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Endogenous pain modulation in chronic orofacial pain

a systematic review and meta-analysis

Moana-Filho, Estephan J.a,*; Herrero Babiloni, Albertob; Theis-Mahon, Nicole R.c

doi: 10.1097/j.pain.0000000000001263
Systematic Review and Meta-Analysis
Global Year 2018

Abnormal endogenous pain modulation was suggested as a potential mechanism for chronic pain, ie, increased pain facilitation and/or impaired pain inhibition underlying symptoms manifestation. Endogenous pain modulation function can be tested using psychophysical methods such as temporal summation of pain (TSP) and conditioned pain modulation (CPM), which assess pain facilitation and inhibition, respectively. Several studies have investigated endogenous pain modulation function in patients with nonparoxysmal orofacial pain (OFP) and reported mixed results. This study aimed to provide, through a qualitative and quantitative synthesis of the available literature, overall estimates for TSP/CPM responses in patients with OFP relative to controls. MEDLINE, Embase, and the Cochrane databases were searched, and references were screened independently by 2 raters. Twenty-six studies were included for qualitative review, and 22 studies were included for meta-analysis. Traditional meta-analysis and robust variance estimation were used to synthesize overall estimates for standardized mean difference. The overall standardized estimate for TSP was 0.30 (95% confidence interval: 0.11-0.49; P = 0.002), with moderate between-study heterogeneity (Q [df = 17] = 41.8, P = 0.001; I2 = 70.2%). Conditioned pain modulation's estimated overall effect size was large but above the significance threshold (estimate = 1.36; 95% confidence interval: −0.09 to 2.81; P = 0.066), with very large heterogeneity (Q [df = 8] = 108.3, P < 0.001; I2 = 98.0%). Sensitivity analyses did not affect the overall estimate for TSP; for CPM, the overall estimate became significant if specific random-effect models were used or if the most influential study was removed. Publication bias was not present for TSP studies, whereas it substantially influenced CPM's overall estimate. These results suggest increased pain facilitation and trend for pain inhibition impairment in patients with nonparoxysmal OFP.

aDivision of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, MN, United States

bFaculty of Dental Medicine, Université de Montréal; CIUSSS Nord Ile Montreal -Hôpital du Sacré-Coeur de Montréal; CEAMS E-1300, 5400 Boul Gouin O. Montréal, Canada

cHealth Sciences Libraries, University of Minnesota, Minneapolis, MN, United States

Corresponding author. Address: Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, 6-320d Moos Tower, 515 Delaware St SE, Minneapolis, MN 55455, United States. Tel.: +1 (612) 624-3338; fax: +1 (612) 626-0138. E-mail address: (E.J. Moana-Filho).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

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Received March 12, 2018

Received in revised form April 09, 2018

Accepted April 23, 2018

© 2018 International Association for the Study of Pain
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