Journal
PAIN
Volume 157, Issue 11, Pages 2410-2419Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/j.pain.0000000000000689
Keywords
Conditioned pain modulation (CPM); Diffuse noxious inhibitory control (DNIC); Endogenous pain modulation; Reliability; Systematic review
Categories
Funding
- National Institute for Health Research
- Health Education England Clinical Doctoral Research Fellowship
- European Commission NeuroPain FP7 Grant EC [2013-602891]
- Health Education England
- DOLORisk
- European Union Horizon research and innovation programme [633491]
- H2020 Societal Challenges Programme [633491] Funding Source: H2020 Societal Challenges Programme
- National Institutes of Health Research (NIHR) [CDRF-2013-04-009] Funding Source: National Institutes of Health Research (NIHR)
- National Institute for Health Research [CDRF-2013-04-009] Funding Source: researchfish
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A systematic literature review was undertaken to determine if conditioned pain modulation (CPM) is reliable. Longitudinal, English language observational studies of the repeatability of a CPM test paradigm in adult humans were included. Two independent reviewers assessed the risk of bias in 6 domains; study participation; study attrition; prognostic factor measurement; outcome measurement; confounding and analysis using the Quality in Prognosis Studies (QUIPS) critical assessment tool. Intraclass correlation coefficients (ICCs) less than 0.4 were considered to be poor; 0.4 and 0.59 to be fair; 0.6 and 0.75 good and greater than 0.75 excellent. Ten studies were included in the final review. Meta-analysis was not appropriate because of differences between studies. The intersession reliability of the CPM effect was investigated in 8 studies and reported as good (ICC = 0.6-0.75) in 3 studies and excellent (ICC > 0.75) in subgroups in 2 of those 3. The assessment of risk of bias demonstrated that reporting is not comprehensive for the description of sample demographics, recruitment strategy, and study attrition. The absence of blinding, a lack of control for confounding factors, and lack of standardisation in statistical analysis are common. Conditioned pain modulation is a reliable measure; however, the degree of reliability is heavily dependent on stimulation parameters and study methodology and this warrants consideration for investigators. The validation of CPM as a robust prognostic factor in experimental and clinical pain studies may be facilitated by improvements in the reporting of CPM reliability studies.
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