Modulación endógena del dolor en el dolor orofacial crónico: revisión sistemática y metaanálisis.: Publicado originalmente en la Revista Pain. 2018 Aug;159(8):1441-1455. Traducción: Nicolás E. Barbosa.

Estephan J. Moana-Filho; Alberto Herrero Babiloni; Nicole R. Theis-Mahon

doi:10.47924/neurotarget201940

Autores/as

Estephan J. Moana-Filho División de TTM y Dolor Orofacial, Facultad de Odontología, Universidad de Minnesota, Minneapolis, MN, Estados Unidos.
Alberto Herrero Babiloni Facultad de Odontología, Université de Montréal CIUSSS Nord Ile Montreal -Hôpital du Sacré-Coeur de Montréal.
Nicole R. Theis-Mahon Bibliotecas de Ciencias de la Salud, Universidad de Minnesota, Minneapolis, MN, Estados Unidos.

DOI:

https://doi.org/10.47924/neurotarget201940

Palabras clave:

Modulación del dolor endógeno, Dolor orofacial crónico, Sumatoria temporal del dolor, Modulación del dolor condicionado, Metaanálisis

Resumen

Se sugirió a la modulación anormal endógena del dolor como un mecanismo potencial para el dolor crónico, es decir, mayor facilitación del dolor y / o alteración de la inhibición del dolor en la manifestación de los síntomas subyacentes. La función de modulación endógena del dolor puede ser testeada utilizando métodos psicofísicos como la suma temporal del dolor (TSP) y la modulación condicionada del dolor (CPM), que evalúan la facilitación y la inhibición del dolor, respectivamente. Varios estudios han investigado la función de modulación endogena del dolor en pacientes con dolor orofacial no paroxístico (OFP) y han informado resultados mixtos. Este estudio tuvo como objetivo proporcionar, a través de una síntesis cualitativa y cuantitativa de la literatura disponible, estimaciones generales para las respuestas de TSP / CPM en pacientes con OFP en relación con los controles. Se realizaron búsquedas en las bases de datos MEDLINE, Embase y Cochrane, y 2 evaluadores examinaron las referencias de forma independiente. Se incluyeron 26 estudios para la revisión cualitativa y 22 estudios se incluyeron para el metaanálisis. Se utilizaron el metaanálisis tradicional y la estimación robusta de la varianza para sintetizar las estimaciones generales de la diferencia de medias estandarizada. La estimación estandarizada general para TSP fue de 0.30 (intervalo de confianza del 95%: 0.11-0.49; P = 0.002), con una heterogeneidad moderada entre los estudios [Q (df = 17) = 41.8, P = 0.001; I2 = 70.2%]. El tamaño estimado del efecto global de la modulación del dolor condicionado fue grande pero por encima del umbral de significación (estimación = 1,36; intervalo de confianza del 95%: - 0.09 a 2.81; P = 0.066), con una heterogeneidad muy grande [Q (df = 8) =108.3, P < 0.001 ; l2 = 98.0%]. Los análisis de sensibilidad no afectaron la estimación general de TSP; para CPM, la estimación general se volvió significativa si se usaban modelos específicos de efectos aleatorios o si se eliminaba el estudio más influyente. El sesgo de publicación no estuvo presente en los estudios de TSP, mientras que influyó sustancialmente en la estimación general de CPM. Estos resultados sugieren una mayor facilitación del dolor y una tendencia al deterioro de la inhibición del dolor en pacientes con OFP no paroxística.

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