目的:主要目的是确定经皮(PENS)和经皮(TENS)电神经刺激对肌肉骨骼疼痛患者内源性疼痛机制的影响。
方法:系统综述和荟萃分析。
方法:搜索于2022年3月1日在EMBASE进行,CINAHL,PubMed,PEDro,科克伦图书馆,WebofScience,Medline和SCOPUS数据库。比较经皮或经皮电刺激与安慰剂的随机对照试验,纳入对照组或标准治疗的肌肉骨骼疼痛患者。结果测量是QST体感变量,如压力下的疼痛阈值(PPT),条件性疼痛调制(CPM)和疼痛时间总和(TSP)。使用ReviewManager5.4对合并数据进行评估。
结果:24项RCT(N=24)纳入定性分析,23项纳入荟萃分析。PENS和TENS对局部PPTs的即时效应显著,效应大小适中(SMD0.53,95%CI:0.34至0.72,p<0.00001)。当只分析偏倚风险较低的研究时,异质性从I2=58%(P<0.00001)到I2=15%(P=0.01),并且观察到总体效应降低(SMD0.33,95%CI:0.7~0.58).与对照组相比,对局部PPTs的短期影响不显着(P=0.13)。对局部PPTs的中期影响显着,显示出较大的影响大小(SMD0.55,95%CI:0.9至1.00,p=0.02)。对CPM的即时效应是显著的,具有大的效应大小(SMD0.94,95%CI:0.48至1.41,p<0.0001)。
结论:PENS和TENS对肌肉骨骼痛患者的局部机械性痛觉过敏有轻度-中度的即时效应。这些效果似乎不会随着时间的推移而持续。分析表明,对中枢疼痛机制产生影响,在远端PPT和PENS对CPM的情况下,但需要进一步研究才能得出更清晰的结论。
The main aim was to determine the effects of percutaneous electrical nerve stimulation (PENS) and transcutaneous electrical nerve stimulation (TENS) on endogenous pain mechanisms in patients with musculoskeletal pain.
A systematic
review and meta-analysis.
The search was conducted on March 1, 2022, in the EMBASE, CINAHL, PubMed, PEDro, Cochrane Library, Web of Science, Medline, and SCOPUS databases. Randomized controlled trials comparing the use of transcutaneous or percutaneous electrostimulation with a placebo, control group, or standard treatment in patients with musculoskeletal pain were included. Outcome measurements were quantitative sensory testing somatosensory variables like pressure pain threshold (PPT), conditioned pain modulation, and temporal summation of pain. The pooled data were evaluated in
Review Manager 5.4.
Twenty-four randomized controlled trials (n = 24) were included in the qualitative analysis and 23 in the meta-analysis. The immediate effects of PENS and TENS on local PPTs were significant, with a moderate effect size (standardized mean difference [SMD] 0.53; 95% confidence interval [CI]: 0.34 to 0.72; P < 0.00001). When only studies with a lower risk of bias were analyzed, the heterogeneity decreased from I2 = 58% (P < 0.00001) to I2 = 15% (P = 0.01), and a decrease in the overall effect was observed (SMD 0.33; 95% CI: 0.7 to 0.58). The short-term effects on local PPTs were not significant when compared with the control group (P = 0.13). The mid-term effects on local PPTs were significant, showing a large effect size (SMD 0.55; 95% CI: 0.9 to 1.00; P = 0.02). The immediate effects on conditioned pain modulation were significant, with a large effect size (SMD 0.94; 95% CI: 0.48 to 1.41; P < 0.0001).
PENS and TENS have a mild-moderate immediate effect on local mechanical hyperalgesia in patients with musculoskeletal pain. It appears that these effects are not sustained over time. Analyses suggest an effect on central pain mechanisms producing a moderate increase in remote PPT, an increase in conditioned pain modulation, but further studies are needed to draw clearer conclusions.