Reliability of conditioned pain modulation: a systematic review

Donna L Kennedy, Harriet I Kemp, Deborah Ridout, David Yarnitsky, Andrew S C Rice, Donna L Kennedy, Harriet I Kemp, Deborah Ridout, David Yarnitsky, Andrew S C Rice

Abstract

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.

Conflict of interest statement

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

Figures

Figure 1.
Figure 1.
Study flow diagram. CPM, conditioned pain modulation.
Figure 2.
Figure 2.
Risk of bias in study confounding and reliability. The ICC is the highest reported reliability coefficient for CPM effect. For risk of bias score, 1 = low risk; 2 = moderate risk; and 3 = high risk. CPM, conditioned pain modulation; ICC, intraclass correlation coefficient.

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Source: PubMed

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