{"title":"Somatosensory Profiling of Patients With Cluster Headache: A Systematic Review and Meta-analysis","authors":"","doi":"10.1016/j.jpain.2024.02.012","DOIUrl":null,"url":null,"abstract":"<div><p>The objectives were 1) to synthesize quantitative sensory testing results in cluster headache (CH) patients and to identify somatosensory differences from healthy subjects (HS), and 2) between symptomatic and asymptomatic sides in CH patients. Two independent reviewers conducted a literature search in MEDLINE, EMBASE, Web of Science, and CINAHL databases. Studies with observational designs were included. Methodological quality and risk of bias were assessed with the Newcastle Ottawa Scale. The selected studies underwent qualitative and quantitative analyses. The qualitative analysis showed inconsistent findings among multiple studies. Meta-analysis showed lower pressure pain thresholds (PPTs) on the symptomatic side of CH patients than HS in V<sub>2</sub> (standardized mean difference [SMD] −1.01 [95% confidence interval (CI) −1.79, −.23], <em>P</em> = .01, I<sup>2</sup> = 73%, n = 114), V<sub>3</sub> (SMD −1 [95% CI −1.54, .45], <em>P</em> < .01, I<sup>2</sup> = 82%, n = 354), and cervical region (SMD −1.25 [95% CI −2.07, −.44], <em>P</em> < .01, I<sup>2</sup> = 84%, n = 194). Furthermore, lower PPTs than those detected in HS were found on the asymptomatic side in V<sub>3</sub> (SMD −.77 [95% CI −1.27, −.27], <em>P</em> < .01, I<sup>2</sup> = 79%, n = 354) and in the cervical region (SMD −1.13 [95% CI −1.97, −.3], <em>P</em> < .01, I<sup>2</sup> = 85%, n = 194). However, no differences were found in V<sub>1</sub> or the extratrigeminal points between these groups. No significant changes were found between symptomatic and asymptomatic sides in trigeminal and extratrigeminal regions. Mechanical hyperalgesia in the trigemino-cervical region of patients with CH could suggest the presence of central pain mechanisms. These results are of clinical relevance because their presence could be associated with a poorer prognosis, chronification, and treatment response.</p></div><div><h3>Perspective</h3><p>This study provides consistent findings on the somatosensory profile characterizing patients with CH. Clinicians should assess PPTs and other quantitative sensory testing variables in the trigeminal and extratrigeminal (cervical) regions.</p></div>","PeriodicalId":51095,"journal":{"name":"Journal of Pain","volume":"25 8","pages":"Article 104498"},"PeriodicalIF":4.0000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Pain","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1526590024003791","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
The objectives were 1) to synthesize quantitative sensory testing results in cluster headache (CH) patients and to identify somatosensory differences from healthy subjects (HS), and 2) between symptomatic and asymptomatic sides in CH patients. Two independent reviewers conducted a literature search in MEDLINE, EMBASE, Web of Science, and CINAHL databases. Studies with observational designs were included. Methodological quality and risk of bias were assessed with the Newcastle Ottawa Scale. The selected studies underwent qualitative and quantitative analyses. The qualitative analysis showed inconsistent findings among multiple studies. Meta-analysis showed lower pressure pain thresholds (PPTs) on the symptomatic side of CH patients than HS in V2 (standardized mean difference [SMD] −1.01 [95% confidence interval (CI) −1.79, −.23], P = .01, I2 = 73%, n = 114), V3 (SMD −1 [95% CI −1.54, .45], P < .01, I2 = 82%, n = 354), and cervical region (SMD −1.25 [95% CI −2.07, −.44], P < .01, I2 = 84%, n = 194). Furthermore, lower PPTs than those detected in HS were found on the asymptomatic side in V3 (SMD −.77 [95% CI −1.27, −.27], P < .01, I2 = 79%, n = 354) and in the cervical region (SMD −1.13 [95% CI −1.97, −.3], P < .01, I2 = 85%, n = 194). However, no differences were found in V1 or the extratrigeminal points between these groups. No significant changes were found between symptomatic and asymptomatic sides in trigeminal and extratrigeminal regions. Mechanical hyperalgesia in the trigemino-cervical region of patients with CH could suggest the presence of central pain mechanisms. These results are of clinical relevance because their presence could be associated with a poorer prognosis, chronification, and treatment response.
Perspective
This study provides consistent findings on the somatosensory profile characterizing patients with CH. Clinicians should assess PPTs and other quantitative sensory testing variables in the trigeminal and extratrigeminal (cervical) regions.
期刊介绍：
The Journal of Pain publishes original articles related to all aspects of pain, including clinical and basic research, patient care, education, and health policy. Articles selected for publication in the Journal are most commonly reports of original clinical research or reports of original basic research. In addition, invited critical reviews, including meta analyses of drugs for pain management, invited commentaries on reviews, and exceptional case studies are published in the Journal. The mission of the Journal is to improve the care of patients in pain by providing a forum for clinical researchers, basic scientists, clinicians, and other health professionals to publish original research.
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