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Effect of a single session of muscle-biased therapy on pain sensitivity: a systematic review and meta-analysis of randomized controlled trials.

Gay CW, Alappattu MJ, Coronado RA, Horn ME, Bishop MD - J Pain Res (2013)

Bottom Line: Inadequate treatment parameters have been suggested to account for inconsistent effects across studies.Study results were pooled using a random-effects model to estimate the overall effect size of a single dose of MBT on pain sensitivity as well as the effect of MBT, dependent on comparison group and population type.The results suggest that MBT had a favorable effect on pressure pain thresholds when compared with no-treatment and sham/inert groups, and effects comparable with those of other active treatments.

View Article: PubMed Central - PubMed

Affiliation: Rehabilitation Science Doctoral Program, College of Public Health and Health Professions, Gainesville, FL.

ABSTRACT

Background: Muscle-biased therapies (MBT) are commonly used to treat pain, yet several reviews suggest evidence for the clinical effectiveness of these therapies is lacking. Inadequate treatment parameters have been suggested to account for inconsistent effects across studies. Pain sensitivity may serve as an intermediate physiologic endpoint helping to establish optimal MBT treatment parameters. The purpose of this review was to summarize the current literature investigating the short-term effect of a single dose of MBT on pain sensitivity in both healthy and clinical populations, with particular attention to specific MBT parameters of intensity and duration.

Methods: A systematic search for articles meeting our prespecified criteria was conducted using Cumulative Index to Nursing and Allied Health Literature (CINAHL) and MEDLINE from the inception of each database until July 2012, in accordance with guidelines from the Preferred Reporting Items for Systematic reviews and Meta-Analysis. Relevant characteristics from studies included type, intensity, and duration of MBT and whether short-term changes in pain sensitivity and clinical pain were noted with MBT application. Study results were pooled using a random-effects model to estimate the overall effect size of a single dose of MBT on pain sensitivity as well as the effect of MBT, dependent on comparison group and population type.

Results: Reports from 24 randomized controlled trials (23 articles) were included, representing 36 MBT treatment arms and 29 comparative groups, where 10 groups received active agents, 11 received sham/inert treatments, and eight received no treatment. MBT demonstrated a favorable and consistent ability to modulate pain sensitivity. Short-term modulation of pain sensitivity was associated with short-term beneficial effects on clinical pain. Intensity of MBT, but not duration, was linked with change in pain sensitivity. A meta-analysis was conducted on 17 studies that assessed the effect of MBT on pressure pain thresholds. The results suggest that MBT had a favorable effect on pressure pain thresholds when compared with no-treatment and sham/inert groups, and effects comparable with those of other active treatments.

Conclusion: The evidence supports the use of pain sensitivity measures by future research to help elucidate optimal therapeutic parameters for MBT as an intermediate physiologic marker.

No MeSH data available.


Related in: MedlinePlus

Flow chart of study identification, selection, and inclusion.Abbreviation: CINAHL, Cumulative Index to Nursing and Allied Health Literature.
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Related In: Results  -  Collection


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f1-jpr-6-007: Flow chart of study identification, selection, and inclusion.Abbreviation: CINAHL, Cumulative Index to Nursing and Allied Health Literature.

Mentions: We identified a total of 1084 articles from the systematic search of MEDLINE (n = 582) and CINAHL (n = 502), and nine articles from a review of reference lists. After removing duplicates, we screened and assessed 995 titles. Of these, we excluded 939 articles after title or abstract screening. We selected the full texts of 39 articles to be screened by two independent reviewers. Twenty-three studies were excluded based on study design,35 inability to compare the effects of a single session of MBT,36–52 intervention was not considered MBT,53–57 or no pain sensitivity measure.58–67 As a result, 23 articles representing 24 studies were identified as meeting the criterion for inclusion in this review. Figure 1 depicts a flow diagram of the study selection process with reasons for exclusion at each stage. Hou et al reported on two separate study designs that included separate samples, and both studies were included. Thirteen of the studies compared two groups.68–80 Nine of the studies compared three groups.28,81–87 Two studies compared six groups.88


Effect of a single session of muscle-biased therapy on pain sensitivity: a systematic review and meta-analysis of randomized controlled trials.

Gay CW, Alappattu MJ, Coronado RA, Horn ME, Bishop MD - J Pain Res (2013)

Flow chart of study identification, selection, and inclusion.Abbreviation: CINAHL, Cumulative Index to Nursing and Allied Health Literature.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3569047&req=5

f1-jpr-6-007: Flow chart of study identification, selection, and inclusion.Abbreviation: CINAHL, Cumulative Index to Nursing and Allied Health Literature.
Mentions: We identified a total of 1084 articles from the systematic search of MEDLINE (n = 582) and CINAHL (n = 502), and nine articles from a review of reference lists. After removing duplicates, we screened and assessed 995 titles. Of these, we excluded 939 articles after title or abstract screening. We selected the full texts of 39 articles to be screened by two independent reviewers. Twenty-three studies were excluded based on study design,35 inability to compare the effects of a single session of MBT,36–52 intervention was not considered MBT,53–57 or no pain sensitivity measure.58–67 As a result, 23 articles representing 24 studies were identified as meeting the criterion for inclusion in this review. Figure 1 depicts a flow diagram of the study selection process with reasons for exclusion at each stage. Hou et al reported on two separate study designs that included separate samples, and both studies were included. Thirteen of the studies compared two groups.68–80 Nine of the studies compared three groups.28,81–87 Two studies compared six groups.88

Bottom Line: Inadequate treatment parameters have been suggested to account for inconsistent effects across studies.Study results were pooled using a random-effects model to estimate the overall effect size of a single dose of MBT on pain sensitivity as well as the effect of MBT, dependent on comparison group and population type.The results suggest that MBT had a favorable effect on pressure pain thresholds when compared with no-treatment and sham/inert groups, and effects comparable with those of other active treatments.

View Article: PubMed Central - PubMed

Affiliation: Rehabilitation Science Doctoral Program, College of Public Health and Health Professions, Gainesville, FL.

ABSTRACT

Background: Muscle-biased therapies (MBT) are commonly used to treat pain, yet several reviews suggest evidence for the clinical effectiveness of these therapies is lacking. Inadequate treatment parameters have been suggested to account for inconsistent effects across studies. Pain sensitivity may serve as an intermediate physiologic endpoint helping to establish optimal MBT treatment parameters. The purpose of this review was to summarize the current literature investigating the short-term effect of a single dose of MBT on pain sensitivity in both healthy and clinical populations, with particular attention to specific MBT parameters of intensity and duration.

Methods: A systematic search for articles meeting our prespecified criteria was conducted using Cumulative Index to Nursing and Allied Health Literature (CINAHL) and MEDLINE from the inception of each database until July 2012, in accordance with guidelines from the Preferred Reporting Items for Systematic reviews and Meta-Analysis. Relevant characteristics from studies included type, intensity, and duration of MBT and whether short-term changes in pain sensitivity and clinical pain were noted with MBT application. Study results were pooled using a random-effects model to estimate the overall effect size of a single dose of MBT on pain sensitivity as well as the effect of MBT, dependent on comparison group and population type.

Results: Reports from 24 randomized controlled trials (23 articles) were included, representing 36 MBT treatment arms and 29 comparative groups, where 10 groups received active agents, 11 received sham/inert treatments, and eight received no treatment. MBT demonstrated a favorable and consistent ability to modulate pain sensitivity. Short-term modulation of pain sensitivity was associated with short-term beneficial effects on clinical pain. Intensity of MBT, but not duration, was linked with change in pain sensitivity. A meta-analysis was conducted on 17 studies that assessed the effect of MBT on pressure pain thresholds. The results suggest that MBT had a favorable effect on pressure pain thresholds when compared with no-treatment and sham/inert groups, and effects comparable with those of other active treatments.

Conclusion: The evidence supports the use of pain sensitivity measures by future research to help elucidate optimal therapeutic parameters for MBT as an intermediate physiologic marker.

No MeSH data available.


Related in: MedlinePlus