联合运动和心理治疗方案对慢性肌肉骨骼疼痛成人神经系统敏感化测量指标的有效性 - 系统评价和荟萃分析。 - Suppr

The effectiveness of a combined exercise and psychological treatment programme on measures of nervous system sensitisation in adults with chronic musculoskeletal pain - a systematic review and meta-analysis.

机构信息

School of Public Health, Physiotherapy and Sports Science, Health Sciences Building, University College Dublin, Belfield, Dublin 4, Ireland.

出版信息

BMC Musculoskelet Disord. 2024 Feb 14;25(1):140. doi: 10.1186/s12891-024-07274-8.

BACKGROUND

Quantitative sensory testing (QST) offers information regarding underlying mechanisms contributing to chronic pain (CP) in adults with musculoskeletal disorders. This review examined the use of QST measures in adults with CP following participation in a combined exercise and psychological intervention.

METHODS

The review was conducted in accordance with the PRISMA guidelines. Five databases were searched from inception to November 2022. All study designs which evaluated the effects of a combined exercise and psychological treatment on measures of nervous system sensitivity in adults with chronic musculoskeletal pain were included.

RESULTS

A total of 13 studies met the selection criteria, 10 of which were included in a meta-analysis. Local pressure pain thresholds were the most frequently used measure (n = 12 studies). Meta-analysis revealed statistically significantly improvements in favour of the combined exercise and psychological intervention group, compared to a control group, for local pressure pain threshold measures [SMD = 0.44, 95% CI 0.08-0.81, I = 84%], pain intensity scores [SMD=-0.89, 95% CI -1.66- -0.13, I = 94%] and the Central Sensitisation Inventory [SMD=-0.69, 95% CI -1.37- -0.02, I = 87%]. There were no significant differences found between groups for remote pressure pain thresholds, temporal summation or conditioned pain modulation.

CONCLUSIONS

The results suggest that a combined exercise and psychological intervention may lead to greater improvements in local pressure pain threshold, pain intensity and Central Sensitisation Inventory scores when compared to a control intervention in adults with CP, however these findings must be interpreted with caution as a large degree of heterogeneity was present in these results (I: 84-94%). Further large, longitudinal studies are required using standardised QST measurement procedures and patient reported outcome measures to explore changes in nervous system sensitisation.

TRIAL REGISTRATION

This systematic review is registered with PROSPERO, ID Number CRD42022380464.

背景

定量感觉测试（QST）提供了有关导致成年人肌肉骨骼疾病慢性疼痛（CP）的潜在机制的信息。本综述检查了在成年人接受综合运动和心理干预后，使用 QST 测量方法对 CP 的影响。

方法

本综述按照 PRISMA 指南进行。从开始到 2022 年 11 月，在五个数据库中进行了搜索。所有评估综合运动和心理治疗对慢性肌肉骨骼疼痛成年人神经系统敏感性测量值影响的研究设计均被纳入。

结果

共有 13 项研究符合选择标准，其中 10 项研究纳入荟萃分析。局部压痛阈值是最常用的测量方法（n=12 项研究）。荟萃分析显示，与对照组相比，综合运动和心理干预组在局部压痛阈值测量[SMD=0.44，95%置信区间 0.08-0.81，I=84%]、疼痛强度评分[SMD=-0.89，95%置信区间-1.66- -0.13，I=94%]和中央敏感化量表[SMD=-0.69，95%置信区间-1.37- -0.02，I=87%]方面有统计学意义的改善。在远程压痛阈值、时间总和或条件性疼痛调制方面，两组之间没有发现显著差异。

结论

结果表明，与对照组相比，综合运动和心理干预可能导致 CP 成年人的局部压痛阈值、疼痛强度和中央敏感化量表评分有更大的改善，但是由于这些结果存在高度异质性（I：84-94%），因此必须谨慎解释这些发现。需要进一步进行大型、纵向研究，使用标准化 QST 测量程序和患者报告的结果测量来探索神经系统敏感性的变化。