。
低至中等质量的证据表明，上肢肌腱病/过度使用损伤患者的压痛阈值在症状部位和对侧/镜像部位存在双侧超敏反应。在外侧上髁炎中，有中等质量的证据支持节段相关部位（颈部）的双侧压痛敏感性，但在肩峰下撞击综合征中则没有。没有报告广泛的压痛痛觉过敏的证据。
早期识别疼痛调节改变的人可以指导临床医生制定治疗策略。本综述表明，上肢肌腱病/过度使用损伤中存在外周和中枢疼痛机制之间的复杂相互作用，并且上肢疾病患者可能存在不同的亚组。
