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  • Central hyperexcitability as measured with nociceptive flexor reflex threshold in chronic musculoskeletal pain: A systematic review

    Author(s)
    Lim, Edwin Choon Wyn
    Sterling, Michele
    Stone, Andrew
    Vicenzino, Bill
    Griffith University Author(s)
    Sterling, Michele
    Year published
    2011
    Metadata
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    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) ...
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    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.
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    Journal Title
    Pain
    Volume
    152
    Issue
    8
    DOI
    https://doi.org/10.1016/j.pain.2011.03.033
    Subject
    Biomedical and clinical sciences
    Clinical sciences not elsewhere classified
    Psychology
    Publication URI
    http://hdl.handle.net/10072/60861
    Collection
    • Journal articles

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