Arvanitidis Michail, Falla Deborah, Sanderson Andy, Martinez-Valdes Eduardo
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, UK.
Department of Sport and Exercise Sciences, Institute of Sport, Manchester Metropolitan University, Manchester, UK.
Eur J Pain. 2025 Feb;29(2):e4716. doi: 10.1002/ejp.4716. Epub 2024 Aug 23.
In the presence of pain, whether clinical or experimentally induced, individuals commonly show impairments in the control of muscle force (commonly known as force steadiness). In this systematic review and meta-analysis, we synthesized the available evidence on the influence of clinical and experimental pain on force steadiness.
MEDLINE, EMBASE, PubMed, CINAHL Plus and Web of Science databases were searched from their inception to 19 December 2023, using MeSH terms and pre-selected keywords related to pain and force steadiness. Two independent reviewers screened studies for inclusion and assessed their methodological quality using a modified Newcastle-Ottawa risk of bias tool.
In total, 32 studies (19 clinical pain and 13 experimental pain) were included. Meta-analyses revealed reduced force steadiness in the presence of clinical pain as measured by the coefficient of variation (CoV) and standard deviation (SD) of force (standardized mean difference; SMD = 0.80, 95% CI = 0.31-1.28 and SMD = 0.61, 95% CI = 0.11-1.11). These findings were supported by moderate and low strength of evidence respectively. In the presence of experimental pain, meta-analyses revealed reductions in force steadiness when measured by the CoV of force but not by the SD of force (SMD = 0.50, 95% CI = 0.01-0.99; and SMD = 0.44, 95% CI = -0.04 to 0.92), each supported by very low strength of evidence.
This work demonstrates that pain, particularly clinical pain, impairs force steadiness. Such impairments likely have clinical relevance and could become targets for treatment when managing people experiencing musculoskeletal pain.
This systematic review and meta-analyses enhances our understanding of motor impairments observed in people experiencing musculoskeletal pain. It underscores the significance of incorporating force steadiness assessment when managing individuals experiencing musculoskeletal pain. Additionally, it suggests that future research should explore the potential benefits of force steadiness training in alleviating patients' symptoms and enhancing their functional performance. This could potentially lead to the development of innovative therapeutic approaches for individuals suffering from musculoskeletal pain.
在存在疼痛的情况下，无论是临床疼痛还是实验诱导的疼痛，个体通常在肌肉力量控制方面表现出受损（通常称为力量稳定性）。在这项系统评价和荟萃分析中，我们综合了关于临床和实验性疼痛对力量稳定性影响的现有证据。
从MEDLINE、EMBASE、PubMed、CINAHL Plus和Web of Science数据库建库起至2023年12月19日进行检索，使用与疼痛和力量稳定性相关的医学主题词和预先选定的关键词。两名独立评审员筛选纳入研究，并使用改良的纽卡斯尔-渥太华偏倚风险工具评估其方法学质量。
总共纳入了32项研究（19项临床疼痛研究和13项实验性疼痛研究）。荟萃分析显示，在存在临床疼痛的情况下，以力量的变异系数（CoV）和标准差（SD）衡量，力量稳定性降低（标准化均数差；SMD = 0.80，95% CI = 0.31 - 1.28和SMD = 0.61，95% CI = 0.11 - 1.11）。这些发现分别得到了中等强度和低强度证据的支持。在存在实验性疼痛的情况下，荟萃分析显示，以力量的CoV衡量时力量稳定性降低，但以力量的SD衡量时未降低（SMD = 0.50，95% CI = 0.01 - 0.99；以及SMD = 0.44，95% CI = -0.04至0.92），每项均得到非常低强度证据的支持。
这项研究表明疼痛，尤其是临床疼痛，会损害力量稳定性。这种损害可能具有临床相关性，并且在管理肌肉骨骼疼痛患者时可能成为治疗靶点。
这项系统评价和荟萃分析增强了我们对肌肉骨骼疼痛患者中观察到的运动障碍的理解。它强调了在管理肌肉骨骼疼痛患者时纳入力量稳定性评估的重要性。此外，它表明未来的研究应探索力量稳定性训练在减轻患者症状和提高其功能表现方面的潜在益处。这可能会为患有肌肉骨骼疼痛的个体开发创新的治疗方法。
