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The effect of experimental and clinical musculoskeletal pain on spinal and supraspinal projections to motoneurons and motor unit properties in humans: A systematic review

Sanderson, Andy and Wang, Shuwfen F and Elgueta‐Cancino, Edith and Martinez‐Valdes, Eduardo and Sanchis‐Sanchez, Enrique and Liew, Bernard and Falla, Deborah (2021) 'The effect of experimental and clinical musculoskeletal pain on spinal and supraspinal projections to motoneurons and motor unit properties in humans: A systematic review.' European Journal of Pain. ISSN 1090-3801

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Abstract

Background and Objective Numerous studies have examined the influence of pain on spinal reflex excitability, motor unit behaviour and corticospinal excitability. Nevertheless, there are inconsistencies in the conclusions made. This systematic review sought to understand the effect of pain on spinal and supraspinal projections to motoneurons and motor unit properties by examining the influence of clinical or experimental pain on the following three domains: H-reflex, corticospinal excitability and motor unit properties. Databases and Data Treatment MeSH terms and preselected keywords relating to the H-reflex, motor evoked potentials and motor unit decomposition in chronic and experimental pain were used to perform a systematic literature search using Cumulative Index of Nursing and Allied Health Literature (CINAHL), Excerpta Medica dataBASE (EMBASE), Web of Science, Medline, Google Scholar and Scopus databases. Two independent reviewers screened papers for inclusion and assessed the methodological quality using a modified Downs and Black risk of bias tool; a narrative synthesis and three meta-analyses were performed. Results Sixty-one studies were included, and 17 different outcome variables were assessed across the three domains. Both experimental and clinical pain have no major influence on measures of the H-reflex, whereas experimental and clinical pain appeared to have differing effects on corticospinal excitability. Experimental pain consistently reduced motor unit discharge rate, a finding which was not consistent with data obtained from patients. The results indicate that when in tonic pain, induced via experimental pain models, inhibitory effects on motoneuron behaviour were evident. However, in chronic clinical pain populations, more varied responses were evident likely reflecting individual adaptations to chronic symptoms. Significance This is a comprehensive systematic review and meta-analysis which synthesizes evidence on the influence of pain on spinal and supraspinal projections to motoneurons and motor unit properties considering measures of the H-reflex, corticospinal excitability and motor unit behaviour. The H-reflex is largely not influenced by the presence of either clinical or experimental pain. Whilst inhibitory effects on corticospinal excitability and motor unit behaviour were evident under experimental pain conditions, more variable responses were observed for people with painful musculoskeletal disorders.

Item Type: Article
Divisions: Faculty of Science and Health > Sport, Rehabilitation and Exercise Sciences, School of
Depositing User: Elements
Date Deposited: 05 Jul 2021 07:58
Last Modified: 05 Jul 2021 07:58
URI: http://repository.essex.ac.uk/id/eprint/30700

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