{"title":"丛集性头痛患者的体感特征分析：系统回顾和荟萃分析。","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":"{\"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}","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
摘要
研究目的是：1）综合丛集性头痛（CH）患者的定量感觉测试结果，确定与健康受试者（HS）的体感差异；2）CH 患者有症状侧和无症状侧的体感差异。两位独立审稿人在 MEDLINE、EMBASE、Web of Science 和 CINAHL 数据库中进行了文献检索。纳入的研究均为观察性设计。采用纽卡斯尔-渥太华量表评估方法学质量和偏倚风险。对所选研究进行了定性和定量分析。定性分析显示多项研究的结果不一致。元分析显示，CH 患者症状侧的压力痛阈值（PPTs）在 V2 [SMD -1.01 (95% CI -1.79, -0.23), p = 0.01, I2=73%, n=114]、V3 [SMD -1 (95% CI -1.54, 0.45), p 2=82%, n=354]和颈部区域 [SMD -1.25 (95% CI -2.07, -0.44), p 2=84%, n=194]低于 HS。此外，在 V3 [SMD -0.77 (95% CI -1.27, -0.27], p 2=79%, n=354]和颈部 [SMD -1.13 (95% CI -1.97, -0.3), p 2=85%, n=194]，无症状侧的 PPT 值低于 HS 检测到的 PPT 值。然而，在 V1 或三叉神经外点，这些组别之间没有发现差异。有症状和无症状两侧的三叉神经和三叉神经外区域没有发现明显变化。CH患者三叉神经-颈椎区域的机械性痛觉减退可能表明存在中枢疼痛机制。这些结果具有临床意义，因为它们的存在可能与较差的预后、慢性化和治疗反应有关。观点：本研究提供了有关 CH 患者体感特征的一致结论。临床医生应评估三叉神经和三叉神经外（颈椎）区域的 PPTs 和其他 QST 变量。
Somatosensory Profiling of Patients With Cluster Headache: A Systematic Review and Meta-analysis
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.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
