Central hyperexcitabiity as measured with nociceptive flexor reflex threshod in chronic musculoskeletal pain: A systematic review

Lim, Edwin Choon Wyn, Sterling, Michele, Stone, Andrew and Vicenzino, Bill (2011) Central hyperexcitabiity as measured with nociceptive flexor reflex threshod in chronic musculoskeletal pain: A systematic review. Pain, 152 8: 1811-1820. doi:10.1016/j.pain.2011.03.033


Author Lim, Edwin Choon Wyn
Sterling, Michele
Stone, Andrew
Vicenzino, Bill
Title Central hyperexcitabiity as measured with nociceptive flexor reflex threshod in chronic musculoskeletal pain: A systematic review
Journal name Pain   Check publisher's open access policy
ISSN 0304-3959
1872-6623
Publication date 2011-08
Sub-type Article (original research)
DOI 10.1016/j.pain.2011.03.033
Volume 152
Issue 8
Start page 1811
End page 1820
Total pages 10
Place of publication Amsterdam, Netherlands
Publisher Elsevier BV
Collection year 2012
Language eng
Formatted abstract
Chronic musculoskeletal conditions are increasingly conceived as involving altered central nervous system processing, and impaired nociceptive flexor reflex (NFR) appears to reflect altered central nervous system processing. The primary objective was to synthesize the evidence for impaired NFR in these conditions. The secondary objective was to evaluate the NFR stimuli parameters employed by reviewed studies. Electronic databases: MEDLINE, CINAHL, Embase, PEDro, Google Scholar, and Cochrane library were searched from the mid-1960s to June 2010. Experimental reports were systematically reviewed and meta-analysis (where possible) was performed. NFR thresholds and parameters of NFR stimuli were extracted. Sixteen trials were identified, 11 of which were suitable for inclusion in the meta-analysis. Compared to healthy controls, standardized mean differences in NFR threshold were significantly lower in subjects with primary headache (−0.45; 95% confidence interval [CI] −0.77 to −0.13, P = 0.005), fibromyalgia (−0.63; 95% CI −0.93 to −0.34, P < 0.0001), knee pain (−1.51; 95% CI −2.10 to −0.93, P < 0.00001) and whiplash (−0.73; 95% CI −1.11 to −0.35, P = 0.0002). Employed stimuli parameters vary between studies, with inter-pulse duration (P = 0.044) being identified by multiple regression analysis as independent predictors of the variability in NFR threshold in healthy controls. The results indicate that there is evidence of central hyperexcitability in people with chronic musculoskeletal pain. Our review also suggests that shorter inter-pulse duration tends to yield smaller variability in NFR threshold. However, further research investigating optimal stimulation parameters is still warranted.
Keyword Nociceptive flexion reflex
RIII
Musculoskeletal disorder
Pain
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Available online 27 April 2011.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2012 Collection
School of Health and Rehabilitation Sciences Publications
School of Medicine Publications
 
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Created: Thu, 23 Jun 2011, 09:59:24 EST by Chesne McGrath on behalf of Medicine - Royal Brisbane and Women's Hospital