1
|
Rouhi S, Egorova-Brumley N, Jordan AS. Chronic sleep deficiency and its impact on pain perception in healthy females. J Sleep Res 2024:e14284. [PMID: 38972675 DOI: 10.1111/jsr.14284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/19/2024] [Accepted: 06/25/2024] [Indexed: 07/09/2024]
Abstract
Acute sleep deprivation in experimental studies has been shown to induce pain hypersensitivity in females. However, the impact of natural sleep deficiency and fluctuations across the week on pain perception remains unclear. A sleep-monitoring headband and self-reports were utilized to assess objective and subjective sleep in longer (> 6 hr) and short sleepers (< 6 hr). Pain sensitivity measures including heat, cold, pressure pain thresholds, pain inhibition (conditioned pain modulation) and facilitation (tonic pain summation) were assessed on Mondays and Fridays. Forty-one healthy young (23.9 ± 0.74 years) women participated. Short sleepers slept on average 2 hr less than longer sleepers (297.9 ± 8.2 min versus 418.5 ± 10.9 min) and experienced impaired pain inhibitory response (mean = -21.14 ± 7.9°C versus mean = 15.39 ± 9.5°C; p = 0.005). However, no effect was observed in pain thresholds and pain summation (p > 0.05). Furthermore, pain modulatory responses differed between Mondays and Fridays. Chronic sleep deficiency (< 6 hr) compromises pain responses, notably on Mondays. Maintaining a consistent sleep pattern with sufficient sleep (> 6 hr) throughout the week may protect against pain sensitization and the development of chronic pain in females. Further research is needed, especially in patients with chronic pain.
Collapse
Affiliation(s)
- Shima Rouhi
- The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Amy S Jordan
- The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
2
|
Herrero Babiloni A, Brazeau D, Jodoin M, Theis-Mahon N, Martel MO, Lavigne GJ, Moana-Filho EJ. The Impact of Sleep Disturbances on Endogenous Pain Modulation: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2024; 25:875-901. [PMID: 37914093 DOI: 10.1016/j.jpain.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
The bidirectional relationship between sleep and pain problems has been extensively demonstrated but despite all the accumulating evidence, their shared mechanisms are currently not fully understood. This review examined the association between sleep disturbances, defined as a broad array of sleep-related outcomes (eg, poor quality, short duration, insomnia), and endogenous pain modulation (EPM) in healthy and clinical populations. Our search yielded 6,151 references, and 37 studies met the eligibility criteria. Qualitative results showed mixed findings regarding the association between sleep disturbances and temporal summation of pain (TSP) and conditioned pain modulation (CPM), with poor sleep more commonly associated with decreased pain inhibition in both populations. Quantitative results indicated that such associations were not statistically significant, neither in healthy populations when EPM outcomes were assessed for changes pre-/post-sleep intervention (TSP: .31 [95%CI: -.30 to .92]; P = .321; CPM: .40 [95%CI: -.06 to .85] P = .088) nor in clinical populations when such association was assessed via correlation (TSP: -.00 [95%CI: -.22 to .21] P = .970; CPM: .12 [95%CI: -.05 to .29]; P = .181). For studies that reported results by sex, meta-analysis showed that experimental sleep disturbances impaired pain inhibition in females (1.43 [95%CI: .98-1.88]; P < .001) but not in males (-.30 [95%CI: -2.69 to 1.60]; P = .760). Only one study investigating the association between sleep disturbances and offset analgesia was identified, while no studies assessing spatial summation of pain were found. Overall, this review provides a comprehensive overview of the association between sleep disturbances and EPM function, emphasizing the need for further investigation to clarify specific mechanisms and phenotypic subtypes. PERSPECTIVE: This review shines a light on the association between sleep disturbances and endogenous pain modulation function. Qualitatively, we found a frequent association between reduced sleep quality and impaired pain inhibition. However, quantitatively such an association was not corroborated. Sex-specific effects were observed, with females presenting sleep-related impaired pain inhibition but not males.
Collapse
Affiliation(s)
- Alberto Herrero Babiloni
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada; Sacre-Coeur Hospital, University of Montreal, Quebec, Canada
| | - Daphnée Brazeau
- Sacre-Coeur Hospital, University of Montreal, Quebec, Canada; Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Marianne Jodoin
- Sacre-Coeur Hospital, University of Montreal, Quebec, Canada; Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Nicole Theis-Mahon
- Health Sciences Libraries, University of Minnesota, Minneapolis, MN, United States
| | - Marc O Martel
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada; Faculty of Dentistry, McGill University, Montreal, QC, Canada; Department of Anesthesia, McGill University, Montreal, QC, Canada
| | - Gilles J Lavigne
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada; Sacre-Coeur Hospital, University of Montreal, Quebec, Canada; Faculty of Dental Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Estephan J Moana-Filho
- Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
3
|
Rouhi S, Topcu J, Egorova-Brumley N, Jordan AS. The impact of sleep disturbance on pain perception: A systematic review examining the moderating effect of sex and age. Sleep Med Rev 2023; 71:101835. [PMID: 37586144 DOI: 10.1016/j.smrv.2023.101835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 07/27/2023] [Accepted: 08/06/2023] [Indexed: 08/18/2023]
Abstract
Females have increased pain sensitivity and are more vulnerable to chronic pain conditions. Sleep disturbances are comorbid with chronic pain and exacerbate pain symptoms. Different types of sleep disturbance affect pain perception distinctly, but it is not clear if these effects are equal in men and women. This systematic review investigated potential differences in how sleep disturbance affects pain in males and females. We searched EBSCO, MEDLINE, Psych INFO, Science Direct, and Web of Science from January 2001 to November 2022 and found 38 studies with 978 participants. Separate random-effects models were used to estimate the pooled effect sizes based on standardized mean differences (SMDs) of experimental sleep disturbance paradigms on various pain outcomes. Sex moderated the effect of sleep disturbance on pain facilitation (SMD = 0.13; 95%CI: 0.004 to 0.022; p=.009) and pain inhibition (SMD = 0.033; 95%CI: 0.011 to 0.054; p=.005), with increased facilitation and decreased inhibition in females, but the opposite effect in males. Further, age moderated the effects of total sleep deprivation (SMD = -0.194; 95%CI -0.328 to -0.060; p=.008) on pain sensitivity and fragmented sleep (SMD = -0.110; 95%CI: 0.148 to -0.072; p<.001) on pain threshold. While the moderating effect of sex and age on the sleep-pain relationship was small, these factors need to be considered in future sleep-pain research.
Collapse
|
4
|
Haack M, Engert LC, Besedovsky L, Goldstein MR, Devine JK, Dang R, Olia K, Molina V, Bertisch SM, Sethna N, Simpson N. Alterations of pain pathways by experimental sleep disturbances in humans: central pain-inhibitory, cyclooxygenase, and endocannabinoid pathways. Sleep 2023; 46:zsad061. [PMID: 36881901 PMCID: PMC10262178 DOI: 10.1093/sleep/zsad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/20/2022] [Indexed: 03/09/2023] Open
Abstract
STUDY OBJECTIVES There is strong evidence that sleep disturbances are an independent risk factor for the development of chronic pain conditions. The mechanisms underlying this association, however, are still not well understood. We examined the effect of experimental sleep disturbances (ESDs) on three pathways involved in pain initiation/resolution: (1) the central pain-inhibitory pathway, (2) the cyclooxygenase (COX) pathway, and (3) the endocannabinoid (eCB) pathway. METHODS Twenty-four healthy participants (50% females) underwent two 19-day long in-laboratory protocols in randomized order: (1) an ESD protocol consisting of repeated nights of short and disrupted sleep with intermittent recovery sleep; and (2) a sleep control protocol consisting of nights with an 8-hour sleep opportunity. Pain inhibition (conditioned pain modulation, habituation to repeated pain), COX-2 expression at monocyte level (lipopolysaccharide [LPS]-stimulated and spontaneous), and eCBs (arachidonoylethanolamine, 2-arachidonoylglycerol, docosahexaenoylethanolamide [DHEA], eicosapentaenoylethanolamide, docosatetraenoylethanolamide) were measured every other day throughout the protocol. RESULTS The central pain-inhibitory pathway was compromised by sleep disturbances in females, but not in males (p < 0.05 condition × sex effect). The COX-2 pathway (LPS-stimulated) was activated by sleep disturbances (p < 0.05 condition effect), and this effect was exclusively driven by males (p < 0.05 condition × sex effect). With respect to the eCB pathway, DHEA was higher (p < 0.05 condition effect) in the sleep disturbance compared to the control condition, without sex-differential effects on any eCBs. CONCLUSIONS These findings suggest that central pain-inhibitory and COX mechanisms through which sleep disturbances may contribute to chronic pain risk are sex specific, implicating the need for sex-differential therapeutic targets to effectively reduce chronic pain associated with sleep disturbances in both sexes. CLINICAL TRIALS REGISTRATION NCT02484742: Pain Sensitization and Habituation in a Model of Experimentally-induced Insomnia Symptoms. https://clinicaltrials.gov/ct2/show/NCT02484742.
Collapse
Affiliation(s)
- Monika Haack
- Harvard Medical School, Boston, MA, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Larissa C Engert
- Harvard Medical School, Boston, MA, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Luciana Besedovsky
- Harvard Medical School, Boston, MA, USA
- Institute of Medical Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | | | - Jaime K Devine
- Institutes for Behavior Resources, Inc., Baltimore, MD, USA
| | - Rammy Dang
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Keeyon Olia
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Victoria Molina
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Suzanne M Bertisch
- Harvard Medical School, Boston, MA, USA
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Navil Sethna
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesia and Perioperative Medicine, Children’s Hospital Boston, Boston, MA, USA
| | - Norah Simpson
- Stanford Sleep Heath & Insomnia Program, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| |
Collapse
|
5
|
Hertel E, McPhee ME, Petersen KK. Investigation of pain sensitivity following 3 nights of disrupted sleep in healthy individuals. Eur J Pain 2023. [PMID: 36862019 DOI: 10.1002/ejp.2101] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/02/2023] [Accepted: 02/28/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Poor quality sleep is a common complaint among people with chronic pain. The co-occurrence of poor sleep quality and chronic pain often comes with increased pain intensity, more disability and a higher cost of healthcare. Poor sleep has been suggested to affect measures of peripheral and central pain mechanisms. To date, sleep provocations are the only models proven to affect measures of central pain mechanisms in healthy subjects. However, there are limited studies investigating the effect of several nights of sleep disruption on measures of central pain mechanisms. METHODS The current study implemented three nights of sleep disruption with three planned awakenings per night in 30 healthy subjects sleeping at home. Pain testing was conducted at the same time of day at baseline and follow-up for each subject. Pressure pain thresholds were assessed bilaterally on the infraspinatus and gastrocnemius muscles. Using handheld pressure algometry, suprathreshold pressure pain sensitivity and area were also investigated on the dominant infraspinatus muscle. Cuff-pressure pain detection and tolerance thresholds, temporal summation of pain and conditioned pain modulation were investigated using cuff-pressure algometry. RESULTS Temporal summation of pain was significantly facilitated (p = 0.022), suprathreshold pain areas (p = 0.005) and intensities (p < 0.05) were significantly increased, and all pressure pain thresholds were decreased (p < 0.005) after sleep disruption compared to baseline. CONCLUSIONS The current study found that three consecutive nights of sleep disruption at home induced pressure hyperalgesia and increased measures of pain facilitation in healthy subjects, which is consistent with previous findings. SIGNIFICANCE Poor quality of sleep is often experienced by patients with chronic pain, with the most common complaint being nightly awakenings. This exploratory study is the first to investigate changes in measures of central and peripheral pain sensitivity in healthy subjects after sleep disruptions for three consecutive nights without any restrictions on total sleep time. The findings suggest that disruptions to sleep continuity in healthy individuals can induce increased sensitivity to measures of central and peripheral pain sensitization.
Collapse
Affiliation(s)
- E Hertel
- Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Mathemathical Modeling of Knee Osteoarthritis (MathKOA), Aalborg University, Aalborg, Denmark
| | - M E McPhee
- Center for Neuroplasticity and Pain (CNAP), Aalborg University, Aalborg, Denmark
| | - K K Petersen
- Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Mathemathical Modeling of Knee Osteoarthritis (MathKOA), Aalborg University, Aalborg, Denmark.,Center for Neuroplasticity and Pain (CNAP), Aalborg University, Aalborg, Denmark
| |
Collapse
|
6
|
Stroemel-Scheder C, Lautenbacher S. The Effects of Recovery Sleep on Experimental Pain. THE JOURNAL OF PAIN 2023; 24:490-501. [PMID: 36273778 DOI: 10.1016/j.jpain.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
Recent research suggests that recovery sleep (RS) has the potential to restore pain sensitivity and modulation after hyperalgesia due to preceding sleep deprivation. However, it has not yet been systematically examined whether the restoration of these pain parameters is driven by sleep characteristics of RS. Thus, the present study assessed changes in experimental pain during RS after total sleep deprivation (TSD) to test whether RS parameters predicted the restoration of the pain system. Thirty healthy participants completed one night of habitual sleep, one night of TSD and a subsequent recovery night. At-home sleep during baseline and recovery was assessed using portable polysomnography and a questionnaire. Before and after each night pressure pain thresholds (PPTs), temporal pain summation (TSP) and conditioned pain modulation (CPM) were assessed. PPTs decreased after TSD and increased following RS, indicating a restoration of pain sensitivity after hyperalgesia. RS characteristics did not predict this restoration, suggesting other mechanisms (eg, changes in serotonergic activity) underlying the observed pain changes. TSP indicated a lack of effect of experimental sleep manipulations on excitatory processes whereas CPM lacked sufficient reliability to investigate inhibitory processes. Thus, results indicate moderate effects of sleep manipulations on pain sensitivity, but not on pain modulation. PERSPECTIVE: This article highlights the potential of recovery sleep to let pain thresholds return to normal following their decrease after a night of total sleep deprivation. In contrast, endogenous pain modulation (temporal pain summation, conditioned pain modulation) was not affected by sleep deprivation and recovery sleep.
Collapse
|
7
|
Albinni B, de Zambotti M, Iacovides S, Baker FC, King CD. The complexities of the sleep-pain relationship in adolescents: A critical review. Sleep Med Rev 2023; 67:101715. [PMID: 36463709 PMCID: PMC9868111 DOI: 10.1016/j.smrv.2022.101715] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 10/20/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022]
Abstract
Chronic pain is a common and disabling condition in adolescents. Disturbed sleep is associated with many detrimental effects in adolescents with acute and chronic pain. While sleep and pain are known to share a reciprocal relationship, the sleep-pain relationship in adolescence warrants further contextualization within normally occurring maturation of several biopsychological processes. Since sleep and pain disorders begin to emerge in early adolescence and are often comorbid, there is a need for a comprehensive picture of their interrelation especially related to temporal relationships and mechanistic drivers. While existing reviews provide a solid foundation for the interaction between disturbed sleep and pain in youth, we will extend this review by highlighting current methodological challenges for both sleep and pain assessments, exploring the recent evidence for directionality in the sleep-pain relationship, reviewing potential mechanisms and factors underlying the relationship, and providing direction for future investigations. We will also highlight the potential role of digital technologies in advancing the understanding of the sleep and pain relationship. Ultimately, we anticipate this information will facilitate further research and inform the management of pain and poor sleep, which will ultimately improve the quality of life in adolescents and reduce the risk of pain persisting into adulthood.
Collapse
Affiliation(s)
- Benedetta Albinni
- Center for Health Sciences, SRI International, Menlo Park, CA, USA; Department of Psychology, University of Campania "Luigi Vanvitelli", Italy
| | | | - Stella Iacovides
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Fiona C Baker
- Center for Health Sciences, SRI International, Menlo Park, CA, USA; Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Christopher D King
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Behavioral Medicine and Clinical Psychology, Pediatric Pain Research Center (PPRC), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| |
Collapse
|
8
|
Kourbanova K, Alexandre C, Latremoliere A. Effect of sleep loss on pain-New conceptual and mechanistic avenues. Front Neurosci 2022; 16:1009902. [PMID: 36605555 PMCID: PMC9807925 DOI: 10.3389/fnins.2022.1009902] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Sleep disturbances increase pain sensitivity in clinical and preclinical settings, but the precise mechanisms are unknown. This represents a major public health issue because of the growing sleep deficiency epidemic fueled by modern lifestyle. To understand the neural pathways at the intersection between sleep and pain processes, it is critical to determine the precise nature of the sleep disruptions that increase pain and the specific component of the pain response that is targeted. Methods We performed a review of the literature about sleep disturbances and pain sensitivity in humans and rodents by taking into consideration the targeted sleep stage (REMS, non-NREMS, or both), the amount of sleep lost, and the different types of sleep disruptions (partial or total sleep loss, duration, sleep fragmentation or interruptions), and how these differences might affect distinct components of the pain response. Results We find that the effects of sleep disturbances on pain are highly conserved among species. The major driver for pain hypersensitivity appears to be the total amount of sleep lost, while REMS loss by itself does not seem to have a direct effect on pain sensitivity. Sleep loss caused by extended wakefulness preferentially increases pain perception, whereas interrupted and limited sleep strongly dysregulates descending controls such as DNIC, especially in women. Discussion We discuss the possible mechanisms involved, including an increase in inflammatory processes, a loss of nociceptive inhibitory pathways, and a defect in the cognitive processing of noxious input.
Collapse
Affiliation(s)
- Kamila Kourbanova
- Department of Neurosurgery, Neurosurgery Pain Research Institute, Johns Hopkins School of Medicine, Baltimore, MD, United States,Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Chloe Alexandre
- Department of Neurosurgery, Neurosurgery Pain Research Institute, Johns Hopkins School of Medicine, Baltimore, MD, United States,Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, United States,Chloe Alexandre
| | - Alban Latremoliere
- Department of Neurosurgery, Neurosurgery Pain Research Institute, Johns Hopkins School of Medicine, Baltimore, MD, United States,Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, United States,*Correspondence: Alban Latremoliere
| |
Collapse
|
9
|
Chang JR, Fu SN, Li X, Li SX, Wang X, Zhou Z, Pinto SM, Samartzis D, Karppinen J, Wong AYL. The differential effects of sleep deprivation on pain perception in individuals with or without chronic pain: A systematic review and meta-analysis. Sleep Med Rev 2022; 66:101695. [DOI: 10.1016/j.smrv.2022.101695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/09/2022] [Accepted: 09/11/2022] [Indexed: 11/29/2022]
|
10
|
Simultaneous measurement of intra-epidermal electric detection thresholds and evoked potentials for observation of nociceptive processing following sleep deprivation. Exp Brain Res 2022; 240:631-649. [PMID: 34993590 PMCID: PMC8739349 DOI: 10.1007/s00221-021-06284-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/01/2021] [Indexed: 12/12/2022]
Abstract
Sleep deprivation has been shown to increase pain intensity and decrease pain thresholds in healthy subjects. In chronic pain patients, sleep impairment often worsens the perceived pain intensity. This increased pain perception is the result of altered nociceptive processing. We recently developed a method to quantify and monitor altered nociceptive processing by simultaneous tracking of psychophysical detection thresholds and recording of evoked cortical potentials during intra-epidermal electric stimulation. In this study, we assessed the sensitivity of nociceptive detection thresholds and evoked potentials to altered nociceptive processing after sleep deprivation in an exploratory study with 24 healthy male and 24 healthy female subjects. In each subject, we tracked nociceptive detection thresholds and recorded central evoked potentials in response to 180 single- and 180 double-pulse intra-epidermal electric stimuli. Results showed that the detection thresholds for single- and double-pulse stimuli and the average central evoked potential for single-pulse stimuli were significantly decreased after sleep deprivation. When analyzed separated by sex, these effects were only significant in the male population. Multivariate analysis showed that the decrease of central evoked potential was associated with a decrease of task-related evoked activity. Measurement repetition led to a decrease of the detection threshold to double-pulse stimuli in the mixed and the female population, but did not significantly affect any other outcome measures. These results suggest that simultaneous tracking of psychophysical detection thresholds and evoked potentials is a useful method to observe altered nociceptive processing after sleep deprivation, but is also sensitive to sex differences and measurement repetition.
Collapse
|
11
|
Smith MT. Highlighting the possibilities of precision sleep medicine by focusing on sleep-Pain interactions: Basic clinical research and pragmatic trials needed. Sleep Med Rev 2021; 59:101542. [PMID: 34593297 DOI: 10.1016/j.smrv.2021.101542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 11/21/2022]
Affiliation(s)
- Michael T Smith
- Johns Hopkins University School of Medicine, Division of Behavioral Medicine, 5510 Nathan Shock Drive, STE 100 Baltimore, MD, 21224, USA
| |
Collapse
|
12
|
Fiedler LS, Machado LA, Costa YM, Conti PCR, Bonjardim LR. Influence of self-reported physical activity and sleep quality on conditioned pain modulation in the orofacial region. Clin Oral Investig 2020; 25:1195-1202. [PMID: 32643089 DOI: 10.1007/s00784-020-03424-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 06/19/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate the influence of self-reported physical activity and sleep quality on conditioned pain modulation (CPM) in the orofacial region. MATERIALS AND METHODS Ninety healthy participants aged 18-50 years old were evenly distributed according to the level of physical activity into low, moderate, and high level. The classification of physical activity was based on modified criteria of the International Physical Activity Questionnaire (IPAQ), considering intensity, duration, and frequency of physical activity. The Pittsburgh Sleep Quality Index (PSQI) assessed sleep quality and the individuals were then classified as good or poor sleepers. CPM was assessed using the pressure pain threshold (PPT) of the anterior temporalis as test stimulus and hand immersion in hot water as conditioning stimulus. ANOVA was applied to the data and Tukey's posttest was applied when the main effects or interactions were significant (p < 0.050). RESULTS There was no significant main effect of neither physical activity nor sleep quality on pain modulation. However, individuals who reported high level of physical activity and good quality of sleep had a greater pain modulation (- 0.60 ± 0.34) when compared with those who reported moderate (- 0.10 ± 0.25) and low level of physical activity (- 0.10 ± 0.52) and good sleep quality (p < 0.028). CONCLUSIONS Pain modulation seems to be more efficient in individuals who report a good sleep quality and a high level of physical activity. CLINICAL RELEVANCE Conditioned pain modulation is highly variable in healthy people. Therefore, a multifactorial approach should be taken into consideration in the evaluation of the efficacy of endogenous analgesia.
Collapse
Affiliation(s)
- Leticia Soares Fiedler
- Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Laila Aguiar Machado
- Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Yuri Martins Costa
- Department of Biosciences, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | | | - Leonardo Rigoldi Bonjardim
- Department of Biological Sciences, Bauru School of Dentistry, University of Sao Paulo, Al. Octávio Pinheiro Brizolla 9-75 CEP Vila Universitária, Bauru, SP, 17012-901, Brazil.
| |
Collapse
|
13
|
Staffe AT, Bech MW, Clemmensen SLK, Nielsen HT, Larsen DB, Petersen KK. Total sleep deprivation increases pain sensitivity, impairs conditioned pain modulation and facilitates temporal summation of pain in healthy participants. PLoS One 2019; 14:e0225849. [PMID: 31800612 PMCID: PMC6892491 DOI: 10.1371/journal.pone.0225849] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 11/13/2019] [Indexed: 01/08/2023] Open
Abstract
Chronic pain patients often suffer from insomnia or impaired sleep which has been associated with increased pain sensitivity, but a limited amount of studies have investigated the effects of total sleep deprivation on central pain mechanisms. Therefore, the aim of this study was to determine the effects of total sleep deprivation on temporal summation, conditioned pain modulation, thermal and pressure pain sensitivity in healthy participants. Twenty-four healthy participants took part in this two-session trial. The measurements were conducted after a night of habitual sleep (baseline) and following 24 hours of total sleep deprivation. Detection thresholds for cold and warmth and pain thresholds for cold and heat were assessed. Cuff induced pressure pain detection and tolerance thresholds, temporal summation and conditioned pain modulation were assessed with user-independent, computer-controlled cuff algometry. Conditioned pain modulation was significantly impaired, temporal summation was significantly facilitated and pain sensitivity to pressure and cold pain were significantly increased at follow-up compared with baseline. In conclusion, this study found that one night of total sleep deprivation impaired descending pain pathways, facilitated spinal excitability and sensitized peripheral pathways to cold and pressure pain. Future studies are encouraged to investigate if sleep therapy might normalize pain sensitivity in sleep-deprived chronic pain patients.
Collapse
Affiliation(s)
- Alexander Torp Staffe
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Mathias Winther Bech
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | | | - Henriette Tranberg Nielsen
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Dennis Boye Larsen
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Kristian Kjær Petersen
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Center for Neuroplasticity and Pain, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- * E-mail:
| |
Collapse
|
14
|
Fjeld OR, Grotle M, Matre D, Pedersen LM, Lie MU, Småstuen MC, Storheim K, Heuch I, Stubhaug A, Zwart JA, Nilsen KB. Predicting the outcome of persistent sciatica using conditioned pain modulation: 1-year results from a prospective cohort study. Scand J Pain 2019; 20:69-75. [DOI: 10.1515/sjpain-2019-0112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/28/2019] [Indexed: 02/06/2023]
Abstract
Abstract
Background and aims
Recovery in patients hospitalised with severe sciatica is unpredictable. Prognostic tools to aid clinicians in the early identification of patients at risk of developing chronic sciatic pain are warranted. Conditioned pain modulation (CPM) is a psychophysical measure of the endogenous pain modulatory pathways. Several studies have suggested CPM as a potentially important predictive biomarker for the development of chronic pain. The aim of the study was to determine whether CPM effect in patients still suffering from leg pain 6 weeks after hospital discharge for severe sciatica is associated with persistent leg pain at 12 months. A potential association would suggest that measuring CPM effect could be a valuable prognostic tool in the hospital management of sciatica.
Methods
A prospective cohort study in which CPM effect was measured 6 weeks after hospital discharge following an acute admission with sciatica as the main complaint. The impact of CPM effect on the outcome was analysed using logistic regression. The outcome measured was self-reported leg pain score of ≥1 in the past week on a 0–10 numeric rating scale (NRS) at 12 months post discharge.
Results
A total of 111 patients completed the entire study, 51 of whom received non-randomised surgical treatment. Crude and confounder adjusted analyses showed no significant association between CPM effect and leg-pain measured at 12 months, crude Odds Ratio 0.87, 95% CI 0.7–1.1, p = 0.23.
Conclusions
Our results suggest that CPM assessment has limited prognostic value for the long-term outcome in severe sciatica when measured 6 weeks after hospital discharge.
Implications
The present study adds important knowledge concerning the limited clinical use of late CPM testing in sciatica patients. The heterogeneity in patients, the wide range of treatments received and a generally favourable outcome are factors that may affect CPM’s clinical value as a prognostic factor for severe sciatica.
Collapse
Affiliation(s)
- Olaf R. Fjeld
- Research and Communication Unit for Musculoskeletal Health (FORMI) , Oslo University Hospital, Ullevål , Oslo , Norway
- Department of Neurology , Oslo University Hospital , Oslo , Norway
- Institute of Clinical Medicine , Faculty of Medicine, University of Oslo , Oslo , Norway
| | - Margreth Grotle
- Research and Communication Unit for Musculoskeletal Health (FORMI) , Oslo University Hospital, Ullevål , Oslo , Norway
- Faculty of Health Science , OsloMet - Oslo Metropolitan University , Oslo , Norway
| | - Dagfinn Matre
- Department of Work Psychology and Physiology , National Institute of Occupational Health , Oslo , Norway
| | - Linda M. Pedersen
- Research and Communication Unit for Musculoskeletal Health (FORMI) , Oslo University Hospital, Ullevål , Oslo , Norway
| | - Marie U. Lie
- Research and Communication Unit for Musculoskeletal Health (FORMI) , Oslo University Hospital, Ullevål , Oslo , Norway
| | - Milada C. Småstuen
- Research and Communication Unit for Musculoskeletal Health (FORMI) , Oslo University Hospital, Ullevål , Oslo , Norway
- Institute of Physiotherapy, Faculty of Health Science , Oslo and Akershus University College , Oslo , Norway
| | - Kjersti Storheim
- Research and Communication Unit for Musculoskeletal Health (FORMI) , Oslo University Hospital, Ullevål , Oslo , Norway
| | - Ingrid Heuch
- Research and Communication Unit for Musculoskeletal Health (FORMI) , Oslo University Hospital, Ullevål , Oslo , Norway
| | - Audun Stubhaug
- Department of Pain Management and Research, Faculty of Medicine , University of Oslo, Oslo , Norway
| | - John-Anker Zwart
- Research and Communication Unit for Musculoskeletal Health (FORMI) , Oslo University Hospital, Ullevål , Oslo , Norway
- Department of Neurology , Oslo University Hospital , Oslo , Norway
- Norway Institute of Clinical Medicine, Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Kristian Bernhard Nilsen
- Research and Communication Unit for Musculoskeletal Health (FORMI) , Oslo University Hospital, Ullevål , Oslo , Norway
- Department of Neurology , Oslo University Hospital , Oslo , Norway
- Department of Neuromedicine and Movement Science , Norwegian University of Science and Technology , Trondheim , Norway
| |
Collapse
|
15
|
Herrero Babiloni A, De Koninck BP, Beetz G, De Beaumont L, Martel MO, Lavigne GJ. Sleep and pain: recent insights, mechanisms, and future directions in the investigation of this relationship. J Neural Transm (Vienna) 2019; 127:647-660. [DOI: 10.1007/s00702-019-02067-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/16/2019] [Indexed: 12/13/2022]
|
16
|
Ree A, Nilsen KB, Knardahl S, Sand T, Matre D. Sleep restriction does not potentiate nocebo‐induced changes in pain and cortical potentials. Eur J Pain 2019; 24:110-121. [DOI: 10.1002/ejp.1466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/30/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Anbjørn Ree
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine University of Oslo Oslo Norway
| | - Kristian Bernhard Nilsen
- Department of Neurology Oslo University Hospital Oslo Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI) Oslo University Hospital Oslo Norway
| | - Stein Knardahl
- Department of Work Psychology and Physiology National Institute of Occupational Health Oslo Norway
| | - Trond Sand
- Department of Neurology and Clinical Neurophysiology St. Olavs Hospital Trondheim Norway
- Department of Neuromedicine and movement science Norwegian University of Science and Technology Trondheim Norway
| | - Dagfinn Matre
- Department of Work Psychology and Physiology National Institute of Occupational Health Oslo Norway
| |
Collapse
|
17
|
Lie MU, Petriu E, Matre D, Hansson P, Andersen OK, Zwart JA, Nilsen KB. Psychophysical or spinal reflex measures when assessing conditioned pain modulation? Eur J Pain 2019; 23:1879-1889. [PMID: 31359580 DOI: 10.1002/ejp.1462] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 07/05/2019] [Accepted: 07/23/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Assessing conditioning pain modulation (CPM) with spinal reflex measures may produce more objective and stable CPM effects than using psychophysical measures. The aim of the study was to compare the CPM effect and test-retest reliability between a psychophysical protocol with thermal test-stimulus and a spinal reflex protocol with electrical test-stimulus. METHODS Twenty-five healthy volunteers participated in two identical experiments separated by minimum 1 week. The thermal test-stimulus was a constant heat stimulation of 120 s on the subjects' forearm with continuous ratings of pain intensity on a 10 cm visual analogue scale. The electrical test-stimulus was repeated electrical stimulation on the arch of the foot for 120 s, which elicited a nociceptive withdrawal reflex recorded from the anterior tibial muscle. Conditioning stimulus was a 7°C water bath. Differences in the magnitude and test-retest reliability were investigated with repeated-measures analysis of variance and by relative and absolute reliability indices. RESULTS The CPM effect was -46% and 4.5% during the thermal and electrical test-stimulus (p < 0.001) respectively. Intraclass correlation coefficient of 0.5 and 0.4 was found with the electrical and thermal test-stimulus respectively. Wide limits of agreement were found for both the electrical (-3.4 to 3.8 mA) and the thermal test-stimulus (-3.2 to 3.6 cm). CONCLUSIONS More pronounced CPM effect was demonstrated when using a psychophysical protocol with thermal test-stimulus compared to a spinal reflex protocol with electrical test-stimulus. Fair relative reliability and poor absolute reliability (due to high intraindividual variability) was found in both protocols. SIGNIFICANCE The large difference in CPM effect between the two protocols suggests that the CPM effect relates to pain perception rather than nociception on the spinal level. Due to poor absolute intrarater reliability, we recommend caution and further research before using any of the investigated CPM protocols in clinical decision making on an individual level.
Collapse
Affiliation(s)
- Marie Udnesseter Lie
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Elena Petriu
- Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Dagfinn Matre
- Department of Work Psychology and Physiology, National Institute of Occupational Health, Oslo, Norway
| | - Per Hansson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Ole Kaeseler Andersen
- Center for Neuroplasticity and Pain (CNAP), SMI®, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - John-Anker Zwart
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Kristian Bernhard Nilsen
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
18
|
Chronic exposure to insufficient sleep alters processes of pain habituation and sensitization. Pain 2019; 159:33-40. [PMID: 28891869 DOI: 10.1097/j.pain.0000000000001053] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Chronic pain conditions are highly comorbid with insufficient sleep. While the mechanistic relationships between the 2 are not understood, chronic insufficient sleep may be 1 pathway through which central pain-modulatory circuits deteriorate, thereby contributing to chronic pain vulnerability over time. To test this hypothesis, an in-laboratory model of 3 weeks of restricted sleep with limited recovery (5 nights of 4-hour sleep per night followed by 2 nights of 8-hour sleep per night) was compared with 3 weeks of 8-hour sleep per night (control protocol). Seventeen healthy adults participated, with 14 completing both 3-week protocols. Measures of spontaneous pain, heat-pain thresholds, cold-pain tolerance (measuring habituation to cold over several weeks), and temporal summation of pain (examining the slope of pain ratings during cold water immersion) were assessed at multiple points during each protocol. Compared with the control protocol, participants in the sleep-restriction protocol experienced mild increases in spontaneous pain (P < 0.05). Heat-pain thresholds decreased after the first week of sleep restriction (P < 0.05) but normalized with longer exposure to sleep restriction. By contrast, chronic exposure to restricted sleep was associated with decreased habituation to, and increased temporal summation in response to cold pain (both P < 0.05), although only in the past 2 weeks of the sleep-restriction protocol. These changes may reflect abnormalities in central pain-modulatory processes. Limited recovery sleep did not completely resolve these alterations in pain-modulatory processes, indicating that more extensive recovery sleep is required. Results suggest that exposure to chronic insufficient sleep may increase vulnerability to chronic pain by altering processes of pain habituation and sensitization.
Collapse
|
19
|
Rosseland R, Pallesen S, Nordhus IH, Matre D, Blågestad T. Effects of Sleep Fragmentation and Induced Mood on Pain Tolerance and Pain Sensitivity in Young Healthy Adults. Front Psychol 2018; 9:2089. [PMID: 30429815 PMCID: PMC6220068 DOI: 10.3389/fpsyg.2018.02089] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 10/10/2018] [Indexed: 01/05/2023] Open
Abstract
Background: Experimental research exploring the sleep/pain-relationship has typically focused on total or partial sleep deprivation, hereby failing to reproduce the mere fragmented sleep pattern typically observed in patients with chronic pain. Further, little research is done on how affect moderates the sleep–pain relationship after sleep fragmentation. The present study sought to clarify the relationship between pain, sleep and positive and negative affect. Methods: In an experimental counterbalanced crossover design, 35 healthy young adults were subjected to several pain measures after one night of fragmented sleep, compared to one control night of normal sleep, both conducted in their own homes, and respectively, positive and negative affect induction using validated film clips and facial feedback procedures. Sleep was monitored using sleep diaries. Results: Increased pain sensitivity after one night of experimentally induced sleep fragmentation was found, compared to after one control night of undisturbed sleep. No main effects of induced affect on pain were found, and sleep x induced affect interaction was not significant. Conclusion: The present study supports the adverse effect of sleep fragmentation on pain sensitivity, however, affect was not found to be a moderator in the sleep–pain relationship. The results underline the need for further research within this field.
Collapse
Affiliation(s)
- Ragna Rosseland
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Inger Hilde Nordhus
- Department of Clinical Psychology, University of Bergen, Bergen, Norway.,Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
| | - Dagfinn Matre
- Department of Work Psychology and Physiology, National Institute of Occupational Health, Oslo, Norway
| | - Tone Blågestad
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
20
|
The Role of Sex in Sleep Deprivation Related Changes of Nociception and Conditioned Pain Modulation. Neuroscience 2018; 387:191-200. [DOI: 10.1016/j.neuroscience.2017.09.044] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 09/11/2017] [Accepted: 09/24/2017] [Indexed: 11/19/2022]
|
21
|
Karmann AJ, Lauer C, Ziegler E, Killian L, Horn-Hofmann C, Lautenbacher S. Associations of nocturnal sleep with experimental pain and pain catastrophizing in healthy volunteers. Biol Psychol 2018. [DOI: 10.1016/j.biopsycho.2018.02.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
22
|
Pieh C, Jank R, Waiß C, Pfeifer C, Probst T, Lahmann C, Oberndorfer S. Night-shift work increases cold pain perception. Sleep Med 2018; 45:74-79. [DOI: 10.1016/j.sleep.2017.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/01/2017] [Accepted: 12/05/2017] [Indexed: 02/07/2023]
|
23
|
A tonic heat test stimulus yields a larger and more reliable conditioned pain modulation effect compared to a phasic heat test stimulus. Pain Rep 2017; 2:e626. [PMID: 29392240 PMCID: PMC5741326 DOI: 10.1097/pr9.0000000000000626] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/15/2017] [Accepted: 09/13/2017] [Indexed: 11/26/2022] Open
Abstract
Introduction The interest in conditioned pain modulation (CPM) as a clinical tool for measuring endogenously induced analgesia is increasing. There is, however, large variation in the CPM methodology, hindering comparison of results across studies. Research comparing different CPM protocols is needed in order to obtain a standardized test paradigm. Objectives The aim of the study was to assess whether a protocol with phasic heat stimuli as test-stimulus is preferable to a protocol with tonic heat stimulus as test-stimulus. Methods In this experimental crossover study, we compared 2 CPM protocols with different test-stimulus; one with tonic test-stimulus (constant heat stimulus of 120-second duration) and one with phasic test-stimuli (3 heat stimulations of 5 seconds duration separated by 10 seconds). Conditioning stimulus was a 7°C water bath in parallel with the test-stimulus. Twenty-four healthy volunteers were assessed on 2 occasions with minimum 1 week apart. Differences in the magnitude and test-retest reliability of the CPM effect in the 2 protocols were investigated with repeated-measures analysis of variance and by relative and absolute reliability indices. Results The protocol with tonic test-stimulus induced a significantly larger CPM effect compared to the protocol with phasic test-stimuli (P < 0.001). Fair and good relative reliability was found with the phasic and tonic test-stimuli, respectively. Absolute reliability indices showed large intraindividual variability from session to session in both protocols. Conclusion The present study shows that a CPM protocol with a tonic test-stimulus is preferable to a protocol with phasic test-stimuli. However, we emphasize that one should be cautious to use the CPM effect as biomarker or in clinical decision making on an individual level due to large intraindividual variability.
Collapse
|
24
|
Kristiansen ES, Nielsen LS, Christensen SS, Botvid SHC, Nørgaard Poulsen J, Gazerani P. Sleep deprivation sensitizes human craniofacial muscles. Somatosens Mot Res 2017; 34:116-122. [DOI: 10.1080/08990220.2017.1317241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
| | - Louise Skou Nielsen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | | | | | - Parisa Gazerani
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| |
Collapse
|