Papers of the Week

In patients with neck pain, it is unclear whether pain inhibition and facilitation endogenous pain mechanisms are altered. This systematic review and meta-analysis aimed improve their understanding by assessing conditioned pain modulation (CPM) and temporal summation of pain (TSP) in patients with neck pain associated with whiplash (WAD) or of a non-specific (NSNP) nature compared to pain-free controls. Very low certainty evidence suggests: impaired CPM when assessed remotely in chronic WAD patients (n = 7; 230 patients and 204 controls; SMD = -0.47 [-0.89 to -0.04]; P = 0.04) but not locally (n = 6; 155 patients and 150 controls; SMD = -0.34 [-0.68 to 0.01]; P = 0.05), impaired CPM in chronic NSNP patients when assessed locally (n = 5; 223 patients and 162 controls; SMD = -0.55 [-1.04 to -0.06]; P = 0.04) but not remotely (n = 3; 72 patients and 66 controls; SMD = -0.33 [-0.92 to 0.25]; P = 0.13), TSP not facilitated in either chronic WAD (local TSP: n = 4; 90 patients and 87 controls; SMD = 0.68 [-0.62 to 1.99]) (remote TSP: n = 8; 254 patients and 214 controls; SMD = 0.18 [-0.12 to 0.48]) or chronic NSNP (local TSP: n = 2; 139 patients and 92 controls; SMD = 0.21 [-1.00 to 1.41]), (remote TSP: n = 3; 91 patients and 352 controls; SMD = 0.60 [-1.33 to 2.52]). The evidence is very uncertain whether CPM is impaired and TSP facilitated in patients with WAD and NSNP. PERSPECTIVE: This review and meta-analysis presents the current evidence on CPM and TSP in patients with WAD and NSNP. Standardization of measurement methodology is needed to draw clear conclusions. Subsequently, future studies should investigate the clinical relevance of these measurements as prognostic variables or predictors of treatment success.