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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

Forest plot depicting subgroup effect of MBT based on type of sample population.Notes: Open diamond depicts overall effect size across all studies included in this subgroup analysis. Colored diamonds depict subgroup effect size based on type of comparison group. For example, top colored diamond is effect size for MBT studies with clinical samples. The width of diamond corresponds to its 95% CI (listed in figure). Individual study effect sizes (and 95% CI) are depicted with boxes (whiskers). Box and whisker size and thickness for each individual study illustrate the weighted contribution of that study to the overall effect size (eg, larger boxes/thicker lines contribute more to overall effect size). aSham comparison; bcontrol comparison; cactive comparison.Abbreviations: CI, confidence interval; MBT, muscle-biased therapy.
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f3-jpr-6-007: Forest plot depicting subgroup effect of MBT based on type of sample population.Notes: Open diamond depicts overall effect size across all studies included in this subgroup analysis. Colored diamonds depict subgroup effect size based on type of comparison group. For example, top colored diamond is effect size for MBT studies with clinical samples. The width of diamond corresponds to its 95% CI (listed in figure). Individual study effect sizes (and 95% CI) are depicted with boxes (whiskers). Box and whisker size and thickness for each individual study illustrate the weighted contribution of that study to the overall effect size (eg, larger boxes/thicker lines contribute more to overall effect size). aSham comparison; bcontrol comparison; cactive comparison.Abbreviations: CI, confidence interval; MBT, muscle-biased therapy.

Mentions: The same 17 studies were able to be stratified by comparison group and the results are depicted in Figure 2. Five studies included comparisons of MBT with active treatment (I2 = 45.2%, P = 0.12), ten with sham treatment (I2 = 0.0%, P = 0.55), and eight with no-treatment controls (I2 = 60.4%, P < 0.05). A small, favorable effect on increasing pressure pain thresholds was observed when MBT was compared with sham treatments (Hedges g = 0.268 [95% CI 0.078–0.457], P < 0.05) and a small-to-moderate, favorable effect when compared with no-treatment controls (Hedges g = 0.471 [95% CI 0.113–0.830], P < 0.05). No favorable effect was observed when MBT was compared with other active interventions (Hedges g = 0.036 [95% CI −0.289–0.362], P = 0.83). Twelve of the 17 studies were stratified based on sample population and the results are depicted in Figure 3. Five studies were removed because they included individuals with induced pain (eg, delayed-onset muscle soreness) or nonclinical trigger points. Ten studies examined the effect of MBT on pressure pain threshold responses in clinical participants (I2 = 66.0%, P < 0.05), while five studies examined these effects in healthy participants (I2 = 0.0%, P = 0.41). A small-to-moderate, favorable effect on increasing pressure pain thresholds following MBT was seen in studies with clinical participants (Hedges g = 0.454 [95% CI 0.112–0.796], P < 0.05). A small, favorable effect was seen in studies with healthy participants (Hedges g = 0.205 [95% CI −0.036–0.445], P = 0.10), but was not statistically significant.


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)

Forest plot depicting subgroup effect of MBT based on type of sample population.Notes: Open diamond depicts overall effect size across all studies included in this subgroup analysis. Colored diamonds depict subgroup effect size based on type of comparison group. For example, top colored diamond is effect size for MBT studies with clinical samples. The width of diamond corresponds to its 95% CI (listed in figure). Individual study effect sizes (and 95% CI) are depicted with boxes (whiskers). Box and whisker size and thickness for each individual study illustrate the weighted contribution of that study to the overall effect size (eg, larger boxes/thicker lines contribute more to overall effect size). aSham comparison; bcontrol comparison; cactive comparison.Abbreviations: CI, confidence interval; MBT, muscle-biased therapy.
© Copyright Policy
Related In: Results  -  Collection

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

f3-jpr-6-007: Forest plot depicting subgroup effect of MBT based on type of sample population.Notes: Open diamond depicts overall effect size across all studies included in this subgroup analysis. Colored diamonds depict subgroup effect size based on type of comparison group. For example, top colored diamond is effect size for MBT studies with clinical samples. The width of diamond corresponds to its 95% CI (listed in figure). Individual study effect sizes (and 95% CI) are depicted with boxes (whiskers). Box and whisker size and thickness for each individual study illustrate the weighted contribution of that study to the overall effect size (eg, larger boxes/thicker lines contribute more to overall effect size). aSham comparison; bcontrol comparison; cactive comparison.Abbreviations: CI, confidence interval; MBT, muscle-biased therapy.
Mentions: The same 17 studies were able to be stratified by comparison group and the results are depicted in Figure 2. Five studies included comparisons of MBT with active treatment (I2 = 45.2%, P = 0.12), ten with sham treatment (I2 = 0.0%, P = 0.55), and eight with no-treatment controls (I2 = 60.4%, P < 0.05). A small, favorable effect on increasing pressure pain thresholds was observed when MBT was compared with sham treatments (Hedges g = 0.268 [95% CI 0.078–0.457], P < 0.05) and a small-to-moderate, favorable effect when compared with no-treatment controls (Hedges g = 0.471 [95% CI 0.113–0.830], P < 0.05). No favorable effect was observed when MBT was compared with other active interventions (Hedges g = 0.036 [95% CI −0.289–0.362], P = 0.83). Twelve of the 17 studies were stratified based on sample population and the results are depicted in Figure 3. Five studies were removed because they included individuals with induced pain (eg, delayed-onset muscle soreness) or nonclinical trigger points. Ten studies examined the effect of MBT on pressure pain threshold responses in clinical participants (I2 = 66.0%, P < 0.05), while five studies examined these effects in healthy participants (I2 = 0.0%, P = 0.41). A small-to-moderate, favorable effect on increasing pressure pain thresholds following MBT was seen in studies with clinical participants (Hedges g = 0.454 [95% CI 0.112–0.796], P < 0.05). A small, favorable effect was seen in studies with healthy participants (Hedges g = 0.205 [95% CI −0.036–0.445], P = 0.10), but was not statistically significant.

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