Conditioned pain modulation and temporal summation in patients with knee osteoarthritis: A systematic review and meta-analysis

IF 4 2区医学 Q1 CLINICAL NEUROLOGY

Journal of Pain Pub Date : 2025-08-01 DOI:10.1016/j.jpain.2025.105464

Leonardo Rodríguez-Lagos , Josué Fernández-Carnero , Sofía Laguarta-Val , Beatriz Serrano-García , Daniel Martín-Vera , Nils Runge , Alberto Arribas-Romano

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引用次数: 0

Abstract

This review aims to determine the current evidence on conditioned pain modulation (CPM) and temporal summation of pain (TSP) in patients with knee osteoarthritis (KOA) compared to healthy pain-free controls. A comprehensive search was conducted across. seven electronic databases (MEDLINE/PubMed, EMBASE, CINAHL, PsycINFO, Cochrane Library, Web of Science, and Scopus) were searched. Studies measuring CPM/TSP in patients with KOA compared to a group of healthy pain-free controls were included. Two reviewers independently determined study eligibility, rated risk of bias and extracted data. Where possible, data were combined into meta-analyses and pooled estimates with 95% confidence intervals (CI) for standardized mean differences (SMD) were calculated. From a total of 1943 papers identified in the initial search, 19 studies were included after screening. Most studies were of moderate to high risk of bias. Very low-certainty evidence suggests lower local CPM efficiency with a moderate effect size (556 patients and 379 controls; SMD = −0.55 [−0.86 to −0.24]; p = 0.00) and higher TSP with a small effect size when assessed both locally (910 patients and 463 controls; SMD = 0.40 [0.21 to 0.58]; p = 0.00) and remotely (468 patients and 231 controls; SMD = 0.27 [0.04 to 0.51]; p = 0.03) in KOA patients compared to pain-free controls. These findings suggest impaired CPM and facilitated TSP in patients with KOA. Clinicians should implement treatment strategies not only directed at nociceptive sources but also aimed at addressing alterations in central pain processing and symptoms related to nociplastic pain.

Protocol registration

(CRD42022370869).

Perspective

This study highlights the impaired conditioned pain modulation and facilitated temporal summation in knee osteoarthritis patients, suggesting central sensitization. These findings emphasize the need for targeted treatments to address both nociceptive sources and central pain processing alterations.

查看原文本刊更多论文

膝关节骨关节炎患者的条件疼痛调节和时间累积：一项系统回顾和荟萃分析。

本综述旨在确定与健康无疼痛对照相比，膝关节骨关节炎（KOA）患者的条件疼痛调节（CPM）和疼痛时间累积（TSP）的现有证据。进行了全面的搜索。检索了7个电子数据库（MEDLINE/PubMed、EMBASE、CINAHL、PsycINFO、Cochrane Library、Web of Science和Scopus）。将KOA患者的CPM/TSP与一组健康无痛对照进行比较。两名审稿人独立确定研究资格，评定偏倚风险并提取数据。在可能的情况下，将数据合并到荟萃分析中，并计算标准化平均差异（SMD）的95%置信区间（CI）的汇总估计。从最初检索的1943篇论文中，筛选后纳入了19篇研究。大多数研究偏倚风险为中至高。非常低确定性的证据表明，局部CPM效率较低，效应大小中等(556例患者和379例对照；SMD = -0.55 [-0.86 ~ -0.24]；p = 0.00)和较高的TSP，在局部评估时效应较小(910例患者和463例对照；SMD = 0.40 [0.21 ~ 0.58]；P = 0.00)和远程(468例患者和231例对照组；SMD = 0.27 [0.04 ~ 0.51]；p = 0.03)。这些结果提示KOA患者的CPM受损并促进了TSP。临床医生应实施治疗策略，不仅针对伤害性来源，而且旨在解决中枢性疼痛加工的改变和与伤害性疼痛相关的症状。协议注册：（crd42022370869）。观点：本研究强调了膝关节骨性关节炎患者的条件疼痛调节受损和促进时间累积，提示中枢致敏。这些发现强调需要有针对性的治疗来解决伤害性来源和中枢性疼痛处理的改变。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Pain 医学-临床神经学

CiteScore

6.30

自引率

7.50%

发文量

441

审稿时长

42 days

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.