1
|
Arribas-Romano A, Fernández-Carnero J, Rodríguez-Lagos L, Molina-Álvarez M, Zabala-Zambrano J, Lezaun-Hernández L, Contreras-Padilla L, Mercado F. CPM-Related Mechanisms Could Play a Key Role in the Effects on Pain Sensitivity Induced by Manual Therapy: Three Crossover Trials Investigating the Effects of Manual Pressure. J Clin Med 2024; 13:3648. [PMID: 38999214 PMCID: PMC11242484 DOI: 10.3390/jcm13133648] [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: 04/30/2024] [Revised: 06/15/2024] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
Objective: The aim of this study is to assess whether pain-inducing manual pressure (PIMP) leads to effects on pressure pain threshold (PPT) mediated by conditioned pain modulation (CPM) and whether these effects are influenced by the intensity and repetition of the stimulus. Additionally, the influence of psychological factors and physical activity on the response to PIMP was explored. Methods: A total of 72 pain-free students were randomly assigned to three crossover trials. Trial 1 compared the effects of PIMP with the cold pressor task and pain-inducing electrostimulation. Trial 2 compared the effects of manual pressure that elicited moderate pain, mild pain, and no pain. Trial 3 compared a single PIMP stimulation with four stimuli applied at the same site or at different sites. Results: PIMP produced a lower increase in PPT than cold pressor task and no difference with electrostimulation. Manual pressure that caused moderate pain led to a greater increase in PPT compared to mild pain and pain-free application. Repetition of PIMP stimulus, whether at the same or different sites, did not significantly increase PPT compared to a single stimulation. No association with psychological factors or physical activity was found. Conclusions: PIMP produces an increase in PPT, suggesting the involvement of CPM-related mechanisms.
Collapse
Affiliation(s)
- Alberto Arribas-Romano
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (A.A.-R.); (L.R.-L.)
- Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (M.M.-Á.); (F.M.)
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, 28922 Madrid, Spain
| | - Josué Fernández-Carnero
- Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (M.M.-Á.); (F.M.)
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, 28922 Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autonoma de Madrid, 28049 Madrid, Spain; (J.Z.-Z.); (L.L.-H.)
- La Paz Hospital Institute for Health Research, IdiPAZ, 28029 Madrid, Spain
| | - Leonardo Rodríguez-Lagos
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (A.A.-R.); (L.R.-L.)
- Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (M.M.-Á.); (F.M.)
| | - Miguel Molina-Álvarez
- Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (M.M.-Á.); (F.M.)
- Area of Pharmacology, Nutrition and Bromatology, Department of Basic Health Sciences, Rey Juan Carlos University, Unidad Asociada I+D+i Instituto de Química Médica (IQM) CSIC-URJC, 28922 Alcorcón, Spain
| | - Jesús Zabala-Zambrano
- Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autonoma de Madrid, 28049 Madrid, Spain; (J.Z.-Z.); (L.L.-H.)
- Advance Rehabilitation Center Sanitas, 28046 Madrid, Spain
| | - Lucas Lezaun-Hernández
- Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autonoma de Madrid, 28049 Madrid, Spain; (J.Z.-Z.); (L.L.-H.)
- Edurne Esquide Fisioterapia, 31200 Estella, Spain
| | - Lucía Contreras-Padilla
- iCentro Fix You, 28009 Madrid, Spain;
- School of Physiotherapy ONCE, Universidad Autónoma de Madrid, 28022 Madrid, Spain
| | - Francisco Mercado
- Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (M.M.-Á.); (F.M.)
- Department of Psychology, Faculty of Health Sciences, Universidad Rey Juan Carlos, 28922 Madrid, Spain
| |
Collapse
|
2
|
Szikszay TM, Adamczyk WM, Carvalho GF, Dolotov D, Erdmann R, Heitkamp H, Jung A, Luebke L, Rogosch K, Luedtke K. Association between myofascial trigger point therapy and conditioned pain modulation. J Bodyw Mov Ther 2024; 38:73-80. [PMID: 38763618 DOI: 10.1016/j.jbmt.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/10/2023] [Accepted: 12/21/2023] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Myofascial trigger point therapy (MTrP) is a widely used therapeutic approach, although the underlying mechanisms remain unclear. Mechanisms discussed include peripheral involvement of muscles as well as central pain modulating processes such as the conditioned pain modulation (CPM). The aim of this study was to investigate whether the analgesic response of MTrP and the analgesic response of CPM correlate in asymptomatic participants in order to identify shared underlying mechanisms of MTrP and CPM. METHOD Both, CPM and MTrP protocols consisted of heat-based test stimuli (heat pain thresholds before and after the intervention) and pressure-based (conditioning) stimuli. Asymptomatic participants (n = 94) were randomly assigned to receive either mild, intense or no pressure stimuli (between-group design) to both the fingernail and the MTrP of the infraspinatus muscle (within-group design). Pressure stimuli at both locations (fingernail, MTrP) were applied with a pressure algometer for 120 s and continuously adjusted to maintain a constant pain intensity of mild or intense pain. All thermal stimuli were applied on the lower leg with a thermal stimulator. RESULTS A significant correlation was shown between the analgesic effect of CPM and MTrP therapy for mild (r = 0.53, p = 0.002) and intensive stimuli (r = 0.73, p < 0.001). 17.3% of the variance of the MTrP effect were explained by CPM after mild stimulation, and 47.1% after intense stimulation. Pain-related characteristics did not explain the variance within the analgesic response using a regression analysis. CONCLUSIONS Between the analgesic responses following MTrP and CPM paradigms, a moderate to strong correlation was observed, suggesting shared underlying mechanisms.
Collapse
Affiliation(s)
- Tibor M Szikszay
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universität zu Lübeck, Lübeck, Germany; Center of Brain, Behavior and Metabolism (CBBM), Universität zu Lübeck, Lübeck, Germany.
| | - Wacław M Adamczyk
- Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Gabriela F Carvalho
- Department of Physiotherapy, Faculity of Health, Safety and Society, Furtwangen University, Frutwangen, Germany
| | - Daniel Dolotov
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universität zu Lübeck, Lübeck, Germany
| | - Rika Erdmann
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universität zu Lübeck, Lübeck, Germany
| | - Hauke Heitkamp
- Institute of Applied Physiotherapy Osnabrueck (INAP/O), Osnabrueck, Germany
| | - Andres Jung
- Department of Sport Science and Sport, Friedrich-Alexander University Erlangen Nuremberg, Erlangen, Germany
| | - Luisa Luebke
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universität zu Lübeck, Lübeck, Germany
| | - Katharina Rogosch
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universität zu Lübeck, Lübeck, Germany
| | - Kerstin Luedtke
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universität zu Lübeck, Lübeck, Germany; Center of Brain, Behavior and Metabolism (CBBM), Universität zu Lübeck, Lübeck, Germany
| |
Collapse
|
3
|
Knox PJ, Simon CB, Hicks GE. Preliminary Characterization of Age and Chronic Low Back Pain Effects on Multimodal Pain Sensitivity: A Comparison Study in Older Adults with and Without Chronic Low Back Pain. THE JOURNAL OF PAIN 2024:104509. [PMID: 38484855 DOI: 10.1016/j.jpain.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/20/2024] [Accepted: 03/08/2024] [Indexed: 04/29/2024]
Abstract
Though pain sensitivity impairments contribute to chronic pain in younger adults, it is unclear if pain hypersensitivity manifests with aging and is heightened in the geriatric chronic low back pain population. The cross-sectional study preliminarily addressed this gap by measuring pain sensitivity in older adults with chronic low back pain (n = 25) as well as pain-free sex-matched older (n = 25) and younger adults (n = 25). Pain sensitivity was quantified by 8 distinct measures that were subdivided as static (ie, pressure pain thresholds, heat pain thresholds, fixed mechanical pain, and fixed cold pain) and dynamic pain sensitivity (ie, mechanical temporal summation, thermal ramp and hold, heat pain aftersensations, and conditioned pain modulation). Test-retest reliability values for pain sensitivity ranged from moderate to excellent (intraclass correlation coefficients ≥ .500; p's < .05). The main effect for the group was significant (partial η2 = .413, P < .001), revealing between-group differences in pain sensitivity on 5 out of 8 tests (p's ≤ .043). Predominantly, both older adult groups demonstrated increased pain facilitation and decreased pain inhibition during dynamic pain sensitivity testing compared to pain-free younger adults (p's ≤ .044). Despite qualitative differences, static and dynamic pain sensitivity responses were statistically similar between older adults with and without chronic LBP (p's > .05). Findings suggest pain sensitivity can be reliably measured in older adults and that pain hypersensitivity develops with chronological aging, providing partial support for the theory that pain hypersensitivity may impact geriatric chronic pain populations. Further study is needed to more definitively parse out whether pain hypersensitivity is comparatively heightened in older adults with chronic LBP beyond the influence of chronological aging. PERSPECTIVE: This article establishes that surrogate measures of centrally mediated pain sensitization are heightened with aging. Impaired endogenous pain modulation may influence chronic pain development, maintenance, treatment efficacy, and/or ensuing disability, necessitating research to comprehensively characterize how pain hypersensitivity contributes to geriatric chronic pain conditions.
Collapse
Affiliation(s)
- Patrick J Knox
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Corey B Simon
- Department of Orthopaedic Surgery, Physical Therapy Division, Duke University, Durham, North Carolina
| | - Gregory E Hicks
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Bakken AG, Axén I, Eklund A, Warnqvist A, O'Neill S. Temporal stability and responsiveness of a conditioned pain modulation test. Scand J Pain 2023; 23:571-579. [PMID: 36869854 DOI: 10.1515/sjpain-2022-0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 02/22/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVES Conditioned pain modulation is a commonly used quantitative sensory test, measuring endogenous pain control. The temporal stability of the test is questioned, and there is a lack of agreement on the effect of different pain conditions on the conditioned pain modulation response. Thus, an investigation of the temporal stability of a conditioned pain modulation test among patients suffering from persistent or recurrent neck pain is warranted. Further, an investigation into the difference between patients experiencing a clinically important improvement in pain and those not experiencing such an improvement will aid the understanding between changes in pain and the stability of the conditioned pain modulation test. METHODS This study is based on a randomized controlled trial investigating the effect of home stretching exercises and spinal manipulative therapy vs. home stretching exercises alone. As no difference was found between the interventions, all participants were studied as a prospective cohort in this study, investigating the temporal stability of a conditioned pain modulation test. The cohort was also divided into responders with a minimally clinically important improvement in pain and those not experiencing such an improvement. RESULTS Stable measurements of conditioned pain modulation were observed for all independent variables, with a mean change in individual CPM responses of 0.22 from baseline to one week with a standard deviation of 1.34, and -0.15 from the first to the second week with a standard deviation of 1.23. An Intraclass Correlation Coefficient (ICC3 - single, fixed rater) for CPM across the three time points yielded a coefficient of 0.54 (p<0.001). CONCLUSIONS Patients with persistent or recurrent neck pain had stable CPM responses over a 2 week course of treatment irrespective of clinical response.
Collapse
Affiliation(s)
- Anders Galaasen Bakken
- Department of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Stockholm, Sweden
| | - Iben Axén
- Department of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Eklund
- Department of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Stockholm, Sweden
| | - Anna Warnqvist
- Division of Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Søren O'Neill
- Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
| |
Collapse
|
6
|
da Silva ML, Fernandes AM, Silva VA, Galhardoni R, Felau V, de Araujo JO, Rosi J, Brock RS, Kubota GT, Teixeira MJ, Yeng LT, de Andrade DC. Motor corticospinal excitability abnormalities differ between distinct chronic low back pain syndromes. Neurophysiol Clin 2023; 53:102853. [PMID: 37018953 DOI: 10.1016/j.neucli.2023.102853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/26/2023] [Accepted: 02/26/2023] [Indexed: 04/05/2023] Open
Abstract
OBJECTIVES It is not known whether cortical plastic changes reported in low-back pain (LBP) are present in all etiologies of LBP. Here we report on the assessment of patients with three LBP conditions: non-specific-LBP (ns-LBP), failed back surgery syndrome (FBSS), and sciatica (Sc). METHODS Patients underwent a standardized assessment of clinical pain, conditioned pain modulation (CPM), and measures of motor evoked potential (MEPs)-based motor corticospinal excitability (CE) by transcranial magnetic stimulation, including short interval intracortical inhibition (SICI), and intracortical facilitation (ICF). Comparisons were also made with normative data from sex- and age-matched healthy volunteers. RESULTS 60 patients (42 women, 55.1±9.1 years old) with LBP were included (20 in each group). Pain intensity was higher in patients with neuropathic pain [FBSS (6.8±1.3), and Sc (6.4±1.4)] than in those with ns-LBP (4.7±1.0, P<0.001). The same was shown for pain interference (5.9±2.0, 5.9±1.8, 3.2±1.9, P<0.001), disability (16.4±3.3, 16.3±4.3, 10.4±4.3, P<0.001), and catastrophism (31.1±12.3, 33.0±10.4, 17.4±10.7, P<0.001) scores for FBSS, Sc, and ns-LBP groups, respectively. Patients with neuropathic pain (FBSS, Sc) had lower CPM (-14.8±1.9, -14.1±16.7, respectively) compared to ns-LBP (-25.4±16.6; P<0.02). 80.0% of the FBSS group had defective ICF compared to the other two groups (52.5% for ns-LBP, P=0.025 and 52.5% for Sc, P=0.046). MEPs (140%-rest motor threshold) were low in 50.0% of patients in the FBSS group compared to 20.0% of ns-LBP (P=0.018) and 15.0% of Sc (P=0.001) groups. Higher MEPs were correlated with mood scores (r=0.489), and with lower neuropathic pain symptom scores(r=-0.415) in FBSS. CONCLUSIONS Different types of LBP were associated with different clinical, CPM and CE profiles, which were not uniquely related to the presence of neuropathic pain. These results highlight the need to further characterize patients with LBP in psychophysics and cortical neurophysiology studies.
Collapse
Affiliation(s)
- Marcelo Luiz da Silva
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Ana Mércia Fernandes
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Valquíria A Silva
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Ricardo Galhardoni
- School of Medicine, University of City of São Paulo (UNICID), São Paulo, Brazil
| | - Valter Felau
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Joaci O de Araujo
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Jefferson Rosi
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Roger S Brock
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Gabriel T Kubota
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Manoel J Teixeira
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Lin T Yeng
- Pain Center, Institute of Orthopedics and Traumatology, University of São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil; Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
| |
Collapse
|
7
|
Schmid AB, Ridgway L, Hailey L, Tachrount M, Probert F, Martin KR, Scott W, Crombez G, Price C, Robinson C, Koushesh S, Ather S, Tampin B, Barbero M, Nanz D, Clare S, Fairbank J, Baskozos G. Factors predicting the transition from acute to persistent pain in people with 'sciatica': the FORECAST longitudinal prognostic factor cohort study protocol. BMJ Open 2023; 13:e072832. [PMID: 37019481 PMCID: PMC10111910 DOI: 10.1136/bmjopen-2023-072832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/15/2023] [Indexed: 04/07/2023] Open
Abstract
INTRODUCTION Sciatica is a common condition and is associated with higher levels of pain, disability, poorer quality of life, and increased use of health resources compared with low back pain alone. Although many patients recover, a third develop persistent sciatica symptoms. It remains unclear, why some patients develop persistent sciatica as none of the traditionally considered clinical parameters (eg, symptom severity, routine MRI) are consistent prognostic factors.The FORECAST study (factors predicting the transition from acute to persistent pain in people with 'sciatica') will take a different approach by exploring mechanism-based subgroups in patients with sciatica and investigate whether a mechanism-based approach can identify factors that predict pain persistence in patients with sciatica. METHODS AND ANALYSIS We will perform a prospective longitudinal cohort study including 180 people with acute/subacute sciatica. N=168 healthy participants will provide normative data. A detailed set of variables will be assessed within 3 months after sciatica onset. This will include self-reported sensory and psychosocial profiles, quantitative sensory testing, blood inflammatory markers and advanced neuroimaging. We will determine outcome with the Sciatica Bothersomeness Index and a Numerical Pain Rating Scale for leg pain severity at 3 and 12 months.We will use principal component analysis followed by clustering methods to identify subgroups. Univariate associations and machine learning methods optimised for high dimensional small data sets will be used to identify the most powerful predictors and model selection/accuracy.The results will provide crucial information about the pathophysiological drivers of sciatica symptoms and may identify prognostic factors of pain persistence. ETHICS AND DISSEMINATION The FORECAST study has received ethical approval (South Central Oxford C, 18/SC/0263). The dissemination strategy will be guided by our patient and public engagement activities and will include peer-reviewed publications, conference presentations, social media and podcasts. TRIAL REGISTRATION NUMBER ISRCTN18170726; Pre-results.
Collapse
Affiliation(s)
- Annina B Schmid
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, Oxfordshire, UK
| | - Lucy Ridgway
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Louise Hailey
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Mohamed Tachrount
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, Oxfordshire, UK
| | - Fay Probert
- Department of Chemistry, University of Oxford, Oxford, Oxfordshire, UK
| | - Kathryn R Martin
- Academic Primary Care, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Aberdeen Centre for Arhtritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Whitney Scott
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Geert Crombez
- Department of Experimental Clinical and Health Psychology, University of Ghent, Gent, Belgium
| | - Christine Price
- Patient partner FORECAST study, Oxford University, Oxford, UK
| | - Claire Robinson
- Patient partner FORECAST study, Oxford University, Oxford, UK
| | - Soraya Koushesh
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Sarim Ather
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Brigitte Tampin
- Department of Physiotherapy, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Faculty of Business and Social Sciences, University of Applied Sciences, Osnabrueck, Germany
| | - Marco Barbero
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Ticino, Switzerland
| | - Daniel Nanz
- Swiss Center for Musculoskeletal Imaging, Balgrist Campus AG, Zurich, Zurich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Zurich, Switzerland
| | - Stuart Clare
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, Oxfordshire, UK
| | - Jeremy Fairbank
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Georgios Baskozos
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| |
Collapse
|
8
|
Henri C, Marchand S, Giguère CÉ, Léonard G, Potvin S. Inter-subject variability of pleasant pain relief using a data-driven approach in healthy volunteers. FRONTIERS IN PAIN RESEARCH 2022; 3:1003237. [DOI: 10.3389/fpain.2022.1003237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/02/2022] [Indexed: 11/22/2022] Open
Abstract
BackgroundThe offset of a painful and unpleasant sensation can elicit pleasure. This phenomenon, namely pleasant pain relief (PPR), is attracting growing interest in research. While the cold pressor test (CPT) has been frequently used to study the inhibition of pain by the administration of another painful stimulation (inhibitory conditioned pain modulation; ICPM), a preliminary study from our research team has shown that CPT can also elicit a robust and long-lasting PPR. However, its effects on pain relief and inhibition vary greatly between subjects. Although substantial research has been carried out on inter-individual variability in the case of ICPM, the same cannot be said of PPR. Therefore, the current study sought to identify clusters of healthy volunteers with similar dynamic pain responses during the CPT, using a data-driven approach, and to investigate the inter-subject variability for PPR and ICPM.MethodsOne hundred and twenty-two healthy volunteers were recruited. A sequential ICPM paradigm was carried out with CPT (water at 10°C) and a Peltier Thermode to evaluate pain intensity and unpleasantness. Moreover, PPR was measured for four minutes at CPT offset. Statistical analyses were performed using group-based trajectory modelling.ResultsFour trajectories (groups) were identified for CPT pain intensity and unpleasantness ratings with varying levels of tonic pain and pain sensitization (e.g., temporal summation). PPR scores were correlated with both pain ratings trajectories (p < 0.001). On the other hand, no differences were found between groups regarding ICPM efficacy (percentage pain inhibition).DiscussionThis study has provided a first step into the investigation of PPR and ICPM interindividual variability. Using a data-driven approach, it was shown that PPR at CPT offset differs between clusters of participants identified based on dynamic pain intensity and unpleasantness responses from CPT. Thus, it was brought to light that both the levels of tonic pain and pain sensitization underlie individual differences in PPR. The lack of correlation between CPT pain trajectories and ICPM efficacy may be explained by the hypotheses that eliciting ICPM requires only a certain threshold of stimulation which doesn’t need to be noxious. In the future, studies on the inter-subject variability of PPR in large samples of chronic pain patients are warranted.
Collapse
|
9
|
Konditionierte Schmerzmodulation und Manuelle Therapie: Same same but different? PHYSIOSCIENCE 2022. [DOI: 10.1055/a-1741-9846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
10
|
Ojala J, Vanhanen J, Harno H, Lioumis P, Vaalto S, Kaunisto MA, Putaala J, Kangasniemi M, Kirveskari E, Mäkelä JP, Kalso E. A Randomized, Sham-Controlled Trial of Repetitive Transcranial Magnetic Stimulation Targeting M1 and S2 in Central Poststroke Pain: A Pilot Trial. Neuromodulation 2022; 25:538-548. [PMID: 35670063 DOI: 10.1111/ner.13496] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/13/2021] [Accepted: 06/21/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Central poststroke pain (CPSP), a neuropathic pain condition, is difficult to treat. Repetitive transcranial magnetic stimulation (rTMS) targeted to the primary motor cortex (M1) can alleviate the condition, but not all patients respond. We aimed to assess a promising alternative rTMS target, the secondary somatosensory cortex (S2), for CPSP treatment. MATERIALS AND METHODS This prospective, randomized, double-blind, sham-controlled three-arm crossover trial assessed navigated rTMS (nrTMS) targeted to M1 and S2 (10 sessions, 5050 pulses per session at 10 Hz). Participants were evaluated for pain, depression, anxiety, health-related quality of life, upper limb function, and three plasticity-related gene polymorphisms including Dopamine D2 Receptor (DRD2). We monitored pain intensity and interference before and during stimulations and at one month. A conditioned pain modulation test was performed using the cold pressor test. This assessed the efficacy of the descending inhibitory system, which may transmit TMS effects in pain control. RESULTS We prescreened 73 patients, screened 29, and included 21, of whom 17 completed the trial. NrTMS targeted to S2 resulted in long-term (from baseline to one-month follow-up) pain intensity reduction of ≥30% in 18% (3/17) of participants. All stimulations showed a short-term effect on pain (17-20% pain relief), with no difference between M1, S2, or sham stimulations, indicating a strong placebo effect. Only nrTMS targeted to S2 resulted in a significant long-term pain intensity reduction (15% pain relief). The cold pressor test reduced CPSP pain intensity significantly (p = 0.001), indicating functioning descending inhibitory controls. The homozygous DRD2 T/T genotype is associated with the M1 stimulation response. CONCLUSIONS S2 is a promising nrTMS target in the treatment of CPSP. The DRD2 T/T genotype might be a biomarker for M1 nrTMS response, but this needs confirmation from a larger study.
Collapse
Affiliation(s)
- Juhani Ojala
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Jukka Vanhanen
- HUS Diagnostic Center, Clinical Neurophysiology, Clinical Neurosciences, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; BioMag Laboratory, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Hanna Harno
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pantelis Lioumis
- BioMag Laboratory, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
| | - Selja Vaalto
- HUS Diagnostic Center, Clinical Neurophysiology, Clinical Neurosciences, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mari A Kaunisto
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Jukka Putaala
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marko Kangasniemi
- HUS Diagnostic Center, Department of Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Erika Kirveskari
- HUS Diagnostic Center, Clinical Neurophysiology, Clinical Neurosciences, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; BioMag Laboratory, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jyrki P Mäkelä
- BioMag Laboratory, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Eija Kalso
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| |
Collapse
|
11
|
Barbosa LM, da Silva VA, de Lima Rodrigues AL, Mendes Fernandes DTR, de Oliveira RAA, Galhardoni R, Yeng LT, Junior JR, Conforto AB, Lucato LT, Lemos MD, Peyron R, Garcia-Larrea L, Teixeira MJ, de Andrade DC. Dissecting central post-stroke pain: a controlled symptom-psychophysical characterization. Brain Commun 2022; 4:fcac090. [PMID: 35528229 PMCID: PMC9070496 DOI: 10.1093/braincomms/fcac090] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/21/2021] [Accepted: 03/31/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Central post-stroke pain affects up to 12% of stroke survivors and is notoriously refractory to treatment. However, stroke patients often suffer from other types of pain of non- neuropathic nature (musculoskeletal, inflammatory, complex regional) and no head-to-head comparison of their respective clinical and somatosensory profiles has been performed so far.
We compared 39 patients with definite central neuropathic post-stroke pain with two matched- control groups: 32 patients with exclusively non-neuropathic pain developed after stroke and 31 stroke patients not complaining of pain. Patients underwent deep phenotyping via a comprehensive assessment including clinical exam, questionnaires and quantitative sensory testing to dissect central post-stroke pain from chronic pain in general and stroke.
While central post-stroke pain was mostly located in the face and limbs, non-neuropathic pain was predominantly axial and located in neck, shoulders and knees (p<0.05). Neuropathic Pain Symptom Inventory clusters burning (82.1%, n=32, p<0.001), tingling (66.7%, n= 26, p<0.001) and evoked by cold (64.1%, n=25, p<0.001) occurred more frequently in central post-stroke pain. Hyperpathia, thermal and mechanical allodynia also occurred more commonly in this group (p<0.001), which also presented higher levels of deafferentation (p<0.012) with more asymmetric cold and warm detection thresholds compared to controls. In particular, cold hypoesthesia (considered when the threshold of the affected side was less than 41% of the contralateral threshold) odds ratio was 12 (95%CI: 3.8-41.6) for neuropathic pain. Additionally, cold detection threshold/ warm detection threshold ratio correlated with the presence of neuropathic pain (ρ=-0.4, p< 0.001). Correlations were found between specific neuropathic pain symptom clusters and quantitative sensory testing: paroxysmal pain with cold (ρ=-0.4; p=0.008) and heat pain thresholds (ρ=0.5; p=0.003), burning pain with mechanical detection (ρ= -0.4; p=0.015) and mechanical pain thresholds (ρ=-0.4, p<0.013), evoked pain with mechanical pain threshold (ρ= -0.3; p=0.047). Logistic regression showed that the combination of cold hypoesthesia on quantitative sensory testing, the Neuropathic Pain Symptom Inventory, and the allodynia intensity on bedside examination explained 77% of the occurrence of neuropathic pain.
These findings provide insights into the clinical-psychophysics relationships in central post-stroke pain and may assist more precise distinction of neuropathic from non-neuropathic post-stroke pain in clinical practice and in future trials.
Collapse
Affiliation(s)
| | | | | | | | | | - Ricardo Galhardoni
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | - Lin Tchia Yeng
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | - Jefferson Rosi Junior
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
| | | | | | - Marcelo Delboni Lemos
- Department of Radiology, LIM-44, University of São Paulo, 05403-900, São Paulo, Brazil
| | - Roland Peyron
- NeuroPain team, Lyon Neuroscience Research Center (CRNL), Inserm U1028, CNRS UMR5292, UCBL1, UJM, F-6900, Lyon, France
| | - Luis Garcia-Larrea
- NeuroPain team, Lyon Neuroscience Research Center (CRNL), Inserm U1028, CNRS UMR5292, UCBL1, UJM, F-6900, Lyon, France
| | - Manoel Jacobsen Teixeira
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
- Department of Neurology, LIM-62, University of São Paulo, 05403-900, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Pain Center, Discipline of Neurosurgery HC-FMUSP, LIM-62, University of São Paulo, Brazil
- Center for Neuroplasticity and Pain, Department of Health Sciences and Technology, Faculty of Medicine, Aalborg University, DK-9220, Aalborg, Denmark
| |
Collapse
|
12
|
Pietro GD, Stefano GD, Leone C, Lionardo AD, Sgrò E, Blockeel AJ, Caspani O, Garcia-Larrea L, Mouraux A, Phillips KG, Treede RD, Valeriani M, Truini A. The N13 spinal component of somatosensory evoked potentials is modulated by heterotopic noxious conditioning stimulation suggesting an involvement of spinal wide dynamic range neurons. Neurophysiol Clin 2021; 51:517-523. [PMID: 34756635 DOI: 10.1016/j.neucli.2021.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Although somatosensory evoked potentials (SEPs) after median nerve stimulation are widely used in clinical practice, the dorsal horn generator of the N13 SEP spinal component is not clearly understood. To verify whether wide dynamic range neurons in the dorsal horn of the spinal cord are involved in the generation of the N13 SEP, we tested the effect of heterotopic noxious conditioning stimulation, which modulates wide dynamic range neurons, on N13 SEP in healthy humans. METHODS In 12 healthy subjects, we performed the cold pressor test on the left foot as a heterotopic noxious conditioning stimulus to modulate wide dynamic range neurons. To verify the effectiveness of heterotopic noxious conditioning stimulation, we tested the pressure pain threshold at the thenar muscles of the right hand and recorded SEPs after right median nerve stimulation before, during and after the cold pressor test. RESULTS The cold pressor test increased pressure pain threshold by 15% (p = 0.04). During the cold pressor test, the amplitude of the N13 component was significantly lower than that recorded at baseline (by 25%, p = 0.04). DISCUSSION In this neurophysiological study in healthy humans, we showed that a heterotopic noxious conditioning stimulus significantly reduced N13 SEP amplitude. This finding suggests that the N13 SEP might be generated by the segmental postsynaptic response of dorsal horn wide dynamic range neurons.
Collapse
Affiliation(s)
| | | | - Caterina Leone
- Department of Human Neuroscience, University Sapienza, Rome, Italy
| | | | - Emanuele Sgrò
- Department of Human Neuroscience, University Sapienza, Rome, Italy
| | - Anthony James Blockeel
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, United Kingdom
| | - Ombretta Caspani
- Department of Neurophysiology, Mannheim Center for translational Neuroscience (MCTN), Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - Luis Garcia-Larrea
- Lyon Neurosciences Center Research Unit Inserm U 1028, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France; Pain Center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France
| | - André Mouraux
- Université Catholique de Louvain, Institute of Neuroscience (IoNS), Faculty of Medicine, Bruxelles, Belgium
| | - Keith Geoffrey Phillips
- Neuroscience Next Generation Therapeutics, Eli Lilly and Company, Lilly Innovation Center, Cambridge, MA 02142, USA
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for translational Neuroscience (MCTN), Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - Massimiliano Valeriani
- Headache Center, Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy; Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
| | - Andrea Truini
- Department of Human Neuroscience, University Sapienza, Rome, Italy.
| |
Collapse
|
13
|
Kovacevic M, Klicov L, Vuklis D, Neblett R, Knezevic A. Test-retest reliability of pressure pain threshold and heat pain threshold as test stimuli for evaluation of conditioned pain modulation. Neurophysiol Clin 2021; 51:433-442. [PMID: 34304974 DOI: 10.1016/j.neucli.2021.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES There is growing interest in conditioned pain modulation (CPM) protocols for evaluating the function of the descending pain-modulatory system in clinical settings. The aim of this study was to evaluate test-retest reliability of a CPM protocol with contact heat as a conditioning stimulus (CS) and two test stimuli (pressure pain threshold (PPT) and heat pain threshold (HPT)), all applied within one session. In addition, gender and age differences were evaluated. METHODS The study included 87 healthy subjects (average age 37.95 ± 12.02 years, 57.5% females). The magnitude of the results of the CPM test was calculated as the difference between subject-reported pain thresholds before and after application of the CS. To assess the reliability of the protocol, a subgroup of 66 subjects underwent re-test after 14±1 days. In order to investigate the influence of age on the CPM magnitude, subjects were divided into subgroups (20-29, 30-39, 40-49, 50-59 years). RESULTS The pain thresholds for both test stimuli (TS) were significantly higher following the application of the CS (p < 0.001). Values of the interclass correlation coefficient (ICC) for the CPM with PPT as the TS indicated good reliability (ICC=0.631, 95% CI:0.365-0.782), while those for the HPT indicated poor reliability (ICC=0.328, 95% CI:-0.067-0.582). Significant differences in CPM between genders were found for both TS. Significant CPM differences were not detected among the four age subgroups for either TS. CONCLUSIONS CPM effects can be successfully induced with both PPT and HPT as a TS, but PPT showed significantly higher reliability.
Collapse
Affiliation(s)
| | - Ljiljana Klicov
- Medical Rehabilitation Clinic, Clinical Centre of Vojvodina, Novi Sad, Serbia
| | - Dragana Vuklis
- University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
| | - Randy Neblett
- PRIDE Research Foundation, Dallas, TX, United States of America
| | - Aleksandar Knezevic
- University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Medical Rehabilitation Clinic, Clinical Centre of Vojvodina, Novi Sad, Serbia
| |
Collapse
|
14
|
Listik C, Cury RG, da Silva VA, Casagrande SCB, Listik E, Link N, Galhardoni R, Barbosa ER, Teixeira MJ, Ciampi de Andrade D. Abnormal sensory thresholds of dystonic patients are not affected by deep brain stimulation. Eur J Pain 2021; 25:1355-1366. [PMID: 33740316 DOI: 10.1002/ejp.1757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Unlike motor symptoms, the effects of deep brain stimulation (DBS) on non-motor symptoms associated with dystonia remain unknown. METHODS The objective of this study was to assess the effects of DBS on evoked experimental pain and cutaneous sensory thresholds in a crossover, double-blind on/off study and compare these results with those of healthy volunteers (HV). RESULTS Sixteen patients with idiopathic dystonia (39.9 ± 13 years old, n = 14 generalized) with DBS of the globus pallidus internus underwent a battery of quantitative sensory testing and assessment using a pain top-down modulation system (conditioned pain modulation, CPM). Results for the more and less dystonic body regions were compared in on and off stimulation. The patients' results were compared to age- and sex-matched HV. Descending pain modulation CPM responses in dystonic patients (on-DBS, 11.8 ± 40.7; off-DBS, 1.8 ± 22.1) was abnormally low (defective) compared to HV (-15.6 ± 23.5, respectively p = .006 and p = .042). Cold pain threshold and cold hyperalgesia were 54.8% and 95.7% higher in dystonic patients compared to HV. On-DBS CPM correlated with higher Burke-Fahn-Marsden disability score (r = 0.598; p = .014). While sensory and pain thresholds were not affected by DBS on/off condition, pain modulation was abnormal in dystonic patients and tended to be aggravated by DBS. CONCLUSION The analgesic effects after DBS do not seem to depend on short-duration changes in cutaneous sensory thresholds in dystonic patients and may be related to changes in the central processing of nociceptive inputs.
Collapse
Affiliation(s)
- Clarice Listik
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Rubens Gisbert Cury
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Valquiria Aparecida da Silva
- Pain Center, Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | - Eduardo Listik
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Naira Link
- Pain Center, Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Ricardo Galhardoni
- Pain Center, Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.,Federal University of ABC, São Bernardo do Campo, SP, Brazil.,School of Medicine, Santo André, SP, Brazil
| | - Egberto Reis Barbosa
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Manoel Jacobsen Teixeira
- Pain Center, Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Daniel Ciampi de Andrade
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.,Pain Center, Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.,Pain Center, Instituto do Cancer do Estado de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
15
|
Coulombe-Lévêque A, Tousignant-Laflamme Y, Léonard G, Marchand S. The effect of conditioning stimulus intensity on conditioned pain modulation (CPM) hypoalgesia. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2021; 5:22-29. [PMID: 33987521 PMCID: PMC7951153 DOI: 10.1080/24740527.2020.1855972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background: The magnitude and duration of conditioned pain modulation (CPM) likely depends on the nature and intensity of the conditioning stimulus (CS). Aims: The aim of this study was to measure the effect of CS intensity on the duration of CPM hypoalgesia. Methods: In this single-blind, nonrandomized, repeated measures study, we assessed CPM hypoalgesia in 20 healthy participants following cold pressor tests (CPT) at 7°C and 12°C. The test stimulus, a 60-s heat stimulation, was administered before the CPT and immediately after, and again at 5-min intervals until participants’ pain scores returned to pre-CS levels. Two hypoalgesia thresholds were used to establish return to pre-CS level: within −10/100 of baseline and within −20/100 of baseline. Results: CPM hypoalgesia, when defined as a reduction in pain levels >10/100, did not last longer following the more intense 7°C CPT compared to the 12°C CPT (32 min vs. 20 min, respectively; P = 0.06); similar results were obtained when CPM hypoalgesia was defined as a reduction in pain levels of >20/100 (16 min following the 7°C CPT vs. 9 min following the 12°C CPT; P = 0.33). The duration of CPM hypoalgesia was significantly longer when the 10/100 threshold was used compared to the 20/100 threshold, regardless of CPT temperature (P = 0.008 for the 12°C CPT; P < 0.001 for the 7°C CPT). Conclusions: The more intense CS did not induce CPM hypoalgesia of longer duration compared to the less intense CS. The choice of threshold for what constitutes CPM hypoalgesia did have a significant effect on the results.
Collapse
Affiliation(s)
- Alexia Coulombe-Lévêque
- Centre de recherche sur le vieillissement, Sherbrooke, Quebec, Canada.,School of Rehabilitation, Faculty de medicine and health sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Yannick Tousignant-Laflamme
- School of Rehabilitation, Faculty de medicine and health sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada.,Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - Guillaume Léonard
- Centre de recherche sur le vieillissement, Sherbrooke, Quebec, Canada.,School of Rehabilitation, Faculty de medicine and health sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Serge Marchand
- Department of Neurosurgery, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| |
Collapse
|
16
|
Ramaswamy S, Wodehouse T. Conditioned pain modulation-A comprehensive review. Neurophysiol Clin 2020; 51:197-208. [PMID: 33334645 DOI: 10.1016/j.neucli.2020.11.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 11/25/2020] [Accepted: 11/28/2020] [Indexed: 01/05/2023] Open
Abstract
Conditioned pain modulation (CPM) is a centrally processed measure of the net effect of the descending pain pathway. This comprises both the facilitatory as well as the inhibitory effect. In the past, CPM or similar effects have been previously described using different terminologies such as diffuse noxious inhibitory control (DNIC), heterotopic noxious conditioning stimulation (HNCS) or endogenous analgesia (EA). A variety of patient-related factors such as age, gender, hormones, race, genetic and psychological factors have been thought to influence the CPM paradigms. CPM paradigms have also been associated with a wide range of methodological variables including the mode of application of the 'test' as well as the 'conditioning' stimuli. Despite all these variabilities, CPM seems to reliably lend itself to the pain modulation profile concept and could in future become one of the phenotypic biomarkers for pain and also a guide for mechanism-based treatment in chronic pain. Future research should focus on establishing consistent methodologies for measuring CPM and thereby enhancing the robustness of this emerging biomarker for pain.
Collapse
Affiliation(s)
- Shankar Ramaswamy
- 1St Bartholomew's Hospital, Bart's Health NHS Trust, London, EC1A 4AS, UK.
| | - Theresa Wodehouse
- 1St Bartholomew's Hospital, Bart's Health NHS Trust, London, EC1A 4AS, UK
| |
Collapse
|
17
|
Squintani G, Rasera A, Segatti A, Concon E, Bonetti B, Valeriani M, Tinazzi M. Conditioned pain modulation affects the N2/P2 complex but not the N1 wave: A pilot study with laser-evoked potentials. Eur J Pain 2020; 25:550-557. [PMID: 33170987 DOI: 10.1002/ejp.1693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The 'pain-inhibits-pain' effect stems from neurophysiological mechanisms involving endogenous modulatory systems termed diffuse noxious inhibitory controls (DNIC) or conditioned pain modulation (CPM). Laser-evoked potentials (LEPs) components, the N2/P2 complex, and the N1 wave, reflect the medial and lateral pain pathway, respectively: anatomically, the lateral thalamic nuclei (LT) project mainly to the somatosensory cortex (N1 generator), while the medial thalamic nuclei (MT) are bound to the limbic cortices (N2/P2 generators). METHODS We applied a CPM protocol in which the test stimulus was laser stimulation and the conditioning stimulus was a cold pressor test. LEPs recordings were obtained from 15 healthy subjects in three different conditions: baseline, during heterotopic noxious conditioning stimulation (HNCS) and post-HNCS. RESULTS We observed a significant reduction in N2/P2 amplitude during HNCS and a return to pre-test amplitude post-HNCS, whereas the N1 wave remained unchanged during and post-HNCS. CONCLUSIONS Our results indicate that CPM affects only the medial pain system. The spinothalamic tract (STT) transmits to both the LT and the MT, while the spinoreticulothalamic (SRT) projects only to the MT. The reduction in the amplitude of the N2/P2 complex and the absence of change in the N1 wave suggest that DNIC inhibition on the dorsal horn neurons affects only pain transmission via the SRT, while the neurons that give rise to the STT are not involved. The N1 wave can be a reliable neurophysiological parameter for assessment of STT function in clinical practice, as it does not seem to be influenced by CPM. SIGNIFICANCE No reports have described the effect of DNIC on lateral and medial pain pathways. We studied the N1 wave and the N2/P2 complex to detect changes during a CPM protocol. We found a reduction in the amplitude of the N2/P2 complex and no change in the N1 wave. This suggests that the DNIC inhibitory effect on dorsal horns neurons affects only pain transmission via the SRT, whereas the neurons that give rise to the STT are not involved.
Collapse
Affiliation(s)
- Giovanna Squintani
- Neurology and Neurophysiology Unit, Neuroscience Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Andrea Rasera
- Department of Neurological, Neuropsychological, Morphological and Motor Sciences, University of Verona, Verona, Italy
| | - Alessia Segatti
- Neurology and Neurophysiology Unit, Neuroscience Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Elisa Concon
- Neurology and Neurophysiology Unit, Neuroscience Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Bruno Bonetti
- Neurology and Neurophysiology Unit, Neuroscience Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Michele Tinazzi
- Department of Neurological, Neuropsychological, Morphological and Motor Sciences, University of Verona, Verona, Italy
| |
Collapse
|
18
|
Painful Cutaneous Electrical Stimulation vs. Heat Pain as Test Stimuli in Conditioned Pain Modulation. Brain Sci 2020; 10:brainsci10100684. [PMID: 32998204 PMCID: PMC7599732 DOI: 10.3390/brainsci10100684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 09/24/2020] [Accepted: 09/26/2020] [Indexed: 11/30/2022] Open
Abstract
Different paradigms can assess the effect of conditioned pain modulation (CPM). The aim of the present study was to compare heat pain, as an often used test stimulus (TS), to painful cutaneous electrical stimulation (PCES), having the advantage of the additional recording of PCES-related evoked potentials. In 28 healthy subjects we applied heat and PCES at the dominant hand as test stimulus (TS) to compare the CPM-effect elicited by hand immersion into cold water (10 °C) as conditioning stimulus (CS). Subjects rated the pain intensity of TS at baseline, during and 5 min after CS application and additionally of CS, on a numerical rating scale (NRS) (0–100). The ‘early’ (during CS–before CS) and ‘late’ (after CS–before CS) CPM-effects were analyzed. Parallel to the PCES, the related evoked potentials were recorded via Cz to evaluate any changes in PCES-amplitudes. CS reduced significantly the pain intensity of both PCES and heat pain as TS. On a group level, the CPM-effect did not differ significantly between both paradigms. Both early and late CPM-effect based on PCES correlated significantly with the CS pain intensity (r = −0.630 and −0.503, respectively), whereas using heat pain the correlation was not significant. We found a significant reduction of PCES-amplitudes during CS, but this did not correlate with the PCES-induced pain intensity. Correlation with the CS painfulness (r = −0.464) did not achieve the significance level after Bonferroni correction. The extent of the CPM effects was similar in both testing paradigms at group level, despite intraindividual differences. Future studies should further elicit the exact mechanisms explaining the modality of these specific differences.
Collapse
|
19
|
|