European journal of pain : EJP
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Review Meta Analysis
Placebo effects in low back pain; a systematic review and meta-analysis of the literature.
The current treatments of primary musculoskeletal low back pain (LBP) have a low to moderate efficacy, which might be improved by looking at the contribution of placebo effects. However, the size of true placebo effects in LBP is unknown. Therefore, a systematic review and meta-analysis were executed of randomized controlled trials investigating placebo effects in LBP. ⋯ This systematic review and meta-analysis provides evidence of true placebo effects in low back pain (LBP). It shows a significant contribution of placebo effects to chronic LBP symptom relief. The results highlight the importance of patient- and context-related factors in fostering treatment effects in this patient group. New studies could provide insight into the potential value of actively making use of placebo effects in clinical practice.
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Review Meta Analysis
The effect of experimental and clinical musculoskeletal pain on spinal and supraspinal projections to motoneurons and motor unit properties in humans: a systematic review.
Numerous studies have examined the influence of pain on spinal reflex excitability, motor unit behaviour and corticospinal excitability. Nevertheless, there are inconsistencies in the conclusions made. This systematic review sought to understand the effect of pain on spinal and supraspinal projections to motoneurons and motor unit properties by examining the influence of clinical or experimental pain on the following three domains: H-reflex, corticospinal excitability and motor unit properties. ⋯ This is a comprehensive systematic review and meta-analysis which synthesizes evidence on the influence of pain on spinal and supraspinal projections to motoneurons and motor unit properties considering measures of the H-reflex, corticospinal excitability and motor unit behaviour. The H-reflex is largely not influenced by the presence of either clinical or experimental pain. Whilst inhibitory effects on corticospinal excitability and motor unit behaviour were evident under experimental pain conditions, more variable responses were observed for people with painful musculoskeletal disorders.
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Review Meta Analysis
Human surrogate models of central sensitization: a critical review and practical guide.
As in other fields of medicine, development of new medications for management of neuropathic pain has been difficult since preclinical rodent models do not necessarily translate to the clinics. Aside from ongoing pain with burning or shock-like qualities, neuropathic pain is often characterized by pain hypersensitivity (hyperalgesia and allodynia), most often towards mechanical stimuli, reflecting sensitization of neural transmission. ⋯ Being able to mimic aspects of pathological pain directly in humans has a huge potential to understand pathophysiology and provide animal research with translatable biomarkers for drug development. One group of human surrogate models has proven to have excellent predictive validity: they respond to clinically active medications and do not respond to clinically inactive medications, including some that worked in animals but failed in the clinics. They should therefore inform basic research for new drug development.
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Review Meta Analysis
The effect of experimental pain on the excitability of the corticospinal tract in humans: a systematic review and meta-analysis.
Pain influences motor control. Previous reviews observed that pain reduces the excitability of corticospinal projections to muscles tested with transcranial magnetic stimulation. However, the independent effect of the type of pain models (tonic, phasic), pain location and tissues targeted (e.g. muscle, skin) remains unexplored. The objective of this review was to determine the influence of experimental pain and of different methodological factors on the corticospinal excitability. ⋯ This study adds evidence on the effect of specific factors on the modulation of corticospinal excitability during/after experimental pain. The reduction in corticospinal excitability was driven by hand and face pain. We confirmed previous results that muscle pain reduces corticospinal excitability and provided evidence of a similar effect for cutaneous pain. Both models may inform on the influence of different types of pain on motor control. Future studies are needed to determine the origin of the effect of pain.
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Review Meta Analysis
A Systematic Review and Meta-analysis of Radiofrequency Procedures on Innervation to the Shoulder Joint for relieving Chronic Pain.
Studies have reported relief of chronic shoulder pain with non-ablative pulsed neuromodulatory (pRF) or ablative radiofrequency (aRF) procedures on innervation of the shoulder joint but interpretation of these reports is hampered by inconsistent indications, anatomic targets and follow-up. This systematic review was conducted to synthesize the existing literature on procedures employing pRF or aRF for treating chronic shoulder pain. ⋯ This is a comprehensive review of literature on pulsed (non-ablative) and ablative radiofrequency (RF) procedures for chronic shoulder pain. The systematic review and meta-analysis of 7 trials found that pulsed RF for chronic shoulder pain provided similar analgesia and functional improvement as conservative medical management at three months after the procedures. The case series and reports on ablative RF for shoulder pain indicate possible analgesic benefit but their quality was low. This review highlights the need for studies of a high quality on ablative RF treatments for chronic shoulder pain.