A Systematic Review and Meta-analysis of Non-pharmacological Methods to Manipulate Experimentally Induced Secondary Hypersensitivity - 25/09/23
Abstract |
This systematic review and meta-analysis investigated the effects of non-pharmacological manipulations on experimentally induced secondary hypersensitivity in pain-free humans. We investigated the magnitude (change/difference in follow-up ratings from pre-manipulation ratings) of secondary hypersensitivity (primary outcome), and surface area of secondary hypersensitivity (secondary outcome), in 27 studies representing 847 participants. Risk of bias assessment concluded most studies (23 of 27) had an unclear or high risk of performance and detection bias. Further, 2 (of 27) studies had a high risk of measurement bias. Datasets were pooled by the method of manipulation and outcome. The magnitude of secondary hypersensitivity was decreased by diverting attention, anodal transcranial direct current stimulation, or emotional disclosure; increased by directing attention toward the induction site, nicotine deprivation, or negative suggestion; and unaffected by cathodal transcranial direct current stimulation or thermal change. Area of secondary hypersensitivity was decreased by anodal transcranial direct current stimulation, emotional disclosure, cognitive behavioral therapy, hyperbaric oxygen therapy, placebo analgesia, or spinal manipulation; increased by directing attention to the induction site, nicotine deprivation, or sleep disruption (in males only); and unaffected by cathodal transcranial direct current stimulation, thermal change, acupuncture, or electroacupuncture. Meta-analytical pooling was only appropriate for studies that used transcranial direct current stimulation or hyperbaric oxygen therapy, given the high clinical heterogeneity among the studies and unavailability of data. The evidence base for this question remains small. We discuss opportunities to improve methodological rigor including manipulation checks, structured blinding strategies, control conditions or time points, and public sharing of raw data.
Perspective |
We described the effects of several non-pharmacological manipulations on experimentally induced secondary hypersensitivity in humans. By shedding light on the potential for non-pharmacological therapies to influence secondary hypersensitivity, it provides a foundation for the development and testing of targeted therapies for secondary hypersensitivity.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Systematic review including 27 studies with 847 pain-free human participants. |
• | Attention toward the induction increases; attention away decreases secondary hypersensitivity. |
• | Manipulations had consistent effects on both magnitude and area of secondary hypersensitivity. |
• | Enhance methodological rigor with manipulation checks, structured blinding, and control conditions. |
Key words : Secondary hyperalgesia, Hypersensitivity, Central senitization, Pain, Pinprick pain, Complementary therapies
Plan
| 1 | PROSPERO registration number: CRD42020146486. |
| GJB was supported by postgraduate scholarships from the University of Cape Town, Pain SA, and the South African Society of Physiotherapy, and a postgraduate Publication Incentive Award from the University of Cape Town. GJB is currently supported by postgraduate scholarships from the Oppenheimer Memorial Trust and the National Research Fund (South Africa). GJB receives payment for lectures on pain and rehabilitation. GJB has no conflicts of interest related to this work. PCC has no conflicts of interest related to this work. FS was supported as an intern by the National Research Foundation (South Africa). FS is supported by the postgraduate scholarship from the National Research Foundation (South Africa). FS has no conflicts of interest related to this work. LM receives financial support through a postgraduate scholarship from the University of Cape Town and the National Research Foundation (South Africa). LM has no conflicts of interest related to this work. ASCR has no conflicts of interest related to this work. PRK receives payment for consultancy work for Partners in Research, and is the owner of Blueprint Analytics. PRK has no conflicts of interest related to this work. RP receives payment for lectures on pain and rehabilitation. RP has no conflicts of interest related to this work. VJM was supported by the National Research Fund (South Africa) on 120414. VJM is currently supported by the US National Institutes of Health on TW011442. VJM receives payment for lectures on pain and rehabilitation. VJM has no conflicts of interest related to this work. |
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| Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com. |
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| Address reprint requests to Victoria J. Madden, Department of Anaesthesia and Perioperative Medicine, D23 Groote Schuur Hospital, UCT Faculty of Health Sciences, Anzio Rd, Observatory, 7925 Cape Town, South Africa. E-mail: torymadden@gmail.com. |
Vol 24 - N° 10
P. 1759-1797 - octobre 2023 Retour au numéro
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