Chowdhury Nahian S, Chang Wei-Ju, Millard Samantha K, Skippen Patrick, Bilska Katarzyna, Seminowicz David A, Schabrun Siobhan M
Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia.
Center for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia.
J Pain. 2022 Oct;23(10):1680-1696. doi: 10.1016/j.jpain.2022.04.012. Epub 2022 May 21.
Pain alters motor function. This is supported by studies showing reduced corticomotor excitability in response to experimental pain lasting <90 minutes. Whether similar reductions in corticomotor excitability are present with pain of longer durations or whether alterations in corticomotor excitability are associated with pain severity is unknown. Here we evaluated the evidence for altered corticomotor excitability in response to experimental pain of differing durations in healthy individuals. Databases were systematically searched for eligible studies. Measures of corticomotor excitability and pain were extracted. Meta-analyses were performed to examine: (1) group-level effect of pain on corticomotor excitability, and (2) individual-level associations between corticomotor excitability and pain severity. 49 studies were included. Corticomotor excitability was reduced when pain lasted milliseconds-seconds (hedges g's = -1.26 to -1.55) and minutes-hours (g's = -0.55 to -0.9). When pain lasted minutes-hours, a greater reduction in corticomotor excitability was associated with lower pain severity (g = -0.24). For pain lasting days-weeks, there were no group level effects (g = -0.18 to 0.27). However, a greater reduction in corticomotor excitability was associated with higher pain severity (g = 0.229). In otherwise healthy individuals, suppression of corticomotor excitability may be a beneficial short-term strategy with long-term consequences. PERSPECTIVE: This systematic review synthesised the evidence for altered corticomotor excitability in response to experimentally induced pain. Reduced corticomotor excitability was associated with lower acute pain severity but higher sustained pain severity, suggesting suppression of corticomotor excitability may be a beneficial short-term adaptation with long-term consequences.
疼痛会改变运动功能。这一观点得到了多项研究的支持，这些研究表明，在持续时间小于90分钟的实验性疼痛刺激下，皮质运动兴奋性会降低。对于持续时间更长的疼痛，皮质运动兴奋性是否会出现类似降低，或者皮质运动兴奋性的改变是否与疼痛严重程度相关，目前尚不清楚。在此，我们评估了健康个体在不同持续时间的实验性疼痛刺激下，皮质运动兴奋性改变的证据。我们系统检索了数据库中的相关合格研究。提取了皮质运动兴奋性和疼痛的测量指标。进行荟萃分析以检验：（1）疼痛对皮质运动兴奋性的组水平效应；（2）皮质运动兴奋性与疼痛严重程度之间的个体水平关联。共纳入49项研究。当疼痛持续毫秒至秒（效应量 Hedge's g = -1.26至-1.55）以及分钟至小时（效应量 Hedge's g = -0.55至-0.9）时，皮质运动兴奋性降低。当疼痛持续分钟至小时时，皮质运动兴奋性降低幅度越大，疼痛严重程度越低（效应量 Hedge's g = -0.24）。对于持续数天至数周的疼痛，未发现组水平效应（效应量 Hedge's g = -0.18至0.27）。然而，皮质运动兴奋性降低幅度越大，疼痛严重程度越高（效应量 Hedge's g = 0.229）。在其他方面健康的个体中，抑制皮质运动兴奋性可能是一种有益的短期策略，但会带来长期影响。观点：本系统评价综合了实验性疼痛刺激下皮质运动兴奋性改变的证据。皮质运动兴奋性降低与急性疼痛严重程度较低但持续性疼痛严重程度较高相关，这表明抑制皮质运动兴奋性可能是一种有益的短期适应性反应，但会带来长期影响。
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