Conditioned Pain Modulation and Temporal Summation of Pain in Patients With Traumatic and Non-Specific Neck Pain: A Systematic Review and Meta-Analysis - 11/10/23

Doi : 10.1016/j.jpain.2023.09.002

Alberto Arribas-Romano ^⁎,^†,^‡, Josué Fernández-Carnero ^†,^‡,^§,^¶,^∥, Hector Beltran-Alacreu ^⁎⁎,^††, Isabel M. Alguacil-Diego ^‡,^‡‡, Juan Nicolás Cuenca-Zaldívar ^§§,^¶¶,^∥∥, Leonardo Rodríguez-Lagos ^⁎,^†, Nils Runge ^⁎⁎⁎,^†††, Francisco Mercado ^†,^‡‡‡
^⁎ Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
^† Cognitive Neuroscience, Pain, and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
^‡ Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain
^§ Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
^¶ La Paz Hospital Institute for Health Research, IdiPAZ, Madrid, Spain
^∥ Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
^⁎⁎ Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing of Toledo, Universidad de Castilla-La Mancha, Toledo, Spain
^†† CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
^‡‡ Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory (LAMBECOM), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
^§§ Research Group in Nursing and Health Care, Puerta de Hierro Health Research Institute, Segovia de Arana (IDIPHISA), Madrid, Spain
^¶¶ Primary Health Center “El Abajon”, Las Rozas de Madrid, Spain
^∥∥ Grupo de Investigación en Fisioterapia y Dolor, Departamento de Fisioterapia, Facultad de Enfermería y Fisioterapia, Universidad de Alcalá, Alcalá de Henares, Spain
^⁎⁎⁎ Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
^††† Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Belgium
^‡‡‡ Department of Psychology, Faculty of Health Sciences, Universidad Rey Juan Carlos, Madrid, Spain

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Abstract

In patients with neck pain, it is unclear whether pain inhibition and facilitation endogenous pain mechanisms are altered. This systematic review and meta-analysis aimed to improve their understanding by assessing conditioned pain modulation (CPM) and temporal summation of pain (TSP) in patients with neck pain associated with whiplash-associated disorders (WAD) or of a nonspecific neck pain (NSNP) nature compared to pain-free controls. Very low certainty evidence suggests: impaired CPM when assessed remotely in chronic WAD patients (n = 7, 230 patients and 204 controls, standardized mean differences (SMD) = −.47 [−.89 to −.04]; P = .04) but not locally (n = 6, 155 patients and 150 controls; SMD = −.34 [−.68 to .01]; P = .05), impaired CPM in chronic NSNP patients when assessed locally (n = 5, 223 patients and 162 controls; SMD = −.55 [−1.04 to −.06]; P = .04) but not remotely (n = 3, 72 patients and 66 controls; SMD = −.33 [−.92 to .25]; P = .13), TSP not facilitated in either chronic WAD (local TSP: n = 4, 90 patients and 87 controls; SMD = .68 [−.62 to 1.99]) (remote TSP: n = 8, 254 patients and 214 controls; SMD = .18 [−.12 to .48]) or chronic NSNP (local TSP: n = 2, 139 patients and 92 controls; SMD = .21 [−1.00 to 1.41]), (remote TSP: n = 3; 91 patients and 352 controls; SMD = .60 [−1.33 to 2.52]). The evidence is very uncertain whether CPM is impaired and TSP facilitated in patients with WAD and NSNP.

Perspective

This review and meta-analysis present the current evidence on CPM and TSP in patients with WAD and NSNP. Standardization of measurement methodology is needed to draw clear conclusions. Subsequently, future studies should investigate the clinical relevance of these measurements as prognostic variables or predictors of treatment success.

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Highlights

•	The evidence for impaired CPM in people with traumatic or nonspecific neck pain is very uncertain.
•	It is very uncertain if TSP is facilitated in people with traumatic or nonspecific neck pain.
•	To improve the evidence, standardization of CPM and TSP methodology is required.

Le texte complet de cet article est disponible en PDF.

Keywords : Conditioned pain modulation, Temporal summation of pain, Neck pain, Whiplash-associated disorders, Pain mechanisms

Plan

	A. Arribas-Romano was supported with a university teacher training contract (FPU) in the early stages of this work by the Spanish Ministry of Universities. The authors have no conflicts of interest to declare.
	Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
	Address reprint requests to Josué Fernández-Carnero, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, 28922 Alcorcón, Spain. E-mail: josue.fernandez@urjc.es