PDF(Pubmed)
Abstract：
OBJECTIVE: Quantitative sensory testing (QST) provides an assessment of cutaneous and deep tissue sensitivity and pain perception under normal and pathological settings. Approximately 2-4% of individuals undergoing groin hernia repair (GHR) develop severe persistent postsurgical pain (PPSP). The aims of this systematic review of PPSP-patients were (1) to retrieve and methodologically characterize the available QST literature and (2) to explore the role of QST in understanding mechanisms underlying PPSP following GHR.
METHODS: A systematic literature search was conducted from JAN-1992 to SEP-2022 in PubMed, EMBASE, and Google Scholar. For inclusion, studies had to report at least one QST-modality in patients with PPSP. Risk of bias assessment of the studies was conducted utilizing the Newcastle Ottawa Scale and Cochrane\'s Risk of Bias assessment tool 2.0. The review provided both a qualitative and quantitative analysis of the results. A random effects model was used for meta-analysis.
RESULTS: Twenty-five studies were included (5 randomized controlled trials, 20 non-randomized controlled trials). Overall, risk of bias was low. Compared with the contralateral side or controls, there were significant alterations in somatosensory function of the surgical site in PPSP-patients. Following thresholds were significantly increased: mechanical detection thresholds for punctate stimuli (mean difference (95% CI) 3.3 (1.6, 6.9) mN (P = 0.002)), warmth detection thresholds (3.2 (1.6, 4.7) °C (P = 0.0001)), cool detection thresholds (-3.2 (-4.9, -1.6) °C (P = 0.0001)), and heat pain thresholds (1.9 (1.1, 2.7) °C (P = 0.00001)). However, the pressure pain thresholds were significantly decreased (-76 (-123, -30) kPa (P = 0.001)).
CONCLUSIONS: Our review demonstrates a plethora of methods used regarding outcome assessments, data processing, and data interpretation. From a pathophysiological perspective, the most consistent findings were postsurgical cutaneous deafferentation and development of a pain generator in deeper connective tissues.
BACKGROUND: CRD42022331750.
METHODS: A systematic literature search was conducted from JAN-1992 to SEP-2022 in PubMed, EMBASE, and Google Scholar. For inclusion, studies had to report at least one QST-modality in patients with PPSP. Risk of bias assessment of the studies was conducted utilizing the Newcastle Ottawa Scale and Cochrane\'s Risk of Bias assessment tool 2.0. The review provided both a qualitative and quantitative analysis of the results. A random effects model was used for meta-analysis.
RESULTS: Twenty-five studies were included (5 randomized controlled trials, 20 non-randomized controlled trials). Overall, risk of bias was low. Compared with the contralateral side or controls, there were significant alterations in somatosensory function of the surgical site in PPSP-patients. Following thresholds were significantly increased: mechanical detection thresholds for punctate stimuli (mean difference (95% CI) 3.3 (1.6, 6.9) mN (P = 0.002)), warmth detection thresholds (3.2 (1.6, 4.7) °C (P = 0.0001)), cool detection thresholds (-3.2 (-4.9, -1.6) °C (P = 0.0001)), and heat pain thresholds (1.9 (1.1, 2.7) °C (P = 0.00001)). However, the pressure pain thresholds were significantly decreased (-76 (-123, -30) kPa (P = 0.001)).
CONCLUSIONS: Our review demonstrates a plethora of methods used regarding outcome assessments, data processing, and data interpretation. From a pathophysiological perspective, the most consistent findings were postsurgical cutaneous deafferentation and development of a pain generator in deeper connective tissues.
BACKGROUND: CRD42022331750.
摘要：
目的：定量感觉测试（QST）可评估正常和病理环境下的皮肤和深部组织敏感性和疼痛感知。大约2-4%的接受腹股沟疝修补术(GHR)的个体发展为严重的持续性术后疼痛(PPSP)。对PPSP患者进行系统综述的目的是（1）检索和方法学表征可用的QST文献，以及（2）探讨QST在理解GHR后PPSP潜在机制中的作用。
方法：从1992年1月至SEP-2022年在PubMed，EMBASE,谷歌学者。为了纳入，研究必须报告PPSP患者的至少一种QST模式。使用纽卡斯尔渥太华量表和Cochrane的偏倚风险评估工具2.0对研究进行偏倚风险评估。审查对结果进行了定性和定量分析。采用随机效应模型进行Meta分析。
结果：纳入了25项研究（5项随机对照试验，20项非随机对照试验)。总的来说,偏倚风险较低。与对侧或对照相比，PPSP患者手术部位的体感功能发生了显着改变。以下阈值显着增加：点状刺激的机械检测阈值（平均差异（95％CI）3.3（1.6，6.9）mN（P=0.002）），温暖检测阈值（3.2（1.6，4.7）°C（P=0.0001）），冷检测阈值（-3.2（-4.9，-1.6）°C（P=0.0001）），和热痛阈值（1.9（1.1，2.7）°C（P=0.00001））。然而,压力痛阈值显著降低(-76(-123,-30)kPa(P=0.001)).
结论：我们的综述表明，在结果评估方面使用了过多的方法，数据处理,和数据解释。从病理生理学的角度来看，最一致的发现是术后皮肤脱脂和较深结缔组织中疼痛发生器的发展。
背景：CRD42022331750.
方法：从1992年1月至SEP-2022年在PubMed，EMBASE,谷歌学者。为了纳入，研究必须报告PPSP患者的至少一种QST模式。使用纽卡斯尔渥太华量表和Cochrane的偏倚风险评估工具2.0对研究进行偏倚风险评估。审查对结果进行了定性和定量分析。采用随机效应模型进行Meta分析。
结果：纳入了25项研究（5项随机对照试验，20项非随机对照试验)。总的来说,偏倚风险较低。与对侧或对照相比，PPSP患者手术部位的体感功能发生了显着改变。以下阈值显着增加：点状刺激的机械检测阈值（平均差异（95％CI）3.3（1.6，6.9）mN（P=0.002）），温暖检测阈值（3.2（1.6，4.7）°C（P=0.0001）），冷检测阈值（-3.2（-4.9，-1.6）°C（P=0.0001）），和热痛阈值（1.9（1.1，2.7）°C（P=0.00001））。然而,压力痛阈值显著降低(-76(-123,-30)kPa(P=0.001)).
结论：我们的综述表明，在结果评估方面使用了过多的方法，数据处理,和数据解释。从病理生理学的角度来看，最一致的发现是术后皮肤脱脂和较深结缔组织中疼痛发生器的发展。
背景：CRD42022331750.
