Pain mechanisms in complex regional pain syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomes
Abstract Background Complex regional pain syndrome (CRPS) is a chronic condition following inciting events such as fractures or surgeries with sensorimotor and autonomic manifestations and poor prognosis. This review aimed to provide conclusive evidence about the sensory phenotype of CRPS based on q...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-01-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13018-022-03461-2 |
| _version_ | 1797958559248416768 |
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| author | Mohamed Gomaa Sobeeh Karima Abdelaty Hassan Anabela Gonçalves da Silva Enas Fawzy Youssef Nadia Abdelazim Fayaz Maha Mostafa Mohammed |
| author_facet | Mohamed Gomaa Sobeeh Karima Abdelaty Hassan Anabela Gonçalves da Silva Enas Fawzy Youssef Nadia Abdelazim Fayaz Maha Mostafa Mohammed |
| author_sort | Mohamed Gomaa Sobeeh |
| collection | DOAJ |
| description | Abstract Background Complex regional pain syndrome (CRPS) is a chronic condition following inciting events such as fractures or surgeries with sensorimotor and autonomic manifestations and poor prognosis. This review aimed to provide conclusive evidence about the sensory phenotype of CRPS based on quantitative sensory testing (QST) to understand the underlying pain mechanisms and guide treatment strategies. Databases Eight databases were searched based on a previously published protocol. Forty studies comparing QST outcomes (thermal, mechanical, vibration, and electric detection thresholds, thermal, mechanical, pressure, and electric pain thresholds, wind-up ratio, mechanical pain sensitivity, allodynia, flare area, area after pinprick hyperalgesia, pleasantness after C-tactile stimulation, and pain ratings) in chronic CRPS (adults and children) versus healthy controls were included. Results From 37 studies (14 of low quality, 22 of fair quality, and 1 of good quality), adults with CRPS showed: (i) significant loss of thermal, mechanical, and vibration sensations, significant gain of thermal and mechanical pain thresholds, significant elevation of pain ratings, and no difference in wind-up ratio; (ii) significant reduction of pleasantness levels and increased area of pinprick hyperalgesia, in the affected limb. From three fair-quality studies, adolescents and children with CRPS showed loss of cold detection with cold hyperalgesia in the affected limb. There was moderate to substantial overall heterogeneity. Conclusion Diffuse thermal and mechanical hypoesthesia with primary and secondary hyperalgesia, enhanced pain facilitation evidenced by increased area of pinprick hyperalgesia, and elevated pain ratings are dominant in adults with CRPS. Adolescents and children with CRPS showed less severe sensory abnormalities. |
| first_indexed | 2024-04-11T00:20:41Z |
| format | Article |
| id | doaj.art-5a71d5dc95a64f9b9e247a57b805014e |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-11T00:20:41Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-5a71d5dc95a64f9b9e247a57b805014e2023-01-08T12:16:40ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2023-01-0118114210.1186/s13018-022-03461-2Pain mechanisms in complex regional pain syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomesMohamed Gomaa Sobeeh0Karima Abdelaty Hassan1Anabela Gonçalves da Silva2Enas Fawzy Youssef3Nadia Abdelazim Fayaz4Maha Mostafa Mohammed5Department of Physical Therapy for Musculoskeletal Disorders and its Surgeries, Faculty of Physical Therapy, Cairo UniversityDepartment of Physical Therapy for Musculoskeletal Disorders and its Surgeries, Faculty of Physical Therapy, Cairo UniversityCINTESIS.UA@RISE, School of Health Sciences, University of AveiroDepartment of Physical Therapy for Musculoskeletal Disorders and its Surgeries, Faculty of Physical Therapy, Cairo UniversityDepartment of Physical Therapy for Musculoskeletal Disorders and its Surgeries, Faculty of Physical Therapy, Cairo UniversityDepartment of Physical Therapy for Musculoskeletal Disorders and its Surgeries, Faculty of Physical Therapy, Cairo UniversityAbstract Background Complex regional pain syndrome (CRPS) is a chronic condition following inciting events such as fractures or surgeries with sensorimotor and autonomic manifestations and poor prognosis. This review aimed to provide conclusive evidence about the sensory phenotype of CRPS based on quantitative sensory testing (QST) to understand the underlying pain mechanisms and guide treatment strategies. Databases Eight databases were searched based on a previously published protocol. Forty studies comparing QST outcomes (thermal, mechanical, vibration, and electric detection thresholds, thermal, mechanical, pressure, and electric pain thresholds, wind-up ratio, mechanical pain sensitivity, allodynia, flare area, area after pinprick hyperalgesia, pleasantness after C-tactile stimulation, and pain ratings) in chronic CRPS (adults and children) versus healthy controls were included. Results From 37 studies (14 of low quality, 22 of fair quality, and 1 of good quality), adults with CRPS showed: (i) significant loss of thermal, mechanical, and vibration sensations, significant gain of thermal and mechanical pain thresholds, significant elevation of pain ratings, and no difference in wind-up ratio; (ii) significant reduction of pleasantness levels and increased area of pinprick hyperalgesia, in the affected limb. From three fair-quality studies, adolescents and children with CRPS showed loss of cold detection with cold hyperalgesia in the affected limb. There was moderate to substantial overall heterogeneity. Conclusion Diffuse thermal and mechanical hypoesthesia with primary and secondary hyperalgesia, enhanced pain facilitation evidenced by increased area of pinprick hyperalgesia, and elevated pain ratings are dominant in adults with CRPS. Adolescents and children with CRPS showed less severe sensory abnormalities.https://doi.org/10.1186/s13018-022-03461-2Complex regional pain syndromeSensory profilePain mechanismsQuantitative sensory testing |
| spellingShingle | Mohamed Gomaa Sobeeh Karima Abdelaty Hassan Anabela Gonçalves da Silva Enas Fawzy Youssef Nadia Abdelazim Fayaz Maha Mostafa Mohammed Pain mechanisms in complex regional pain syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomes Journal of Orthopaedic Surgery and Research Complex regional pain syndrome Sensory profile Pain mechanisms Quantitative sensory testing |
| title | Pain mechanisms in complex regional pain syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomes |
| title_full | Pain mechanisms in complex regional pain syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomes |
| title_fullStr | Pain mechanisms in complex regional pain syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomes |
| title_full_unstemmed | Pain mechanisms in complex regional pain syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomes |
| title_short | Pain mechanisms in complex regional pain syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomes |
| title_sort | pain mechanisms in complex regional pain syndrome a systematic review and meta analysis of quantitative sensory testing outcomes |
| topic | Complex regional pain syndrome Sensory profile Pain mechanisms Quantitative sensory testing |
| url | https://doi.org/10.1186/s13018-022-03461-2 |
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