Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom.
Pain. 2023 Jun 1;164(6):1159-1180. doi: 10.1097/j.pain.0000000000002819. Epub 2022 Oct 11.
Experimental pain models are frequently used to understand the influence of pain on the control of human movement. In this systematic review, we assessed the effects of experimentally induced pain in the lumbar region of healthy individuals on trunk muscle activity and spine kinematics. Databases were searched from inception up to January 31, 2022. In total, 26 studies using either hypertonic saline injection (n = 19), heat thermal stimulation (n = 3), nociceptive electrical stimulation (n = 3), or capsaicin (n = 1) were included. The identified adaptations were task dependent, and their heterogeneity was partially explained by the experimental pain model adopted. Meta-analyses revealed an increase of erector spinae activity (standardized mean difference = 0.71, 95% confidence interval [CI] = 0.22-1.19) during full trunk flexion and delayed onset of transversus abdominis to postural perturbation tasks (mean difference = 25.2 ms, 95% CI = 4.09-46.30) in the presence of pain. Low quality of evidence supported an increase in the activity of the superficial lumbar muscles during locomotion and during voluntary trunk movements during painful conditions. By contrast, activity of erector spinae, deep multifidus, and transversus abdominis was reduced during postural perturbation tasks. Reduced range of motion of the lumbar spine in the presence of pain was supported by low quality of evidence. Given the agreement between our findings and the adaptations observed in clinical populations, the use of experimental pain models may help to better understand the mechanisms underlying motor adaptations to low back pain.
实验性疼痛模型常用于理解疼痛对人体运动控制的影响。在本系统评价中，我们评估了健康个体腰部实验性疼痛对躯干肌肉活动和脊柱运动学的影响。从建库开始至 2022 年 1 月 31 日，我们检索了数据库。共纳入 26 项研究，分别采用高渗盐水注射（n = 19）、热刺激（n = 3）、伤害性电刺激（n = 3）或辣椒素（n = 1）。所确定的适应性与任务相关，其异质性部分可以通过采用的实验性疼痛模型来解释。荟萃分析显示，在存在疼痛的情况下，完全躯干屈曲时竖脊肌活动增加（标准化均数差 = 0.71，95%置信区间 [CI] = 0.22-1.19），并且对姿势扰动任务的横突间肌起始延迟（平均差异 = 25.2ms，95%CI = 4.09-46.30）。低质量证据支持在疼痛条件下，腰椎浅层肌肉在运动和自愿躯干运动期间的活动增加。相比之下，在姿势扰动任务中，竖脊肌、深部多裂肌和横突间肌的活动减少。低质量证据支持在存在疼痛时腰椎活动范围减小。鉴于我们的研究结果与临床人群中观察到的适应性之间的一致性，实验性疼痛模型的使用可能有助于更好地理解腰痛患者运动适应性的潜在机制。
