Conditioned pain modulation (CPM) is reduced in irritable bowel syndrome: a systematic review and meta-analysis of CPM and the role of psychological factors

Anna Marcuzzi, Rosemary J. Chakiath, Philip J. Siddall, John E. Kellow, Julia M. Hush, Michael P. Jones, Daniel S. J. Costa, Paul J. Wrigley

Research output: Contribution to journalReview articleResearchpeer-review

Abstract

This systematic review summarises evidence assessing endogenous pain inhibition in people with irritable bowel syndrome (IBS) compared with healthy controls using conditioned pain modulation (CPM) and offset analgesia (OA). Evidence regarding the role of psychological variables is also examined. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Four electronic databases were searched to retrieve studies assessing CPM or OA in adults diagnosed with IBS according to the ROME II/III criteria. Standardized mean differences were calculated for each study and a random effects model was used for meta-analysis. Eleven studies were included, 5 of which reported results on the relationship between CPM and psychological variables. None of the studies assessed OA. The risk of bias assessment found a lack of assessor blinding in all studies. The pooled effect estimate was 0.90 (95% CI, 0.40-1.40) indicating a significantly lower CPM effect in people with IBS compared with controls. This effect was reduced to 0.51 when 1 outlier was excluded from the analysis. In addition, reduced CPM responses were significantly correlated with higher anxiety (r= 0.17 to 0.64), stress (r=0.63), and pain catastrophizing (r=0.38) in people with IBS; however, the evidence available was limited and the strength of these associations variable. Depression was not found to be associated with CPM in these IBS cohorts. The results of this review suggest that people with IBS, as a group, demonstrate reduced pain inhibition measured by CPM. The preliminary evidence about the association between psychological factors and CPM warrants further investigations.

LanguageEnglish
Pages399-408
Number of pages10
JournalJournal of Clinical Gastroenterology
Volume53
Issue number6
DOIs
Publication statusPublished - 1 Jul 2019

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Irritable Bowel Syndrome
Meta-Analysis
Psychology
Pain
Analgesia
Catastrophization
Anxiety
Databases
Depression

Keywords

  • conditioned pain modulation
  • irritable bowel syndrome
  • pain inhibition
  • psychological factors

Cite this

Marcuzzi, Anna ; Chakiath, Rosemary J. ; Siddall, Philip J. ; Kellow, John E. ; Hush, Julia M. ; Jones, Michael P. ; Costa, Daniel S. J. ; Wrigley, Paul J. / Conditioned pain modulation (CPM) is reduced in irritable bowel syndrome : a systematic review and meta-analysis of CPM and the role of psychological factors. In: Journal of Clinical Gastroenterology. 2019 ; Vol. 53, No. 6. pp. 399-408.
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Conditioned pain modulation (CPM) is reduced in irritable bowel syndrome : a systematic review and meta-analysis of CPM and the role of psychological factors. / Marcuzzi, Anna; Chakiath, Rosemary J.; Siddall, Philip J.; Kellow, John E.; Hush, Julia M.; Jones, Michael P.; Costa, Daniel S. J.; Wrigley, Paul J.

In: Journal of Clinical Gastroenterology, Vol. 53, No. 6, 01.07.2019, p. 399-408.

Research output: Contribution to journalReview articleResearchpeer-review

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