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Mansfield M, Roviello G, Thacker M, Willett M, Bannister K, Smith T. The association between conditioned pain modulation and psychological factors in people with chronic spinal pain: A systematic review. Br J Pain 2024; 18:314-324. [PMID: 39092209 PMCID: PMC11289901 DOI: 10.1177/20494637241229970] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
Chronic spinal pain has negative effects on physical and mental well-being. Psychological factors can influence pain tolerance. However, whether these factors influence descending modulatory control mechanisms measured by conditioned pain modulation (CPM) in people with chronic spinal pain is unclear. This systematic review investigated the association between CPM response and psychological factors in people with chronic spinal pain. Published and unpublished literature databases were searched from inception to 23rd October 2023 included MEDLINE, EMBASE, CINAHL, and PubMed. Studies assessing the association between CPM response and psychological factors in people with chronic spinal pain were eligible. Data were pooled through meta-analysis. Methodological quality was assessed using the AXIS tool and the certainty of evidence measured through GRADE. From 2172 records, seven studies (n = 598) were eligible. Quality of included studies was moderate. There was very low certainty of evidence that depression (r = 0.01 [95% CI -0.10 to 0.12], I2 = 0%), and anxiety (r = -0.20 [95% CI -0.56 to 0.16], I2 = 84%), fear avoidance (r = -0.10 [95% CI -0.30 to 0.10], I2 = 70%) had no statistical associations with CPM responder status. Higher pain catastrophising was associated with CPM non-responder status (r = -0.19; 95% CI: -0.37 to -0.02; n = 545; I2: 76%) based on a very low certainty of evidence measured by GRADE. There is currently limited available evidence demonstrating an association between CPM response and psychological factors for people with chronic pain. Managing an individual's chronic pain symptoms irrespective of comorbid psychological distress, should continue until evidence offer insights that more targeted interventions are needed.
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Affiliation(s)
- Michael Mansfield
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
- Centre of Precision Rehabilitation for Spinal Pain, University of Birmingham, Birmingham, UK
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Gianluca Roviello
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
- Physiotherapy Department, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - Mick Thacker
- School of Physiotherapy, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Matthew Willett
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
- Centre of Precision Rehabilitation for Spinal Pain, University of Birmingham, Birmingham, UK
| | - Kirsty Bannister
- Central Modulation of Pain, Wolfson Centre of Age Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Toby Smith
- Warwick Medical School, University of Warwick, Coventry, UK
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Uzawa H, Takeuch S, Nishida Y. Sex differences in conditioned pain modulation effects and its associations with autonomic nervous system activities in healthy, younger individuals: a pilot study. Pain Rep 2024; 9:e1123. [PMID: 38322355 PMCID: PMC10843308 DOI: 10.1097/pr9.0000000000001123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 11/18/2023] [Accepted: 11/23/2023] [Indexed: 02/08/2024] Open
Abstract
Introduction Sex differences in conditioned pain modulation (CPM) have not been sufficiently explored. Objectives This pilot study aimed to examine sex differences in CPM effects and associations between autonomic activities and CPM effects in healthy, younger individuals. Methods University students were recruited from February to March 2021 and divided by sex. They remained seated for 10 minutes as a rest period, then immersed their right hands in cold water for 2 minutes as a cold period. The pressure pain threshold (PPT) was measured after each period, presenting the CPM index (%) using the formula: (PPTcold/PPTrest) × 100. Autonomic nervous system variables were calculated using the formula-(autonomic variablecold/autonomic variablerest) × 100-and suffixed by "index" such as low-frequency/high-frequency (LF/HF) index. Some psychological questionnaires were self-recorded. Sex differences in the CPM index were statistically compared, and a simple linear regression analysis between the CPM and autonomic indices was conducted. Results Thirty-two participants were analyzed (14 women and 18 men; aged 21.1 ± 0.6 and 20.9 ± 0.3 years, respectively). Conditioned pain modulation effects were not different at 127.0 ± 19.1% in women and 124.0 ± 18.7% in men. The LF/HF index, LF normalized unit (nu) index (LFnu), and HFnu index had significant predictor variables for the CPM index across overall samples. The LF/HF index and LFnu index were significant predictor variables for the CPM index for women but not for men. Conclusions Conditioned pain modulation effects between groups seem to be similar. The LF/HF and LFnu indices in women were significant, indicating that descending pain modulations in women might be more associated with autonomic activities than those in men.
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Affiliation(s)
- Hironobu Uzawa
- Department of Physical Therapy, International University of Health and Welfare, Narita, Chiba, Japan
| | - Shinta Takeuch
- Department of Physical Therapy, International University of Health and Welfare, Narita, Chiba, Japan
| | - Yusuke Nishida
- Department of Physical Therapy, International University of Health and Welfare, Narita, Chiba, Japan
- Department of Rehabilitation, International University of Health and Welfare (IUHW) Narita Hospital, Narita, Chiba, Japan
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Granovsky Y, Sprecher E, Yarovinsky N, Shor M, Crystal S. Body-site effect on CPM efficiency in healthy subjects: Central vs. peripheral stimulation. Heliyon 2024; 10:e25156. [PMID: 38317925 PMCID: PMC10839622 DOI: 10.1016/j.heliyon.2024.e25156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/04/2024] [Accepted: 01/22/2024] [Indexed: 02/07/2024] Open
Abstract
Structural changes in the peripheral nerve system in neuropathic states alter sensory capacity of the affected area, thus biasing results of conditioned pain modulation (CPM) responses. The aim of this study was to evaluate CPM efficiency of central (i.e. trunk) vs. peripheral (i.e. limb) application of 'test' and 'conditioning' stimuli. Methods: Healthy volunteers (ages 18-73 yrs) underwent two CPM protocols: 'CPM Limb' and 'CPM Trunk'. Each included two types of test stimuli (Ts) (pressure pain threshold: PPT; and contact heat) conditioned either to hand immersion in cold noxious water (CPM limb), or to noxious contact heat applied on lower back (CPM trunk). Results: Both protocols generated efficient pain inhibition for each of the applied Ts; the PPT-based protocol induced more efficient CPM when the conditioned stimulus was applied on the trunk (p = 0.016). Moreover, the PPT-based CPM responses were significantly correlated (ρ = 0.349; p = 0.007). Conclusions: An efficient CPM induced by both central and peripheral stimulation, along with significant correlation between PPT-based responses, advances using the central 'CPM Trunk' protocol in patients with peripheral neuropathy.
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Affiliation(s)
- Y. Granovsky
- Laboratory of Clinical Neurophysiology, Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - E. Sprecher
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - N. Yarovinsky
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - M. Shor
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - S. Crystal
- Laboratory of Clinical Neurophysiology, Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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Larsen JB, Madeleine P, Sørensen LB, Sachau J, Otto JC, Baron R, Arendt-Nielsen L. Subgrouping of facilitatory or inhibitory conditioned pain modulation responses in patients with chronic knee pain. Explorative analysis from a multicentre trial. Eur J Pain 2024; 28:335-351. [PMID: 37746845 DOI: 10.1002/ejp.2185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 07/07/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Facilitatory and inhibitory conditioned pain modulation (CPM) responses are observed in healthy volunteers and chronic pain patients, but the clinical implications for phenotyping are unknown. This study aimed to subgroup and compare chronic knee pain patients according to their CPM responses. METHODS This explorative, cross-sectional study included 127 patients with chronic knee pain (osteoarthritis or following total knee arthroplasty). Individual CPM responses were categorized as facilitatory (test stimuli pain intensity increased when conditioning stimuli were applied), as inhibitory (test stimuli pain intensity decreased) or as no change (defined as less than 5.3% change in pain intensity). Outcomes were clinical pain intensities, temporal summation, widespread pain, self-reported physical function, PainDETECT questionnaire and Pain Quality Assessment Scale. Data were analysed as comparisons between the inhibitory and the facilitatory groups and using multivariate linear regression models. RESULTS Fifty-four patients had facilitatory CPM responses, 49 had inhibitory CPM responses, and 24 showed no change in CPM response. A between-group difference was observed for self-reported physical function, with the facilitatory CPM group reporting better function (54.4 vs. 46.0, p = 0.028) and the facilitatory CPM group reported more deep pain sensations (3.2 vs. 2.0, p = 0.021). The remaining outcomes showed no between-group differences. Higher clinical pain intensity and facilitated temporal summation were associated in the facilitated CPM group but not in the inhibitory CPM group. CONCLUSION These explorative findings indicated that quantitative clinical and experimental differences exist between facilitatory or inhibitory CPM responses in a chronic knee pain patient population. Differences in patients' CPM responses should be further investigated to unravel possible clinical importance. SIGNIFICANCE Our findings confirm that conditioned pain modulation consist of inhibitory and facilitatory responders among a patient population with chronic knee pain. This explorative study indicates that patients with either facilitatory or inhibitory conditioned pain modulation could exhibit differences in pain outcomes. Subgrouping of chronic pain patients depending on individual conditioned pain modulation responses could be considered in phenotyping patients prior to inclusion in clinical trials or used for personalizing the management regime.
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Affiliation(s)
- J B Larsen
- Musculoskeltal Health and Implementation, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - P Madeleine
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - L B Sørensen
- Musculoskeltal Health and Implementation, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - J Sachau
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - J C Otto
- Ameos Clinic Eutin, Eutin, Germany
| | - R Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - L Arendt-Nielsen
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
- Department of Gastroenterology and Hepatology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
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Patel R, Taylor JL, Dickenson AH, McMahon SB, Bannister K. A back-translational study of descending interactions with the induction of hyperalgesia by high-frequency electrical stimulation in rat and human. Pain 2024:00006396-990000000-00493. [PMID: 38198231 DOI: 10.1097/j.pain.0000000000003166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/29/2023] [Indexed: 01/12/2024]
Abstract
ABSTRACT In humans and animals, high-frequency electrocutaneous stimulation (HFS) induces an "early long-term potentiation-like" sensitisation, where synaptic plasticity is underpinned by an ill-defined interaction between peripheral input and central modulatory processes. The relative contributions of these processes to the initial pain or nociceptive response likely differ from those that underpin development of the heightened response. To investigate the impact of HFS-induced hyperalgesia on pain and nociception in perception and neural terms, respectively, and to explore the impact of descending inhibitory pathway activation on the development of HFS-induced hyperalgesia, we performed parallel studies utilising identical stimuli to apply HFS concurrent to (1) a conditioned pain modulation paradigm during psychophysical testing in healthy humans or (2) a diffuse noxious inhibitory controls paradigm during in vivo electrophysiological recording of spinal neurones in healthy anaesthetised rats. High-frequency electrocutaneous stimulation alone induced enhanced perceptual responses to pinprick stimuli in cutaneous areas secondary to the area of electrical stimulation in humans and increased the excitability of spinal neurones which exhibited stimulus intensity-dependent coded responses to pinprick stimulation in a manner that tracked with human psychophysics, supporting their translational validity. Application of a distant noxious conditioning stimulus during HFS did not alter perceived primary or secondary hyperalgesia in humans or the development of primary or secondary neuronal hyperexcitability in rats compared with HFS alone, suggesting that, upon HFS-response initiation in a healthy nervous system, excitatory signalling escapes inhibitory control. Therefore, in this model, dampening facilitatory mechanisms rather than augmenting top-down inhibitions could prevent pain development.
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Affiliation(s)
- Ryan Patel
- King's College London, Wolfson Centre, Guy's Campus, London, United Kingdom
| | - Joseph L Taylor
- King's College London, Wolfson Centre, Guy's Campus, London, United Kingdom
| | - Anthony H Dickenson
- Department of Neuroscience, Physiology & Pharmacology, University College London, London, United Kingdom
| | - Stephen B McMahon
- King's College London, Wolfson Centre, Guy's Campus, London, United Kingdom
| | - Kirsty Bannister
- King's College London, Wolfson Centre, Guy's Campus, London, United Kingdom
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Ye D, Vo L, Fairchild TJ, Drummond PD. Temple cooling increases parasympathetic activity and decreases pressure pain on the hand. Eur J Pain 2023; 27:353-365. [PMID: 36451612 DOI: 10.1002/ejp.2061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/26/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Applying an ice cube to the temple (the conditioning stimulus) inhibits electrically evoked pain in the forearm. The present study aimed to determine whether temple cooling also inhibits pressure- and heat-pain test stimuli in the upper limb and, if so, to investigate the intra-session test-retest reliability of this response. Additional aims were to establish whether pain inhibition evoked by temple cooling was associated with parasympathetic activity; and to explore sex differences in response. METHODS The sample consisted of 40 healthy adults (24 females). Heart rate was recorded continuously throughout the session. An ice cube (3 × 4 cm contact area) was applied for 1 min to the temple on the dominant side. Before and immediately afterwards, the pressure pain threshold was measured from the dorsal hand and sensitivity to heat (individually adjusted at baseline to elicit moderate pain) was measured from the ventral forearm. The procedures were repeated 15 min later. RESULTS Temple cooling inhibited pressure pain on the hand but not heat pain on the forearm. However, test-retest reliability of pressure pain inhibition was poor. Heart rate decreased during temple cooling, consistent with a "diving" reflex. Males had stronger pressure pain inhibition, lower heart rate and higher overall autonomic activity than females. However, cardiac parasympathetic activation during temple cooling was comparable in both sexes and was unrelated to pain inhibition. CONCLUSIONS These findings indicate that temple cooling evokes pain inhibition that is stronger in males than in females. Cardiac parasympathetic activity does not appear to mediate this response. SIGNIFICANCE The conditioning stimulus in the conditioned pain modulation paradigm is often applied to the upper or lower limbs. This may confound pain-inhibitory effects in people with peripheral neuropathy who typically have enhanced or diminished sensation in the extremities. Applying an ice cube at the temple area induces pain-inhibitory effects on the upper limb after the ice is removed. Future research examining pain modulation in people with peripheral neuropathy may consider adopting temple cooling as the conditioning stimulus.
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Affiliation(s)
- Di Ye
- Discipline of Psychology and Healthy Ageing Research Centre, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Lechi Vo
- Discipline of Psychology and Healthy Ageing Research Centre, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Timothy J Fairchild
- The Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Murdoch, Western Australia, Australia
| | - Peter D Drummond
- Discipline of Psychology and Healthy Ageing Research Centre, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Western Australia, Australia
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Sirucek L, Ganley RP, Zeilhofer HU, Schweinhardt P. Diffuse noxious inhibitory controls and conditioned pain modulation: a shared neurobiology within the descending pain inhibitory system? Pain 2023; 164:463-468. [PMID: 36017879 PMCID: PMC9916052 DOI: 10.1097/j.pain.0000000000002719] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/02/2022] [Accepted: 06/14/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Laura Sirucek
- Department of Chiropractic Medicine, Integrative Spinal Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
| | - Robert Philip Ganley
- Institute for Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
| | - Hanns Ulrich Zeilhofer
- Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
- Institute for Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
- Institute of Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
| | - Petra Schweinhardt
- Department of Chiropractic Medicine, Integrative Spinal Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Uzawa H, Ishii H, Ishida T, Shida T, Furuyama H, Nishida Y. Factors Associated with Low Inter-Session Reliability of Conditioned Pain Modulation in Older People with or Without Chronic Musculoskeletal Pain. J Pain Res 2023; 16:1039-1053. [PMID: 36992922 PMCID: PMC10041985 DOI: 10.2147/jpr.s391943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/16/2023] [Indexed: 03/31/2023] Open
Abstract
Purpose Conditioned pain modulation (CPM) is a measurement of the descending pain pathways that inhibit or facilitate afferent noxious stimuli. The reliability of CPM in older individuals with or without chronic musculoskeletal pain has not been sufficiently reported. This study aimed to examine the inter-session reliability of CPM in these cohorts and the factors in CPM reliability. Patients and Methods Individuals aged 65 or older were recruited in Narita, Japan. The measurements were performed on separate days 2 weeks apart (sessions 1 and 2). Each participant's hand was immersed in cold water, and we measured pressure pain threshold (PPT) before and after the immersion. The ratio before and after PPT measurements was presented as CPM index. The autonomic activities (heart rate variability, heart rate, and blood pressure) were simultaneously measured. An absolute reliability of CPM index was analyzed by the adjusted two-way analysis of variance (ANOVA) and the Bland Altman plot, and relative reliability was analyzed by intraclass correlation coefficient (ICC). Spearman's rho correlation and the adjusted multivariate regression analysis were utilized for examining the CPM reliability factors. Results Thirty-two participants were divided into two groups: chronic pain (n=19) and non-chronic pain (n=13) groups. The mean difference between session 1 and 2 in CPM index showed a systematic error in the chronic pain group at 17.3 (confidence interval, CI: 15.0 to 19.7), but none in the non-chronic pain group at 3.7 (CI: -0.02 to 7.4). The adjusted two-way ANOVA for CPM index did not identify any differences. ICC was not significant at p=-0.247 in the non-chronic and 0.167 in chronic pain. Multivariate regression analysis revealed total power and low/high frequencies as significant factors for CPM index. Conclusion This study identified low inter-session reliability in older adults with chronic musculoskeletal pain and autonomic nervous system activities as factors in CPM reliability.
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Affiliation(s)
- Hironobu Uzawa
- Department of Physical Therapy, International University of Health and Welfare, Narita, Chiba, Japan
- Correspondence: Hironobu Uzawa, Department of Physical Therapy, International University of Health and Welfare, 4-3, Kozunomori, Narita, Chiba, 286-8686, Japan, Tel/Fax +81-746-20-7716, Email
| | - Hideaki Ishii
- Department of Physical Therapy, International University of Health and Welfare, Narita, Chiba, Japan
| | - Takeki Ishida
- Department of Physical Therapy, International University of Health and Welfare, Narita, Chiba, Japan
| | - Takashi Shida
- Department of Medical Technology and Science, International University of Health and Welfare, Narita, Chiba, Japan
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Hiroto Furuyama
- Department of Rehabilitation, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan
| | - Yusuke Nishida
- Department of Physical Therapy, International University of Health and Welfare, Narita, Chiba, Japan
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Monoaminergic mediation of hyperalgesic and analgesic descending control of nociception in mice. Pain 2022; 164:1096-1105. [PMID: 36448969 DOI: 10.1097/j.pain.0000000000002806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/03/2022] [Indexed: 12/02/2022]
Abstract
ABSTRACT Descending control of nociception (DCN; also known as conditioned pain modulation [CPM], the behavioral correlate of diffuse noxious inhibitory controls) is the phenomenon whereby pain inhibits pain in another part of the body and is the subject of increasing study because it may represent a biomarker of chronic pain. We recently discovered that pain modulation upon application of a DCN paradigm involving low-intensity test stimuli occurs in the direction of hyperalgesia in healthy mice and rats, whereas the use of high-intensity stimuli produces analgesia. To elucidate the physiological mechanisms underlying hyperalgesic DCN, we administered agonists and antagonists of norepinephrine (NE) and serotonin (5-HT) receptors, key neurochemical players in the production of analgesic DCN. We find that three different monoamine reuptake inhibitors-the NE-selective reboxetine, the 5-HT-selective fluoxetine, and the dual NE/5-HT agonist duloxetine-all abolish hyperalgesic DCN when administered into the spinal cord (but not systemically), with no effect on heat or mechanical pain sensitivity. Reboxetine's attenuation of hyperalgesic DCN is mediated by α 2 -adrenergic receptors (i.e., blocked by atipamezole), and fluoxetine's effect is mediated by 5-HT 7 receptors (i.e., blocked by SB269970). In contrast, analgesic DCN was found to be reversed by atipamezole and SB269970 themselves, with no effect of reboxetine or fluoxetine. Thus, hyperalgesic DCN appears to be the neurochemical opposite to analgesic DCN. These data further validate and help elucidate a pre-clinical paradigm that mimics dysfunctional CPM, and thus may form the basis of translational experiments that aim to reveal preventative pharmacological strategies for individuals predisposed to persistent pain.
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Nuwailati R, Bobos P, Drangsholt M, Curatolo M. Reliability of conditioned pain modulation in healthy individuals and chronic pain patients: a systematic review and meta-analysis. Scand J Pain 2022; 22:262-278. [PMID: 35142147 DOI: 10.1515/sjpain-2021-0149] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/21/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Conditioned pain modulation (CPM) is a psychophysical parameter that is used to reflect the efficacy of endogenous pain inhibition. CPM reliability is important for research and potential clinical applications. The aim of this systematic review and meta-analysis was to evaluate the reliability of CPM tests in healthy individuals and chronic pain patients. METHODS We searched three databases for peer-reviewed studies published from inception to October 2020: EMBASE, Web of Science and NCBI. Risk of bias and the quality of the included studies were assessed. A meta-analysis with a random effects model was conducted to estimate intraclass correlation coefficients (ICCs). RESULTS Meta-analysis was performed on 25 papers that examined healthy participants (k=21) or chronic pain patients (k=4). The highest CPM intra-session reliability was with pressure as test stimulus (TS) and ischemic pressure (IP) or cold pressor test (CPT) as conditioning stimulus (CS) in healthy individuals (ICC 0.64, 95% CI 0.45-0.77), and pressure as TS with CPT as CS in patients (ICC 0.77, 95% CI 0.70-0.82). The highest inter-session ICC was with IP as TS and IP or CPT as CS (ICC 0.51, 95% CI 0.42-0.59) in healthy subjects. The only data available in patients for inter-session reliability were with pressure as TS and CPT as CS (ICC 0.44, 95% CI 0.11-0.69). Quality ranged from very good to excellent using the QACMRR checklist. The majority of the studies (24 out of 25) scored inadequate in Kappa coefficient reporting item of the COSMIN-ROB checklist. CONCLUSIONS Pressure and CPT were the TS and CS most consistently associated with good to excellent intra-session reliability in healthy volunteers and chronic pain patients. The inter-session reliability was fair or less for all modalities, both in healthy volunteers and chronic pain patients.
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Affiliation(s)
- Rania Nuwailati
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
- Department of Oral Medicine, University of Washington, Seattle, WA, USA
| | - Pavlos Bobos
- Applied Health Research Centre (AHRC), The HUB, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Clinical Epidemiology and Health Care Research, Dalla Lana School of Public Health, Institute of Healthy Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Mark Drangsholt
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
- Department of Oral Medicine, University of Washington, Seattle, WA, USA
| | - Michele Curatolo
- Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA, USA
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
- CLEAR Research Center for Musculoskeletal Disorders, Seattle, WA, USA
- Department of Health Science and Technology, Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
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Bannister K, Kucharczyk MW, Graven-Nielsen T, Porreca F. Introducing descending control of nociception: a measure of diffuse noxious inhibitory controls in conscious animals. Pain 2021; 162:1957-1959. [PMID: 33470750 PMCID: PMC8205930 DOI: 10.1097/j.pain.0000000000002203] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/10/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Kirsty Bannister
- Central Modulation of Pain, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE1 1UL. UK
| | - Mateusz W. Kucharczyk
- Central Modulation of Pain, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE1 1UL. UK
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Frank Porreca
- Department of Pharmacology, University of Arizona, Tucson, Arizona, AZ 85721. USA
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Kucharczyk MW, Derrien D, Dickenson AH, Bannister K. The Stage-Specific Plasticity of Descending Modulatory Controls in a Rodent Model of Cancer-Induced Bone Pain. Cancers (Basel) 2020; 12:cancers12113286. [PMID: 33172040 PMCID: PMC7716240 DOI: 10.3390/cancers12113286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/25/2020] [Accepted: 11/03/2020] [Indexed: 12/31/2022] Open
Abstract
Simple Summary The mechanisms that underlie pain resulting from metastatic bone disease remain elusive. This translates to a clinical and socioeconomic burden—targeted therapy is not possible, and patients do not receive adequate analgesic relief. The heterogeneous nature of metastatic bone disease complicates matters. Early stage cancers are molecularly very different to their late stage counterparts and so is the pain associated with early stage and advanced tumours. Thus, analgesic approaches should differ according to disease stage. In this article, we demonstrate that a unique form of brain inhibitory control responsible for the modulation of incoming pain signals at the level of the spinal cord changes with the progression of bone tumours. This corresponds with the degree of damage to the primary afferents innervating the cancerous tissue. Plasticity in the modulation of spinal neuronal activity by descending control pathways reveals a novel opportunity for targeting bone cancer pain in a stage-specific manner. Abstract Pain resulting from metastatic bone disease is a major unmet clinical need. Studying spinal processing in rodent models of cancer pain is desirable since the percept of pain is influenced in part by modulation at the level of the transmission system in the dorsal horn of the spinal cord. Here, a rodent model of cancer-induced bone pain (CIBP) was generated following syngeneic rat mammary gland adenocarcinoma cell injection in the tibia of male Sprague Dawley rats. Disease progression was classified as “early” or “late” stage according to bone destruction. Even though wakeful CIBP rats showed progressive mechanical hypersensitivity, subsequent in vivo electrophysiological measurement of mechanically evoked deep dorsal horn spinal neuronal responses revealed no change. Rather, a dynamic reorganization of spinal neuronal modulation by descending controls was observed, and this was maladaptive only in the early stage of CIBP. Interestingly, this latter observation corresponded with the degree of damage to the primary afferents innervating the cancerous tissue. Plasticity in the modulation of spinal neuronal activity by descending control pathways reveals a novel opportunity for targeting CIBP in a stage-specific manner. Finally, the data herein have translational potential since the descending control pathways measured are present also in humans.
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Affiliation(s)
- Mateusz Wojciech Kucharczyk
- Central Modulation of Pain Group, Wolfson Centre for Age-Related Diseases, King’s College London, London SE1 1UL, UK;
- Department of Neuroscience, Physiology and Pharmacology, University College London, Gower Street, London WC1E 6BT, UK; (D.D.); (A.H.D.)
- Correspondence: ; Tel.: +44-20-7848-4617; Fax: +44-20-7848-6806
| | - Diane Derrien
- Department of Neuroscience, Physiology and Pharmacology, University College London, Gower Street, London WC1E 6BT, UK; (D.D.); (A.H.D.)
| | - Anthony Henry Dickenson
- Department of Neuroscience, Physiology and Pharmacology, University College London, Gower Street, London WC1E 6BT, UK; (D.D.); (A.H.D.)
| | - Kirsty Bannister
- Central Modulation of Pain Group, Wolfson Centre for Age-Related Diseases, King’s College London, London SE1 1UL, UK;
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