Signs Of Central Sensitization In Patients With Musculoskeletal Disorders And Chronic Comorbidities: A Systematic Review And Meta-Analyses Of Observational Studies

Objectivesthis review aimed to investigate the presence of signs of central sensitization in patients with musculoskeletal disorders and associated chronic comorbidities. Methodswe conducted a systematic review (prespecified protocol CRD42021228970). Two authors independently searched for primary studies published between 2000 and 2021 in Web of Science and PubMed databases. We searched for studies that investigate the presence of signs of central sensitization in patients with musculoskeletal disorder or migraine and a chronic comorbidity. Two authors independently evaluated the methodological quality of the included studies using the "The Joanna Briggs Institute Critical Appraisal tools". When studies were judged homogenous enough, we performed a random effect meta-analysis. Resultswe included 14 observational studies. Overall, patients with musculoskeletal disorders or migraine with an associated comorbidity showed more signs of central sensitization compared with healthy subjects. The quantitative analysis showed that patients with temporomandibular disorders and chronic comorbidities, compared to patients with temporomandibular disorders without comorbidites, have a decreased pressure pain thresholds measured in the masseter area [SMD: -0.52; CI 95%: - 1.02 to -0.03; I2: 67%] and in the trapezius area [SMD: -0.55; CI 95%: -0.96 to -0.14; I2: 0%]. Patients with migraine, chronic low back pain or rheumatoid arthritis and associated fibromyalgia present more signs of central sensitization, measured in different modalities, than subjects without comorbidity. Conclusionswe demonstrated that, in general, patients with musculoskeletal disorders and an associated comorbidity showed an increased incidence of signs of central sensitization compared to healthy subjects and patients with musculoskeletal disorders without comorbities.