1
|
Nahman-Averbuch H, Piché M, Bannister K, Coghill RC. Involvement of propriospinal processes in conditioned pain modulation. Pain 2024; 165:1907-1913. [PMID: 38537057 DOI: 10.1097/j.pain.0000000000003217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 02/05/2024] [Indexed: 08/21/2024]
Affiliation(s)
- Hadas Nahman-Averbuch
- Washington University Pain Center and Division of Clinical and Translational Research, Department of Anesthesiology, Washington University in St Louis School of Medicine, St Louis, MO, United States
| | - Mathieu Piché
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Kirsty Bannister
- Central Modulation of Pain, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Robert C Coghill
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Pediatric Pain Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| |
Collapse
|
2
|
Støve MP, Hirata RP, Palsson TS. Regional and widespread pain sensitivity decreases following stretching in both men and women - Indications of stretch-induced hypoalgesia. J Bodyw Mov Ther 2024; 39:32-37. [PMID: 38876646 DOI: 10.1016/j.jbmt.2024.02.003] [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: 02/11/2022] [Revised: 01/22/2024] [Accepted: 02/25/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION This study aimed to investigate the effect of sex on regional and widespread pain sensitivity following acute bouts of stretching and to investigate the acute effect of stretching on regional and widespread pain sensitivity following stretching. METHODS 73 healthy adults (36 females; mean age 25.6 ± 6.7 years) with an age range from 19 to 62 years were recruited for this experimental study. Regional and distant pain pressure pain thresholds, passive knee extension range of motion and passive resistive torque were measured before and 30 s after four bouts of 30-s static muscle stretching of the knee flexors with 20-s rest between bouts. RESULTS No significant sex differences were found for pressure pain thresholds (p > 0.132), range of motion (p = 0.446) or passive resistive torque (p = 0.559) between pre-stretch and post-stretch measures. There were significant increases in pressure pain thresholds (p = 0.010), range of motion (p = 0.001) and passive resistive torque (p = 0.007) between pre-stretch and post-stretch measures. CONCLUSION Muscle stretching significantly decreased regional and widespread pain sensitivity, indicating that central pain-modulating mechanisms are engaged during muscle stretching, resulting in stretch-induced hypoalgesia. Moreover, the results showed that the effect of stretching on regional and widespread pain sensitivity is not sex-specific.
Collapse
Affiliation(s)
- Morten Pallisgaard Støve
- Department of Physiotherapy, University College of Northern Denmark (UCN) Selma Lagerløfs Vej 2, 9220 Aalborg East, Denmark. https://twitter.com/mortenstoeve
| | - Rogerio Pessoto Hirata
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7D, 9220, Aalborg East, Denmark
| | - Thorvaldur Skuli Palsson
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| |
Collapse
|
3
|
Martín Pérez SE, Rodríguez JD, Kalitovics A, de Miguel Rodríguez P, Bortolussi Cegarra DS, Rodríguez Villanueva I, García Molina Á, Ruiz Rodríguez I, Montaño Ocaña J, Martín Pérez IM, Sosa Reina MD, Villafañe JH, Alonso Pérez JL. Effect of Mirror Therapy on Post-Needling Pain Following Deep Dry Needling of Myofascial Trigger Point in Lateral Elbow Pain: Prospective Controlled Pilot Trial. J Clin Med 2024; 13:1490. [PMID: 38592311 PMCID: PMC10934708 DOI: 10.3390/jcm13051490] [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: 02/01/2024] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 04/10/2024] Open
Abstract
Background: This prospective randomized, controlled pilot trial to explore the immediate effect of adding Mirror Visual Feedback Therapy on pain sensitivity and motor performance among subjects suffering from post-needling pain diagnosed as Lateral Elbow Pain. Methods: A total of 49 participants (23 female, 26 male) were enrolled and randomly allocated to either the experimental group, which received Deep Dry Needling in the m. Brachioradialis, Ischemic Compression, Cold Spray, Stretching, and Mirror Visual Feedback Therapy (n = 25), or a control group without Mirror Visual Feedback Therapy (n = 24). Pre- and post-treatment evaluations included assessments of post-needling pain intensity, pressure pain threshold, two-point discrimination threshold, and maximum hand grip strength. Results: Intergroup analysis revealed a statistically significant reduction in post-needling pain intensity favoring the experimental group (U = 188.00, p = 0.034). Additionally, intragroup analysis showed significant improvements in post-needling pain intensity (MD = 0.400, SEM = 0.271, W = 137.00, p = 0.047) and pressure pain threshold (MD = 0.148 Kg/cm2, SEM = 0.038, W = 262.00, p < 0.001) within the experimental group following the intervention. Conclusions: These findings suggest a potential benefit of integrating Mirror Visual Feedback Therapy into treatment protocols for individuals with Lateral Elbow Pain experiencing post-needling discomfort. Further research is necessary to fully elucidate the clinical implications of these findings.
Collapse
Affiliation(s)
- Sebastián Eustaquio Martín Pérez
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain; (J.D.R.); (A.K.); (P.d.M.R.); (J.L.A.P.)
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (D.S.B.C.); (I.R.V.); (Á.G.M.); (I.R.R.); (J.M.O.); (M.D.S.R.); (J.H.V.)
- Departamento de Medicina Física y Farmacología, Área de Radiología y Medicina Física, Facultad de Ciencias de la Salud, Universidad de la Laguna, 38200 Santa Cruz de Tenerife, Spain
- Escuela de Doctorado y Estudios de Posgrado, Universidad de La Laguna, 38200 Santa Cruz de Tenerife, Spain
| | - Jhoselyn Delgado Rodríguez
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain; (J.D.R.); (A.K.); (P.d.M.R.); (J.L.A.P.)
| | - Alejandro Kalitovics
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain; (J.D.R.); (A.K.); (P.d.M.R.); (J.L.A.P.)
| | - Pablo de Miguel Rodríguez
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain; (J.D.R.); (A.K.); (P.d.M.R.); (J.L.A.P.)
| | - Daniela Sabrina Bortolussi Cegarra
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (D.S.B.C.); (I.R.V.); (Á.G.M.); (I.R.R.); (J.M.O.); (M.D.S.R.); (J.H.V.)
| | - Iremar Rodríguez Villanueva
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (D.S.B.C.); (I.R.V.); (Á.G.M.); (I.R.R.); (J.M.O.); (M.D.S.R.); (J.H.V.)
| | - Álvaro García Molina
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (D.S.B.C.); (I.R.V.); (Á.G.M.); (I.R.R.); (J.M.O.); (M.D.S.R.); (J.H.V.)
| | - Iván Ruiz Rodríguez
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (D.S.B.C.); (I.R.V.); (Á.G.M.); (I.R.R.); (J.M.O.); (M.D.S.R.); (J.H.V.)
| | - Juan Montaño Ocaña
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (D.S.B.C.); (I.R.V.); (Á.G.M.); (I.R.R.); (J.M.O.); (M.D.S.R.); (J.H.V.)
| | - Isidro Miguel Martín Pérez
- Departamento de Medicina Física y Farmacología, Área de Radiología y Medicina Física, Facultad de Ciencias de la Salud, Universidad de la Laguna, 38200 Santa Cruz de Tenerife, Spain
- Escuela de Doctorado y Estudios de Posgrado, Universidad de La Laguna, 38200 Santa Cruz de Tenerife, Spain
| | - María Dolores Sosa Reina
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (D.S.B.C.); (I.R.V.); (Á.G.M.); (I.R.R.); (J.M.O.); (M.D.S.R.); (J.H.V.)
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Jorge Hugo Villafañe
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (D.S.B.C.); (I.R.V.); (Á.G.M.); (I.R.R.); (J.M.O.); (M.D.S.R.); (J.H.V.)
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - José Luis Alonso Pérez
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain; (J.D.R.); (A.K.); (P.d.M.R.); (J.L.A.P.)
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (D.S.B.C.); (I.R.V.); (Á.G.M.); (I.R.R.); (J.M.O.); (M.D.S.R.); (J.H.V.)
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| |
Collapse
|
4
|
Verbelen D, Korogod N, Opsommer E. Physical activity and endogenous pain modulation in older people: a scoping review protocol. JBI Evid Synth 2024; 22:292-297. [PMID: 37872821 DOI: 10.11124/jbies-23-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
OBJECTIVE This scoping review aims to provide an overview of the existing literature on physical activity and endogenous pain modulation (EPM), assessed using conditioned pain modulation (CPM), with a specific focus on older people with chronic pain. INTRODUCTION Approximately 20% of the European population reports chronic pain, highlighting the problem of chronic pain in the general population. This prevalence increases to 50% in older people. Physical activity is one of the most frequently used treatments for pain management and relief. A possible mechanism underlying the positive effects of physical activity on pain may be related to its influence on EPM. The review will map i) types of physical activity used to study its effect on EPM in older people; ii) intervention protocols investigating physical activity and EPM, measured using CPM, in older people experiencing pain; and iii) knowledge gaps requiring further research or interventions adapted to older people with pain. INCLUSION CRITERIA This review will consider studies of people aged 60 years or older, using CPM to examine the effect of physical activity on EPM. All types of care settings will be eligible. METHODS This review will be conducted in accordance with the JBI methodology for scoping reviews. The following databases will be searched: MEDLINE (Ovid), CINAHL (EBSCOhost), Embase, Cochrane Library, Web of Science, JBI Evidence Synthesis , PsycINFO, and PEDro. REVIEW REGISTRATION Open Science Framework https://osf.io/e7ndy/.
Collapse
Affiliation(s)
- Debora Verbelen
- University of Applied Sciences and Arts Western Switzerland (HES-SO) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Natalya Korogod
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Emmanuelle Opsommer
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
- Bureau d'Echanges des Savoirs pour des praTiques Exemplaires de Soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| |
Collapse
|
5
|
Beckwée D, Nijs J, Bierma-Zeinstra SMA, Leemans L, Leysen L, Puts S, Rice D, Schiphof D, Bautmans I. Exercise therapy for knee osteoarthritis pain: how does it work? A study protocol for a randomised controlled trial. BMJ Open 2024; 14:e074258. [PMID: 38199628 PMCID: PMC10806725 DOI: 10.1136/bmjopen-2023-074258] [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: 04/21/2023] [Accepted: 11/28/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Muscle strengthening training (MST) and behavioural graded activity (BGA) show comparable effects on knee osteoarthritic (KOA) pain, but the mechanisms of action remain unclear. Both exercise-induced anti-inflammation and central sensitisation are promising pathways for pain relief in response to exercise therapy in patients with KOA: MST has the potential to decrease inflammation and BGA has the potential to decrease central sensitisation. Hence, this study aims to examine inflammation and central sensitisation as mediators for the effect of MST and/or BGA on pain in patients with KOA. METHODS AND ANALYSIS The Knee OsteoArthritis PAIN trial started on 10 January 2020 (anticipated end: April 2024). The three-arm clinical trial aims to recruit 90 KOA patients who will be randomly allocated to 12 weeks of (1) MST, (2) BGA or (3) care as usual. Assessments will be performed at baseline, 13 and 52 weeks after finishing the intervention. Outcomes, including pain (Knee injury and Osteoarthritis Outcome Score), were chosen in line with the OARSI recommendations for clinical trials of rehabilitation interventions for OA and the IMMPACT/OMERACT recommendations for the assessment of physical function in chronic pain clinical trials. Inflammation as well as features of central sensitisation (including conditioned pain modulation, offset analgesia, temporal summation of pain and event-related potentials following electrical stimulation), will be considered as treatment mediators. A multiple mediators model will be estimated with a path-analysis using structural equation models. In July 2023, all 90 KOA patients have been included and 42 participants already finished the study. ETHICS AND DISSEMINATION This study obtained ethics approval (B.U.N. 143201941843). Unravelling the mechanisms of action of exercise therapy in KOA will not only be extremely valuable for researchers, but also for exercise immunology and pain scientists and clinicians. TRIAL REGISTRATION NUMBER NCT04362618.
Collapse
Affiliation(s)
- David Beckwée
- Rehabilitation Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Movement Antwerp (MOVANT) research group, Universiteit Antwerpen, Antwerpen, Belgium
- Gerontology and Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel, Brussel, Belgium
| | - Jo Nijs
- Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, University of Gothenburg, Goteborg, Sweden
- University Hospital Brussels, Brussels, Belgium
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, Netherlands
- Department of Orthopedics and Sports Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lynn Leemans
- Rehabilitation Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Laurence Leysen
- Rehabilitation Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Sofie Puts
- Rehabilitation Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Gerontology and Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel, Brussel, Belgium
- Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - David Rice
- Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
- Department of Anaesthesiology and Perioperative Medicine, Waitematā Pain Service, Te Whatu Ora Waitematā, Auckland, New Zealand
| | - Dieuwke Schiphof
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Ivan Bautmans
- Gerontology and Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel, Brussel, Belgium
| |
Collapse
|
6
|
Hammert WB, Song JS, Yamada Y, Kataoka R, Wong V, Spitz RW, Seffrin A, Kang A, Loenneke JP. Blood flow restriction augments exercise-induced pressure pain thresholds over repetition and effort matched conditions. J Sports Sci 2024; 42:73-84. [PMID: 38412241 DOI: 10.1080/02640414.2024.2321012] [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: 10/10/2023] [Accepted: 02/13/2024] [Indexed: 02/29/2024]
Abstract
We sought to determine the effects of blood flow restriction (BFR) on exercise-induced hypoalgesia, specifically using low-load (LL) resistance exercise (30% 1RM) protocols that accounted for each individual's local muscular endurance capabilities. Forty-four participants completed four conditions: (1) 70% of maximal BFR repetitions with blood flow restriction (LL+BFR exercise); (2) 70% maximal BFR repetitions without LL+BFR (LL exercise); (3) 70% maximal free flow repetitions (LL+EFFORT exercise); (4) time-matched, non-exercise control (CON). Pressure pain threshold (PPT) was measured before and after exercise. Ischaemic pain threshold and tolerance was assessed only at post. The change in upper body PPT was greater for LL+BFR exercise compared to LL exercise [difference of 0.15 (0.35) kg/cm2], LL+EFFORT exercise [difference of 0.23 (0.45) kg/cm2], and the CON condition. The change in lower body PPT was greater for LL+BFR exercise compared to LL exercise [difference of 0.40 (0.55) kg/cm2], LL+EFFORT exercise [difference of 0.36 (0.62) kg/cm2], and the CON condition. Ischaemic pain thresholds and tolerances did not change. Submaximal exercise with BFR resulted in systemic increases in PPT but had no influence on ischaemic pain sensitivity. This effect is likely unique to BFR as we did not see changes in the effort matched free flow condition.
Collapse
Affiliation(s)
- William B Hammert
- Department of Health, Exercise Science and Recreation Management. Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Jun Seob Song
- Department of Health, Exercise Science and Recreation Management. Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Yujiro Yamada
- Department of Health, Exercise Science and Recreation Management. Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Ryo Kataoka
- Department of Health, Exercise Science and Recreation Management. Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Vickie Wong
- Health and Exercise Science, Solent University, Southampton, UK
| | - Robert W Spitz
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Aldo Seffrin
- Department of Health, Exercise Science and Recreation Management. Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Anna Kang
- Department of Health, Exercise Science and Recreation Management. Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Jeremy P Loenneke
- Department of Health, Exercise Science and Recreation Management. Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| |
Collapse
|
7
|
Jin H, Witjes B, Roy M, Baillet S, de Vos CC. Neurophysiological oscillatory markers of hypoalgesia in conditioned pain modulation. Pain Rep 2023; 8:e1096. [PMID: 37881810 PMCID: PMC10597579 DOI: 10.1097/pr9.0000000000001096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/27/2023] [Accepted: 07/10/2023] [Indexed: 10/27/2023] Open
Abstract
Introduction Conditioned pain modulation (CPM) is an experimental procedure that consists of an ongoing noxious stimulus attenuating the pain perception caused by another noxious stimulus. A combination of the CPM paradigm with concurrent electrophysiological recordings can establish whether an association exists between experimentally modified pain perception and modulations of neural oscillations. Objectives We aimed to characterize how CPM modifies pain perception and underlying neural oscillations. We also interrogated whether these perceptual and/or neurophysiological effects are distinct in patients affected by chronic pain. Methods We presented noxious electrical stimuli to the right ankle before, during, and after CPM induced by an ice pack placed on the left forearm. Seventeen patients with chronic pain and 17 control participants rated the electrical pain in each experimental condition. We used magnetoencephalography to examine the anatomy-specific effects of CPM on the neural oscillatory responses to the electrical pain. Results Regardless of the participant groups, CPM induced a reduction in subjective pain ratings and neural responses (beta-band [15-35 Hz] oscillations in the sensorimotor cortex) to electrical pain. Conclusion Our findings of pain-induced beta-band activity may be associated with top-down modulations of pain, as reported in other perceptual modalities. Therefore, the reduced beta-band responses during CPM may indicate changes in top-down pain modulations.
Collapse
Affiliation(s)
- Hyerang Jin
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Bart Witjes
- Centre for Pain Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Mathieu Roy
- Department of Psychology, McGill University, Montreal, Canada
| | - Sylvain Baillet
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Cecile C. de Vos
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada
- Centre for Pain Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands
| |
Collapse
|
8
|
Basbaum AI, Jensen TS, Keefe FJ. Fifty years of pain research and clinical advances: highlights and key trends. Pain 2023; 164:S11-S15. [PMID: 37831954 PMCID: PMC10787538 DOI: 10.1097/j.pain.0000000000003058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/31/2023] [Indexed: 10/15/2023]
Abstract
ABSTRACT This article highlights advances in basic science preclinical pain research, clinical research, and psychological research occurring over the 50 years since the International Association for the Study of Pain was founded. It presents important findings and key trends in these 3 areas of pain science: basic science preclinical research, clinical research, and psychological research.
Collapse
Affiliation(s)
- Allan I. Basbaum
- Department of Anatomy, University California San Francisco, San Francisco, CA USA 94158
| | - Troels. S Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University Hosital, DK, 8200 Aarhus N, Denmark
| | - Francis J. Keefe
- Duke Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA 27705
| |
Collapse
|
9
|
Nahman-Averbuch H, Callahan D, Darken R, Haroutounian S. Harnessing the conditioned pain modulation response in migraine diagnosis, outcome prediction, and treatment-A narrative review. Headache 2023; 63:1167-1177. [PMID: 37522350 DOI: 10.1111/head.14601] [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: 03/06/2023] [Revised: 05/01/2023] [Accepted: 06/14/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To present the potential use and relevance of the conditioned pain modulation (CPM) response to migraine diagnosis, outcome prediction, and treatment. BACKGROUND The CPM response is a widely used laboratory test to examine inhibitory pain modulation capabilities. METHODS This narrative review summarizes and synthesizes the findings on the CPM response in patients with migraine. RESULTS For diagnosis, we summarized the studies comparing CPM responses between patients with migraine and individuals without migraine or with other headache syndromes, as well as between patients with subtypes of migraine. For prediction, we summarized the studies utilizing the CPM response to predict migraine outcome, such as response to interventions. For treatment, we described a device that utilizes the CPM response for acute and preventative migraine treatment. In addition, we suggest the requirements needed for the CPM response to be used for migraine diagnosis, outcome prediction, and treatment. CONCLUSIONS Although more research is needed, the CPM response could be a useful tool for improving migraine management.
Collapse
Affiliation(s)
- Hadas Nahman-Averbuch
- Department of Anesthesiology, Washington University Pain Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David Callahan
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rachel Darken
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Simon Haroutounian
- Department of Anesthesiology, Washington University Pain Center, Washington University School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
10
|
Huynh V, Lütolf R, Rosner J, Luechinger R, Curt A, Kollias S, Michels L, Hubli M. Intrinsic brain connectivity alterations despite intact pain inhibition in subjects with neuropathic pain after spinal cord injury: a pilot study. Sci Rep 2023; 13:11943. [PMID: 37488130 PMCID: PMC10366123 DOI: 10.1038/s41598-023-37783-w] [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: 03/27/2022] [Accepted: 06/27/2023] [Indexed: 07/26/2023] Open
Abstract
Endogenous pain modulation in humans is frequently investigated with conditioned pain modulation (CPM). Deficient pain inhibition is a proposed mechanism that contributes to neuropathic pain (NP) after spinal cord injury (SCI). Recent studies have combined CPM testing and neuroimaging to reveal neural correlates of CPM efficiency in chronic pain. This study investigated differences in CPM efficiency in relation to resting-state functional connectivity (rsFC) between 12 SCI-NP subjects and 13 age- and sex-matched healthy controls (HC). Twelve and 11 SCI-NP subjects were included in psychophysical and rsFC analyses, respectively. All HC were included in the final analyses. Psychophysical readouts were analysed to determine CPM efficiency within and between cohorts. Group differences of rsFC, in relation to CPM efficiency, were explored with seed-to-voxel rsFC analyses with pain modulatory regions, e.g. ventrolateral periaqueductal gray (vlPAG) and amygdala. Overall, pain inhibition was not deficient in SCI-NP subjects and was greater in those with more intense NP. Greater pain inhibition was associated with weaker rsFC between the vlPAG and amygdala with the visual and frontal cortex, respectively, in SCI-NP subjects but with stronger rsFC in HC. Taken together, SCI-NP subjects present with intact pain inhibition, but can be differentiated from HC by an inverse relationship between CPM efficiency and intrinsic connectivity of supraspinal regions. Future studies with larger cohorts are necessary to consolidate the findings in this study.
Collapse
Affiliation(s)
- Vincent Huynh
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich & University of Zurich, Zurich, Switzerland.
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Robin Lütolf
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Jan Rosner
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Roger Luechinger
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Spyridon Kollias
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich & University of Zurich, Zurich, Switzerland
| | - Lars Michels
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich & University of Zurich, Zurich, Switzerland
| | - Michèle Hubli
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| |
Collapse
|
11
|
Goudman L, De Smedt A, Roggeman S, Fernández-de-las-Peñas C, Hatem SM, Schiltz M, Billot M, Roulaud M, Rigoard P, Moens M. Association between Experimental Pain Measurements and the Central Sensitization Inventory in Patients at Least 3 Months after COVID-19 Infection: A Cross-Sectional Pilot Study. J Clin Med 2023; 12:jcm12020661. [PMID: 36675590 PMCID: PMC9862134 DOI: 10.3390/jcm12020661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/02/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
Fatigue, pain, headache, brain fog, anosmia, ageusia, mood symptoms, and sleep disorders are symptoms commonly experienced by people with post-COVID-19 condition. These symptoms could be considered as manifestations of central sensitization. The aim of this study is to evaluate whether there are indicators of central sensitization by using experimental pain measurements and to determine their association with patient-reported outcome measures (PROMs). A cross-sectional study including 42 patients after COVID-19 infection was conducted. The central sensitization inventory (CSI) was administered as a PROM to evaluate central-sensitization-associated symptoms. Pressure pain thresholds (PPT), temporal summation, and descending nociceptive pain inhibition (CPM) were assessed as experimental pain measurements. The median score on the CSI was 46.5 (Q1-Q3: 33-54). The presence of central-sensitization-associated symptoms was seen in 64.3% of patients based on the CSI (≥40/100 points). A deficient CPM was seen in 12% and 14% of patients when measured at the trapezius and rectus femoris, respectively. A negative correlation between pressure sensitivity on the rectus femoris and the CSI score (r = -0.36, 95%CI -0.13 to -0.65, p = 0.007) was observed. Central-sensitization-associated symptoms were present in up to 64.3% of patients post-COVID-19 infection, based on a PROM, i.e., the CSI. A more objective evaluation of nociceptive processing through experimental pain measurements was less suggestive of indicators of central sensitization. Only a small negative correlation between pressure sensitivity and the CSI was observed, thereby pointing towards the discrepancy between the CSI and experimental pain measurements and presumably the complementary need for both to evaluate potential indicators of central sensitization in this population.
Collapse
Affiliation(s)
- Lisa Goudman
- STIMULUS Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Research Foundation Flanders (FWO), Egmontstraat 5, 1000 Brussels, Belgium
- Correspondence: ; Tel.: +32-24775514
| | - Ann De Smedt
- STIMULUS Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Physical Medicine and Rehabilitation, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Stijn Roggeman
- Department of Physical Medicine and Rehabilitation, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark
| | - Samar M. Hatem
- STIMULUS Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Physical Medicine and Rehabilitation, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Marc Schiltz
- STIMULUS Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Physical Medicine and Rehabilitation, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Maxime Billot
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France
| | - Manuel Roulaud
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France
| | - Philippe Rigoard
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France
- Department of Spine Surgery & Neuromodulation, Poitiers University Hospital, 86021 Poitiers, France
- Pprime Institute UPR 3346, CNRS, ISAE-ENSMA, University of Poitiers, 86360 Chasseneuil-du-Poitou, France
| | - Maarten Moens
- STIMULUS Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| |
Collapse
|
12
|
Neural mechanisms underlying the conditioned pain modulation response: a narrative review of neuroimaging studies. Pain 2023; 164:e25-e46. [PMID: 36017881 DOI: 10.1097/j.pain.0000000000002716] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/25/2022] [Indexed: 01/09/2023]
Abstract
ABSTRACT Processing spatially distributed nociceptive information is critical for survival. The conditioned pain modulation (CPM) response has become a common psychophysical test to examine pain modulation capabilities related to spatial filtering of nociceptive information. Neuroimaging studies have been conducted to elucidate the neural mechanisms underlying the CPM response in health and chronic pain states, yet their findings have not been critically reviewed and synthesized before. This narrative review presents a simplified overview of MRI methodology in relation to CPM assessments and summarizes the findings of neuroimaging studies on the CPM response. The summary includes functional MRI studies assessing CPM responses during scanning as well as functional and structural MRI studies correlating indices with CPM responses assessed outside of the scanner. The findings are discussed in relation to the suggested mechanisms for the CPM response. A better understanding of neural mechanisms underlying spatial processing of nociceptive information could advance both pain research and clinical use of the CPM response as a marker or a treatment target.
Collapse
|
13
|
Christensen SWM, Almsborg, M. H, Vain, M. TS, Vaegter HB. The Effect of Virtual Reality on Cold Pain Sensitivity in Patients with Fibromyalgia and Pain-Free Individuals: A Randomized Crossover Study. Games Health J 2022. [DOI: 10.1089/g4h.2022.0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Steffan Wittrup McPhee Christensen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark
| | - Heidi Almsborg, M.
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Multidisciplinary Pain Center Naestved, Naestved Hospital, Naestved, Denmark
| | - Thomas Søgaard Vain, M.
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Smertefys.nu, Physiotherapy Clinic, Copenhagen, Denmark
| | - Henrik Bjarke Vaegter
- Pain Research Group, Pain Center, Department of Anesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
14
|
Lütolf R, De Schoenmacker I, Rosner J, Sirucek L, Schweinhardt P, Curt A, Hubli M. Anti- and Pro-Nociceptive mechanisms in neuropathic pain after human spinal cord injury. Eur J Pain 2022; 26:2176-2187. [PMID: 36000307 PMCID: PMC9826499 DOI: 10.1002/ejp.2029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/01/2022] [Accepted: 08/20/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Deficient endogenous pain modulation and increased nociceptive excitability are key features of central sensitization and can be assessed in humans by conditioned pain modulation (CPM, anti-nociceptive) and temporal summation of pain (TSP, pro-nociceptive), respectively. This study aimed to investigate these measures as proxies for central sensitization in subjects with chronic neuropathic pain (NP) after spinal cord injury (SCI). METHODS In paraplegic subjects with NP (SCI-NP; n = 17) and healthy controls (HC; n = 17), parallel and sequential sham-controlled CPM paradigms were performed using pressure pain threshold at the hand, that is, above lesion level, as test stimulus. The conditioning stimulus was a noxious cold (verum) or lukewarm water bath (sham) applied contralaterally. Regarding pro-nociceptive mechanisms, a TSP protocol with individually-adjusted pressure pain stimuli at the thenar eminence was used. CPM and TSP magnitudes were related to intensity and spatial extent of spontaneous NP. RESULTS Neither the parallel nor sequential sham-controlled CPM paradigm showed any significant inhibition of above-level pressure pain thresholds for SCI-NP or HC. Accordingly, no group difference in CPM capacity was found, however, subjects with more intense spontaneous NP showed lower inhibitory CPM capacity. TSP was observed for both groups but was not enhanced in SCI-NP. CONCLUSIONS Our results do not support altered above-level anti- or pro-nociceptive mechanisms in SCI-NP compared with HC; however, they also highlight the relevance of spontaneous NP intensity with regards to the capacity of endogenous pain modulation in SCI subjects. SIGNIFICANCE Central sensitization encompasses deficient endogenous pain modulation and increased nociceptive excitability. These two mechanisms can be assessed in humans by conditioned pain modulation and temporal summation of pain, respectively. Our data demonstrates a lack of descending pain inhibition only in subjects with severe neuropathic pain which may hint towards central sensitization at spinal and/or supra-spinal levels. Disentangling the mechanisms of endogenous pain modulation and neuronal hyperexcitability might improve mechanism-based treatment of neuropathic pain in subjects with spinal cord injury.
Collapse
Affiliation(s)
- Robin Lütolf
- Spinal Cord Injury Center, Balgrist University HospitalUniversity of ZurichZurichSwitzerland
| | - Iara De Schoenmacker
- Spinal Cord Injury Center, Balgrist University HospitalUniversity of ZurichZurichSwitzerland
| | - Jan Rosner
- Spinal Cord Injury Center, Balgrist University HospitalUniversity of ZurichZurichSwitzerland,Department of NeurologyUniversity Hospital Bern, Inselspital, University of BernBernSwitzerland
| | - Laura Sirucek
- Integrative Spinal Research, Department of Chiropractic MedicineBalgrist University Hospital, University of ZurichZurichSwitzerland
| | - Petra Schweinhardt
- Integrative Spinal Research, Department of Chiropractic MedicineBalgrist University Hospital, University of ZurichZurichSwitzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University HospitalUniversity of ZurichZurichSwitzerland
| | - Michèle Hubli
- Spinal Cord Injury Center, Balgrist University HospitalUniversity of ZurichZurichSwitzerland
| |
Collapse
|
15
|
Rischer KM, Anton F, González-Roldán AM, Montoya P, van der Meulen M. Better Executive Functions Are Associated With More Efficient Cognitive Pain Modulation in Older Adults: An fMRI Study. Front Aging Neurosci 2022; 14:828742. [PMID: 35875790 PMCID: PMC9302198 DOI: 10.3389/fnagi.2022.828742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/10/2022] [Indexed: 11/17/2022] Open
Abstract
Growing evidence suggests that aging is associated with less efficient endogenous pain modulation as demonstrated by reduced conditioned pain modulation, and that these changes may be mediated by differences in frontal functioning. Yet, little is known about potential age-related changes in cognitive pain modulation, such as distraction from pain. In a first session, 30 healthy young (19-35 years) and 30 healthy older (59-82 years) adults completed a battery of neuropsychological tests. In a second session, we acquired functional brain images while participants completed a working memory task with two levels of cognitive load (high vs. low) and concurrently received individually adjusted heat stimuli (warm vs. painful). In both age groups, completing the high load task was associated with a significant reduction in the perceived intensity and unpleasantness of painful stimuli and a reduction in activation of brain regions involved in pain processing. Group comparisons revealed that young adults showed a stronger de-activation of brain regions involved in pain processing during the high load vs. the low load task, such as the right insula, right mid cingulate cortex and left supramarginal gyrus, compared to older adults. Older adults, on the other hand, showed an increased activation in the anterior cingulate cortex during the high load vs. low load task, when compared to young adults. Covariate analyses indicated that executive functions significantly predicted neural pain modulation in older adults: Better executive functions were associated with a more pronounced de-activation of the insula, thalamus and primary somatosensory cortex and increased activation of prefrontal regions during the high vs. low load task. These findings suggest that cognitive pain modulation is altered in older age and that the preservation of executive functions may have beneficial effects on the efficacy of distraction from pain.
Collapse
Affiliation(s)
- Katharina M. Rischer
- Department of Behavioural and Cognitive Sciences, Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Fernand Anton
- Department of Behavioural and Cognitive Sciences, Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Ana M. González-Roldán
- Cognitive and Affective Neuroscience and Clinical Psychology, Research Institute of Health Sciences, Balearic Islands Health Research Institute, University of the Balearic Islands, Palma, Spain
| | - Pedro Montoya
- Cognitive and Affective Neuroscience and Clinical Psychology, Research Institute of Health Sciences, Balearic Islands Health Research Institute, University of the Balearic Islands, Palma, Spain
| | - Marian van der Meulen
- Department of Behavioural and Cognitive Sciences, Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| |
Collapse
|
16
|
JIAO RM, XIU WC, LI BL, HU XY, SHI LJ, TIAN ZY, YANG JW, HU XY, GANG WJ, JING XH. Acupuncture for atopic eczema: Evidence mapping-based randomized controlled trials, systematic reviews, and meta-analyses. WORLD JOURNAL OF ACUPUNCTURE-MOXIBUSTION 2022. [DOI: 10.1016/j.wjam.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|
17
|
Peterson JA, Bemben MG, Larson RD, Pereira H, Crowson HM, Black CD. Symptomatic but not Asymptomatic COVID-19 Impairs Conditioned Pain Modulation in Young Adults. THE JOURNAL OF PAIN 2022; 23:1923-1932. [PMID: 35872293 PMCID: PMC9303070 DOI: 10.1016/j.jpain.2022.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/07/2022] [Accepted: 06/15/2022] [Indexed: 01/08/2023]
Abstract
Pain is a common symptom reported in COVID-19 patients. Impaired endogenous pain-modulatory mechanisms such as conditioned pain modulation (CPM), and exercise-induced hypoalgesia (EIH) have been found in chronic pain conditions but is often overlooked in acute conditions that evoke painful symptoms, such as COVID-19. The purpose was to compare pressure-pain sensitivity, CPM, and EIH function among individuals who previously had COVID-19, both symptomatically and asymptomatically, and a healthy control group. Pressure pain thresholds of 59 participants were assessed in the forearm and leg using a pressure algometer before and after 1) submersion of their dominant foot in cold water (2°C) for 1min; and 2) isometric knee extension performed to task-failure at 25% of their maximal contraction. The CPM response was attenuated in individuals who were infected with symptomatic COVID-19 (N = 26) compared to asymptomatic COVID-19 (N = 13) in arm (-1.0% ± 20.3 vs 33.3% ± 26.2; P < .001) and leg (12.8% ± 22.0 vs 33.8% ± 28.2; P = .014) and compared to controls (N = 20) in arm only (-1.0% ± 26.2 vs 23.4% ± 28.2; P = .004). The EIH response was not different between groups. CPM was impaired in individuals who had symptomatic COVID-19, which may have long-term implications on pain modulation. Perspective This study reveals that CPM was impaired in individuals who had symptomatic COVID-19 during the first wave of COVID-19, pre vaccine. These findings present a preliminary motive to study the long-term implications of COVID-19 and its effects on pain modulation.
Collapse
|
18
|
Campolo M, Correa L, Gabarrón E, Albayrak M, Quintero-Diaz C, Castellote JM, Casanova-Molla J, Valls-Sole J. Adaptation to tonic heat in healthy subjects and patients with sensory polyneuropathy. Eur J Pain 2022; 26:1056-1068. [PMID: 35263818 DOI: 10.1002/ejp.1930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 02/10/2022] [Accepted: 02/27/2022] [Indexed: 12/11/2022]
Abstract
Adaptation to a constant sensory stimulus involves many sites along the path of sensory volleys towards perception. The evaluation of such phenomenon may be of clinical interest. We studied adaptation to a constant temperature stimulus in healthy subjects to set normative data, and in patients with sensory polyneuropathy (SPN), as proof of concept. Twenty-six healthy subjects and 26 patients with SPN in the context of chemotherapy treatment with oxaliplatin for colon cancer were instructed to express through an electronic VAS system (eVAS) the level of sensation felt when a thermode set at either 39º, 41º, 43º, 45º or 47º was applied to their ventral forearm. The eVAS recordings showed typically an abrupt onset that slowed to approach maximum sensation and continued with a slow decrease indicating adaptation. The time to respond (TR), the velocity of the initial response (VR), the maximum sensation (MA), the time to reach MA (MAt), the onset of adaptation (AO), and the decrease in the sensation level with respect to MA at 30 s after stimulus application (SL30), were dependent on the temperature level in all subjects. However, patients showed significantly delayed TR, slowed VR, decreased MA, delayed AO, and reduced SL30, with respect to healthy subjects. Differences were more pronounced at low temperature levels, with absent AO in 25 patients vs. 2 healthy subjects at temperatures of 39º and 41ºC. The study of adaptation to a constant temperature stimulus can furnish valuable data for the assessment of SPN patients.
Collapse
Affiliation(s)
- Michela Campolo
- EMG and Neuropathic Pain Unit, Department of Neurology. Hospital Clínic, Barcelona
| | - Lilia Correa
- Department of Neurology and Neurophysiology. Hospital del Mar, Barcelona
| | - Eva Gabarrón
- EMG and Neuropathic Pain Unit, Department of Neurology. Hospital Clínic, Barcelona
| | - Merve Albayrak
- EMG and Neuropathic Pain Unit, Department of Neurology. Hospital Clínic, Barcelona
| | | | - Juan M Castellote
- Department of Radiology, Rehabilitation and Physiotherapy, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Jordi Casanova-Molla
- EMG and Neuropathic Pain Unit, Department of Neurology. Hospital Clínic, Barcelona.,Institut d'Investigació Biomedica August Pi Sunyer, IDIBAPS. Barcelona.,Department of Medicine, School of Medicine and Health Sciences, University of Barcelona
| | - Josep Valls-Sole
- Institut d'Investigació Biomedica August Pi Sunyer, IDIBAPS. Barcelona.,Department of Medicine, School of Medicine and Health Sciences, University of Barcelona
| |
Collapse
|
19
|
Sendel M, Lienau F, Fischer D, Moll J, Koch S, Forstenpointner J, Binder A, Baron R. The descending pain modulation system predicts short term efficacy of multimodal pain therapy - an observational prospective cohort study. Postgrad Med 2022; 134:277-287. [PMID: 34895019 DOI: 10.1080/00325481.2021.2017646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Treating chronic pain patients with multimodal pain therapy (MMPT) alters perception, awareness, and processing of pain at multiple therapeutic levels. Several clinical observations suggest that the effects of therapy may go beyond the possible sum of each level of therapy and may be due to a central descending inhibitory effect measurable by conditioned pain modulation (CPM). Thus, we investigated whether CPM is able to identify a group of patients that benefit particularly from MMPT. METHODS This was an observational prospective cohort study. Patients were hospitalized on a special pain medicine ward with specially trained staff for 10 days. The patients were questioned and had investigations before and shortly after MMPT and were followed-up on 3 months post discharge. Before and after treatment, subjects were investigated via CPM and quantitative sensory testing (QST) as well as completing questionnaires. The study was registered in the German Clinical Trials Register (DRKS00006850). RESULTS During the study period of 24 months, 224 chronic pain patients were recruited. 51 percent of patients completed the study period. There was an improvement in overall groups regarding all domains assessed, lasting beyond the end of the intervention. Patients with a sufficient CPM effect, defined as a reduction in pain during the conditioning stimulus, at baseline did show a more pronounced reduction in mean pain ratings than those without. This was not the case 3 months after therapy. Furthermore, sufficient CPM was identified as a predictor for pain reduction using a linear regression model. CONCLUSION In conclusion, this study shows that while a heterogeneous group of patients with chronic pain disorders does sustainably benefit from MMPT in general, patients with a sufficient CPM effect do show a more pronounced decrease in pain ratings directly after therapy in comparison to those without.
Collapse
Affiliation(s)
- M Sendel
- Division of Neurological Pain Research and -therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - F Lienau
- Katholisches Marienkrankenhaus, Department. Of Neurology, Hamburg, Germany
| | - D Fischer
- Asklepios Klinik Nord, Center of Interdisciplinary Pain Therapy, Hamburg, Germany
| | - J Moll
- Asklepios Klinik Nord, Center of Interdisciplinary Pain Therapy, Hamburg, Germany
| | - S Koch
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Kiel, Germany
| | - J Forstenpointner
- Division of Neurological Pain Research and -therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - A Binder
- Division of Neurological Pain Research and -therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany.,Klinikum Saarbrücken, Department. Of Neurology
| | - R Baron
- Division of Neurological Pain Research and -therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| |
Collapse
|
20
|
Lenoir D, Willaert W, Ickmans K, Bernaers L, Nijs J, Malfliet A, Danneels L, Leysen L, De Pauw R, Cagnie B, Coppieters I, Meeus M. Are Reports of Pain, Disability, Quality of Life, Psychological Factors, and Central Sensitization Related to Outcomes of Quantitative Sensory Testing in Patients Suffering From Chronic Whiplash Associated Disorders? Clin J Pain 2021; 38:159-172. [PMID: 34939972 DOI: 10.1097/ajp.0000000000001013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronic whiplash associated disorders (CWAD) are characterized by long-lasting symptoms of neck pain occurring after an acceleration-deceleration injury. Central sensitization (CS) has been suggested as the possible underlying mechanism for these symptoms, and is characterized by changes in the central nervous system. Besides CS, psychological factors are believed to play an important role in the experience of (chronic) pain. OBJECTIVE Investigating the relationships between self-reported pain, disability, quality of life, psychological factors, and symptoms of CS; and electrical-based quantitative sensory testing (QST) outcomes in CWAD patients. Secondly, to investigate the differences in QST between CWAD patients and pain-free controls. METHODS Seventy-two individuals with CWAD and 55 pain-free controls underwent electrical stimuli-based QST. Detection and pain thresholds (EPT), temporal summation (TS), and conditioned pain modulation were examined. Spearman correlation and linear mixed models analyses were performed to assess, respectively, the hypothesized associations and group differences in QST. RESULTS The Pain Catastrophizing magnification subscale correlated with the left wrist EPT (r=-0.332; P=0.004), and the Pain Anxiety Symptom Scale-20 with the left wrist (r=-0.325; P=0.005) and ankle (r=-0.330; P=0.005) EPT. TS at the ankle correlated with the CS inventory (r=0.303; P=0.010), Short Form 36 pain subscale (r=-0.325; P=0.005), and Illness Perception Questionnaire revised consequences subscale (r=0.325; P=0.005). EPTs left (P=0.011) and right wrist (P=0.023) were lower in the CWAD group, but conditioned pain modulation and TS did not differ between groups. CONCLUSION QST outcomes relate to psychological constructs, rather than to self-reported pain intensity and distribution. Local hyperalgesia was found in individuals with CWAD, but no differences in endogenous pain facilitation nor inhibition.
Collapse
Affiliation(s)
- Dorine Lenoir
- Pain in Motion International Research Group, www.paininmotion.be
- Department of Rehabilitation Sciences, Ghent University
- Bijzonder Onderzoeksfonds Gent (BOF), Ghent
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
| | - Ward Willaert
- Pain in Motion International Research Group, www.paininmotion.be
- Department of Rehabilitation Sciences, Ghent University
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
- Research Foundation-Flanders (FWO)
| | - Kelly Ickmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
- Research Foundation-Flanders (FWO)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital, Brussels, Belgium
| | - Lisa Bernaers
- Department of Rehabilitation Sciences, Ghent University
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital, Brussels, Belgium
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy
- University of Gothenburg Center for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anneleen Malfliet
- Pain in Motion International Research Group, www.paininmotion.be
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
- Research Foundation-Flanders (FWO)
| | | | - Laurence Leysen
- Pain in Motion International Research Group, www.paininmotion.be
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
| | - Robby De Pauw
- Department of Rehabilitation Sciences, Ghent University
| | | | - Iris Coppieters
- Pain in Motion International Research Group, www.paininmotion.be
- Department of Rehabilitation Sciences, Ghent University
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
- Research Foundation-Flanders (FWO)
| | - Mira Meeus
- Pain in Motion International Research Group, www.paininmotion.be
- Department of Rehabilitation Sciences, Ghent University
- Faculty of Medicine and Health Science, Department of Rehabilitation Sciences and Physiotherapy-MOVANT Research Group, University of Antwerp, Antwerp
| |
Collapse
|
21
|
Reezigt RR, Kielstra SC, Coppieters MW, Scholten-Peeters GG. No relevant differences in conditioned pain modulation effects between parallel and sequential test design. A cross-sectional observational study. PeerJ 2021; 9:e12330. [PMID: 35003911 PMCID: PMC8679953 DOI: 10.7717/peerj.12330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/27/2021] [Indexed: 12/12/2022] Open
Abstract
Background Conditioned pain modulation (CPM) is measured by comparing pain induced by a test stimulus with pain induced by the same test stimulus, either during (parallel design) or after (sequential design) the conditioning stimulus. Whether design, conditioning stimulus intensity and test stimulus selection affect CPM remains unclear. Methods CPM effects were evaluated in healthy participants (N = 89) at the neck, forearm and lower leg using the cold pressor test as the conditioning stimulus. In three separate experiments, we compared the impact of (1) design (sequential versus parallel), (2) conditioning stimulus intensity (VAS 40/100 versus VAS 60/100), and (3) test stimulus selection (single versus dual, i.e., mechanical and thermal). Statistical analyses of the main effect of design (adjusted for order) and experiment were conducted using linear mixed models with random intercepts. Results No significant differences were identified in absolute CPM data. In relative CPM data, a sequential design resulted in a slightly lower CPM effect compared to a parallel design, and only with a mechanical test stimulus at the neck (−6.1%; 95% CI [−10.1 to −2.1]) and lower leg (−5.9%; 95% CI [−11.7 to −0.1]) but not forearm (−4.5%; 95% CI [−9.0 to 0.1]). Conditioning stimulus intensity and test stimulus selection did not influence the CPM effect nor the difference in CPM effects derived from parallel versus sequential designs. Conclusions Differences in CPM effects between protocols were minimal or absent. A parallel design may lead to a minimally higher relative CPM effect when using a mechanical test stimulus. The conditioning stimulus intensities assessed in this study and performing two test stimuli did not substantially influence the differences between designs nor the magnitude of the CPM effect.
Collapse
Affiliation(s)
- Roland R. Reezigt
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Academy of Health, Department of Physiotherapy, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Sjoerd C. Kielstra
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Michel W. Coppieters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
| | - Gwendolyne G.M. Scholten-Peeters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
22
|
Christensen SWM, Bellosta-López P, Doménech-García V, Herrero P, Palsson TS. Changes in Pain Sensitivity and Conditioned Pain Modulation During Recovery From Whiplash-associated Disorders. Clin J Pain 2021; 37:730-739. [PMID: 34334693 DOI: 10.1097/ajp.0000000000000970] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 07/19/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the pain-sensory profile of patients with whiplash-associated disorders (WADs) prior and post 2 weeks of standardized rehabilitation and after a 6-month follow-up. MATERIALS AND METHODS Twenty-two WAD participants (grade II; 14 women) and 22 sex-matched and age-matched healthy pain-free controls were enrolled. Pressure pain thresholds (PPTs) were assessed at local and distal muscles. Conditioned pain modulation (CPM) of PPTs was assessed using cuff pressure around the upper arm. Referred area of pain following supra-threshold pressure stimulation of the infraspinatus muscle was recorded on a body chart. Psychometric variables (pain intensity, area of perceived pain, pain catastrophizing, kinesiophobia, sleep problems, and depression level) were assessed. WAD group additionally completed the Neck Disability Index. RESULTS The WAD group demonstrated lower local PPTs compared with controls at all time points (P<0.05) and lower distal PPTs at baseline and at 2 weeks when compared with 6 months (within-group) (P<0.05). The WAD group had a reduced CPM response and larger induced referred pain areas compared with controls (P<0.05), while no within-group changes were observed at any time point. The WAD group reported higher pain intensity and perceived area of pain compared with controls at all time points (P<0.05) and a mean Neck Disability Index score of 41% at baseline, 16% at 2 weeks, and 4% at 6 months. Furthermore, the WAD group reported improvements in all other psychometric variables (P<0.05), although only pain catastrophizing levels were comparable to controls at 2 weeks. DISCUSSION PPTs but not CPM improved in the WAD group and were comparable to controls following 2 weeks following standardized rehabilitation, indicating that normalization of CPM may not be required to recover from WAD.
Collapse
Affiliation(s)
- Steffan W M Christensen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University
- Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark
| | | | | | - Pablo Herrero
- Health Sciences Faculty, San Jorge University, Villanueva de Gállego
- Department of Physiatry and Nursing, Health Sciences Faculty, University of Zaragoza, Zaragoza, Spain
| | - Thorvaldur S Palsson
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University
| |
Collapse
|
23
|
Positive affect and distraction enhance while negative affect impairs pain modulation in recurrent low back pain patients and matched controls. Pain 2021; 163:887-896. [PMID: 34382603 DOI: 10.1097/j.pain.0000000000002442] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/12/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Pathophysiological causes of low back pain (LBP) remain generally unclear, so focus has shifted to psychosocial features and central pain processing. Effects of attentional and affective manipulation on conditioned pain modulation (CPM) and tonic pain perception were examined in thirty recurrent LBP patients in two sessions, one with and one without clinical pain, and compared to healthy participants. Phasic cuff pressure on one leg, scored on a numerical rating scale (NRS), was used for test-stimuli (TS) and contralateral tonic cuff pain rated on an electronic visual analogue scale (eVAS) was the conditioning-stimulus (CS). TS were assessed before and during: 1) control with no manipulation/CS, 2) three attentional manipulations (Flanker with/without CS or CS-Only), and 3) three affective manipulations (positive, neutral, negative pictures) with CS. Greater inhibition of TS-NRS scores was observed in CS-only (P=0.028), combined CS&attention (P=0.026), and CS&Positive (P=0.006) than Control paradigms, and greater in CS&Positive (P=0.019) than CS&Negative paradigms. eVAS scores of CS pain increased throughout all paradigms with CS (P<0.05), except the CS&Positive paradigm, and greater facilitation was observed in the CS-Only paradigm than all others (P<0.02) and lower facilitation was additionally observed in the CS&Positive paradigm compared to CS&Attention and CS&Negative paradigms (P<0.01). Flanker effects and interruptive effects of CS pain on attention were observed consistent with prior findings, and affective manipulation produced less shift in valence among people with RLBP than controls (P<0.05). Attention and positive affect with CS pain evoked CPM, and all attentional/affective tasks, especially positive affect, reduced facilitation of CS pain.
Collapse
|
24
|
Palsson TS, Doménech-García V, Boudreau SS, Graven-Nielsen T. Pain referral area is reduced by remote pain. Eur J Pain 2021; 25:1804-1814. [PMID: 33987881 DOI: 10.1002/ejp.1792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 05/02/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Endogenous pain inhibitory mechanisms are known to reduce pain intensity, but whether they influence the size and distribution of pain referral is unclear. This study aimed to determine if referred pain is reduced by applying a remote, conditioning painful stimulus. METHODS Twenty-four healthy men participated in this randomized, crossover study with a control and conditioning session. Referred pain was induced from the infraspinatus muscle (dominant side) by a painful pressure for 60 s. When applying pressure, the intensity was adjusted to a local pain intensity of 7/10 on a numerical rating scale. In the conditioning session, tonic painful pressure was simultaneously applied to the non-dominant leg during induction of referred pain. The area of referred pain was drawn onto a digital body chart and size extracted for data analysis. RESULTS For the total group and in a subgroup with distinct patterns of referred pain (n = 15/24), the pain area perceived in the back and front+back was smaller during the conditioning compared with the control (p < 0.05). No significant difference was found between sessions in a subgroup only demonstrating local pain (n = 9/24). CONCLUSIONS Engaging the descending noxious inhibitory control reduced the size of pain areas predominately when distinct pain referral was present. Assuming a conditioning effect of descending inhibitory control acting on dorsal horn neurons, these findings may indicate that mechanisms underlying pain referral can be modulated by endogenous control. The findings may indicate that referred pain may be a useful proxy to evaluate sensitivity of central pain mechanisms as previously suggested. SIGNIFICANCE The current results indicate a link between endogenous inhibition and pain referral. Descending inhibitory control effects on pain referral support a spinal mechanism involved in pain referral. Future studies should investigate whether the spatial characteristics of referred pain (e.g. size, frequency of affected body regions and distribution away from the primary nociceptive stimulus) can useful to evaluate the efficiency of endogenous pain modulation.
Collapse
Affiliation(s)
- Thorvaldur S Palsson
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Victor Doménech-García
- Department of Physiotherapy, Faculty of Health Sciences, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
| | - Shellie S Boudreau
- Center For Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Thomas Graven-Nielsen
- Center For Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| |
Collapse
|
25
|
Intrinsic attention to pain is associated with a pronociceptive phenotype. Pain Rep 2021; 6:e934. [PMID: 34104840 PMCID: PMC8177874 DOI: 10.1097/pr9.0000000000000934] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/08/2021] [Accepted: 04/17/2021] [Indexed: 11/29/2022] Open
Abstract
Capacity for modulation of incoming nociceptive signals is a determinant of our tendency to attend to pain. Introduction: Evidence suggests that attention to pain is a product of both incoming sensory signals and cognitive evaluation of a stimulus. Intrinsic attention to pain (IAP) is a measure that captures an individual's natural tendency to attend to a painful stimulus and may be important in understanding why pain disrupts cognitive functioning in some individuals more than others. Objective: In this study, we explored the extent to which IAP was associated with the modulation of incoming sensory signals characteristic of a pronociceptive phenotype: temporal summation (TS) and conditioned pain modulation (CPM). Method: 44 healthy participants (23 female; Mage=23.57, S.D.=5.50) were assessed on IAP, TS and CPM. Results: We found that IAP was positively correlated with TS and CPM. A regression model showed that TS and CPM explained 39% of the variance in IAP scores. Both mechanisms seem to contribute independently to the propensity to attend to pain. Conclusion: These findings highlight that modulatory mechanisms at the spinal/supraspinal level exert a strong influence on an individual's ability to disengage from pain.
Collapse
|
26
|
Motor cortex transcranial direct current stimulation effects on knee osteoarthritis pain in elderly subjects with dysfunctional descending pain inhibitory system: A randomized controlled trial. Brain Stimul 2021; 14:477-487. [PMID: 33684598 DOI: 10.1016/j.brs.2021.02.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 02/19/2021] [Accepted: 02/24/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although evidence has indicated a positive effect of transcranial direct current stimulation (tDCS) on reducing pain, few studies have focused on the elderly population with knee osteoarthritis (KOA). OBJECTIVE To evaluate whether tDCS reduces KOA pain in elderly individuals with a dysfunctional descending pain inhibitory system (DPIS). METHODS In a double-blind trial, individuals ≥ 60 years with KOA pain and a dysfunctional DPIS, we randomly assigned patients to receive 15 daily sessions of 2 mA tDCS over the primary motor cortex (anode) and contralateral supraorbital area (cathode) (M1-SO) for 20 min or sham tDCS. Change in pain perception indexed by the Brief Pain Inventory (BPI) at the end of intervention was the primary outcome. Secondary outcomes included: disability, quantitative sensory testing, pain pressure threshold and conditioned pain modulation (CPM). Subjects were followed-up for 2 months. RESULTS Of the 104 enrolled subjects, with mean (SD) age of 73.9 (8.01) years and 88 (84.6%) female, 102 finished the trial. In the intention-to-treat analysis, the active tDCS group had a significantly greater reduction in BPI compared to the sham group (difference, 1.59; 95% CI, 0.95 to 2.23; P < 0.001; Cohen's d, 0.58); and, also a significantly greater improvement in CPM-pressure in the knee (P = 0.01) and CPM-pain in the hand (P = 0.01). These effects were not sustained at follow-up. The intervention was well tolerated, with no severe adverse effects. CONCLUSION M1-SO tDCS is associated with a moderate effect size in reducing pain in elderly patients with KOA after 15 daily sessions of stimulation. This intervention has also shown to modulate the DPIS.
Collapse
|
27
|
Nahman-Averbuch H, Schneider VJ, Chamberlin LA, Van Diest AMK, Peugh JL, Lee GR, Radhakrishnan R, Hershey AD, Powers SW, Coghill RC, King CD. Identification of neural and psychophysical predictors of headache reduction after cognitive behavioral therapy in adolescents with migraine. Pain 2021; 162:372-381. [PMID: 32773592 PMCID: PMC7855380 DOI: 10.1097/j.pain.0000000000002029] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 07/22/2020] [Indexed: 12/22/2022]
Abstract
ABSTRACT Cognitive behavioral therapy (CBT) is a psychological intervention that involves development of coping strategies to reduce the experience of pain. Although CBT is a promising intervention to reduce headache days in patients with migraine, it may not be effective for all patients. Thus, there is a need to identify markers that could predict which patients will respond to CBT. We aimed to determine whether baseline brain function and amygdalar connectivity, assessed by functional magnetic resonance imaging, or pain modulation capacities, assessed by the conditioned pain modulation (CPM) response, can predict a reduction in headache days after CBT in adolescents with migraine. Patients with migraine (n = 20; age range 10-17 years) completed 8 weekly CBT sessions. The CPM response was examined in the trapezius and the leg. Headache days significantly decreased after CBT (P < 0.001). Greater functional connectivity before CBT between the right amygdala and frontal gyrus, anterior cingulate cortex, and precentral gyrus was related to greater headache reduction after CBT. Greater reduction in headache days after CBT was related with less efficient CPM response before CBT at the trapezius (r = -0.492, P = 0.028) but not at the leg. This study found that headache reduction after CBT was related to right amygdala connectivity with frontal and sensorimotor regions at baseline as well as baseline pain modulation capacities. These findings suggest that individual differences in brain function and pain modulation can be associated with clinical improvements and help with determination of CBT responsiveness.
Collapse
Affiliation(s)
- Hadas Nahman-Averbuch
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Center for Understanding Pediatric Pain, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Victor J Schneider
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Leigh Ann Chamberlin
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ashley M. Kroon Van Diest
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Nationwide Children’s Hospital, The Ohio State University
| | - James L. Peugh
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Gregory R. Lee
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine
- Pediatric Neuroimaging Research Consortium, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Rupa Radhakrishnan
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine
| | - Andrew D. Hershey
- Center for Understanding Pediatric Pain, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Scott W. Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Center for Understanding Pediatric Pain, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Robert C. Coghill
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Center for Understanding Pediatric Pain, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Pediatric Neuroimaging Research Consortium, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christopher D. King
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Center for Understanding Pediatric Pain, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| |
Collapse
|
28
|
Hoegh M, Poulsen JN, Petrini L, Graven-Nielsen T. The Effect of Stress on Repeated Painful Stimuli with and Without Painful Conditioning. PAIN MEDICINE 2021; 21:317-325. [PMID: 31241135 DOI: 10.1093/pm/pnz115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Stress and pain have been interrelated in clinical widespread pain conditions. Studies indicate that acute experimental stress in healthy volunteers has a negative effect on the descending inhibitory pain control system and thus the ability to inhibit one painful stimulus with another (conditioned pain modulation [CPM]) although without effect on general pain sensitivity. CPM effects can be assessed immediately after the stress induction, whereas some physiological stress responses (e.g., cortisol release) are delayed and longer lasting. It is unclear whether CPM may relate to stress-induced increases in cortisol. DESIGN Twenty-five healthy men had CPM effects measured over a period of 10 minutes. Pain detection thresholds (PDTs) were assessed by repeated test stimuli with cuff algometry on one leg, with and without painful cuff pressure conditioning on the contralateral leg. CPM effects, assessed as the increase in PDT during conditioning stimulation compared with without, were measured before and after experimental stress and a control condition (Montreal Imaging Stress Task [MIST]). Saliva cortisol levels and self-perceived stress were collected. RESULTS Participants reported the MIST to be more stressful compared with the MIST control, but cortisol levels did not change significantly from baseline. In all sessions, PDT increased during conditioning (P = 0.001), although the MIST compared with the MIST control had no significant effect on PDT or CPM effects. A negative correlation between changes in cortisol and conditioned PDT was found when applying the MIST (P < 0.03). CONCLUSIONS No significant effect of stress was found on CPM compared with a matched control condition. Individual changes in experimental stress and in conditioned pain sensitivity may be linked with cortisol.
Collapse
Affiliation(s)
- Morten Hoegh
- Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Aalborg, Denmark
| | - Jeppe N Poulsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Aalborg, Denmark
| | - Laura Petrini
- Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Aalborg, Denmark
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Aalborg, Denmark
| |
Collapse
|
29
|
Støve MP, Hirata RP, Palsson TS. The tolerance to stretch is linked with endogenous modulation of pain. Scand J Pain 2021; 21:355-363. [PMID: 34387949 DOI: 10.1515/sjpain-2020-0010] [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: 01/09/2020] [Accepted: 11/17/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The effect of stretching on joint range of motion is well documented, and although sensory perception has significance for changes in the tolerance to stretch following stretching the underlining mechanisms responsible for these changes is insufficiently understood. The aim of this study was to examine the influence of endogenous pain inhibitory mechanisms on stretch tolerance and to investigate the relationship between range of motion and changes in pain sensitivity. METHODS Nineteen healthy males participated in this randomized, repeated-measures crossover study, conducted on 2 separate days. Knee extension range of motion, passive resistive torque, and pressure pain thresholds were recorded before, after, and 10 min after each of four experimental conditions; (i) Exercise-induced hypoalgesia, (ii) two bouts of static stretching, (iii) resting, and (iv) a remote, painful stimulus induced by the cold pressor test. RESULTS Exercise-induced hypoalgesia and cold pressor test caused an increase in range of motion (p<0.034) and pressure pain thresholds (p<0.027). Moderate correlations in pressure pain thresholds were found between exercise-induced hypoalgesia and static stretch (Rho>0.507, p=0.01) and exercise-induced hypoalgesia and the cold pressor test (Rho=0.562, p=0.01). A weak correlation in pressure pain thresholds and changes in range of motion were found following the cold pressor test (Rho=0.460, p=0.047). However, a potential carryover hypoalgesic effect may have affected the results of the static stretch. CONCLUSIONS These results suggest that stretch tolerance may be linked with endogenous modulation of pain. Present results suggest, that stretch tolerance may merely be a marker for pain sensitivity which may have clinical significance given that stretching is often prescribed in the rehabilitation of different musculoskeletal pain conditions where reduced endogenous pain inhibition is frequently seen.
Collapse
Affiliation(s)
- Morten Pallisgaard Støve
- Department of Physiotherapy, University College of Northern Denmark (UCN), Aalborg East, Denmark
| | - Rogerio Pessoto Hirata
- Department of Health Science and Technology, SMI®, Faculty of Medicine, Aalborg University, Aalborg East, Denmark
| | - Thorvaldur Skuli Palsson
- Department of Health Science and Technology, SMI®, Faculty of Medicine, Aalborg University, Aalborg East, Denmark
| |
Collapse
|
30
|
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
|
31
|
Abstract
Background:Burning mouth syndrome (BMS) is a chronic and debilitating oral pain of the normal oral mucosa. It mainly affects women in their fifth to seventh decade. Its aetiopathogenesis remains unclear and is probably of multifactorial origin, with increasing evidence that BMS may be a neuropathic disorder. BMS is classified as an idiopathic (nociplastic) orofacial pain with or without somatosensory changes by International Classification of Orofacial Pain (ICOP 2020). The diagnosis of BMS, having excluded ‘oral burning mouth symptoms’, has evolved from basic intraoral exclusion screening to extensive clinical and laboratory investigations, which include the screening of comorbidities and other chronic pains and somatosensory testing. There is no standardised treatment in managing BMS, but a proposed combination of supportive and pharmacological treatment has been recommended.Aim:To review the current concepts of BMS definitions, classifications, aetiopathogenesis, diagnosis techniques, and evidence-based treatments in managing BMS patients.Conclusion:As BMS is a diagnosis by exclusion, thus a stratified approach is required for assessment of patients presenting BMS. A BMS diagnosis protocol is desired using a standardised screening to distinguish BMS from patient’s presenting with ‘oral burning symptoms’, and evaluation of comorbid chronic pain disorders or other medical comorbidities, which will include haematological, fungal, salivary flow, and qualitative sensory testing. Axis II and other additional quantitative sensory testing may further elucidate the causes of this condition. For future BMS prediction and prevention, will be based upon research on the relationship between other chronic pain disorders and familial history, environmental and genetic information.
Collapse
Affiliation(s)
- Huann Lan Tan
- King’s College London, London, UK
- Dentistry, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Tara Renton
- Dentistry, Oral & Craniofacial Science, King’s College London, London, UK
| |
Collapse
|
32
|
Do ATL, Enax-Krumova EK, Özgül Ö, Eitner LB, Heba S, Tegenthoff M, Maier C, Höffken O. Distraction by a cognitive task has a higher impact on electrophysiological measures compared with conditioned pain modulation. BMC Neurosci 2020; 21:53. [PMID: 33287715 PMCID: PMC7720448 DOI: 10.1186/s12868-020-00604-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/23/2020] [Indexed: 12/23/2022] Open
Abstract
Background Conditioned pain modulation (CPM) evaluates the effect of a painful conditioning stimulus (CS) on a painful test stimulus (TS). Using painful cutaneous electrical stimulation (PCES) as TS and painful cold water as CS, the pain relief was paralleled by a decrease in evoked potentials (PCES-EPs). We now aimed to compare the effect of CPM with cognitive distraction on PCES-induced pain and PCES-EP amplitudes. Methods PCES was performed using surface electrodes inducing a painful sensation of 60 (NRS 0–100) on one hand. In a crossover design healthy subjects (included: n = 38, analyzed: n = 23) immersed the contralateral hand into 10 °C cold water (CS) for CPM evaluation and performed the 1-back task for cognitive distraction. Before and during the CS and 1-back task, respectively, subjects rated the pain intensity of PCES and simultaneously cortical evoked potentials were recorded. Results Both CPM and cognitive distraction significantly reduced PCES-EP amplitudes (CPM: 27.6 ± 12.0 μV to 20.2 ± 9.5 μV, cognitive distraction: 30.3 ± 14.2 µV to 13.6 ± 5.2 μV, p < 0.001) and PCES-induced pain (on a 0–100 numerical rating scale: CPM: 58 ± 4 to 41.1 ± 12.3, cognitive distraction: 58.3 ± 4.4 to 38.0 ± 13.0, p < 0.001), though the changes in pain intensity and PCES-amplitude did not correlate. The changes of the PCES-EP amplitudes during cognitive distraction were more pronounced than during CPM (p = 0.001). Conclusions CPM and cognitive distraction reduced the PCES-induced pain to a similar extent. The more pronounced decrease of PCES-EP amplitudes after distraction by a cognitive task implies that both conditions might not represent the general pain modulatory capacity of individuals, but may underlie different neuronal mechanisms with the final common pathway of perceived pain reduction.
Collapse
Affiliation(s)
- A T L Do
- Department of Neurology, Ruhr-University Bochum, BG University Hospital Bergmannsheil gGmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - E K Enax-Krumova
- Department of Neurology, Ruhr-University Bochum, BG University Hospital Bergmannsheil gGmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Ö Özgül
- Department of Neurology, Ruhr-University Bochum, BG University Hospital Bergmannsheil gGmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - L B Eitner
- Department of Pain Medicine, Ruhr-University Bochum, BG University Hospital Bergmannsheil gGmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.,Department of Neuropaediatrics, University Children's Hospital, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany
| | - S Heba
- Department of Neurology, Ruhr-University Bochum, BG University Hospital Bergmannsheil gGmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | | | - C Maier
- Department of Pain Medicine, Ruhr-University Bochum, BG University Hospital Bergmannsheil gGmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - O Höffken
- Department of Neurology, Ruhr-University Bochum, BG University Hospital Bergmannsheil gGmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| |
Collapse
|
33
|
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
|
34
|
Effects of Conditioned Pain Modulation on the Nociceptive Flexion Reflex in Healthy People: A Systematic Review. Clin J Pain 2020; 35:794-807. [PMID: 31268892 DOI: 10.1097/ajp.0000000000000724] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The nociceptive flexion reflex (NFR) is a spinal reflex induced by painful stimuli resulting in a withdrawal response. Research has shown that the NFR is inhibited through endogenous pain inhibitory mechanisms, which can be assessed by conditioned pain modulation (CPM) paradigms. Although accumulating research suggests that the NFR can be affected by CPM, no clear overview of the current evidence exists. Therefore, the present review aimed at providing such a synthesis of the literature. In addition, the influence of personal factors on the CPM of the NFR was investigated. MATERIALS AND METHODS A systematic review was performed and reported following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Five electronic databases were searched to identify relevant articles. Retrieved articles were screened on eligibility using predefined inclusion criteria. Risk of bias was investigated according to the modified Newcastle-Ottawa Scale. Levels of evidence and strength of conclusion were assigned following the guidelines of the Dutch Institute for Healthcare Improvement. RESULTS Forty articles were included. There is some evidence that CPM produced by thermal or mechanical stimuli induces inhibitory effects on the NFR. However, inconclusive evidence exists with regard to the effect of electrical conditioning stimuli. While several personal factors do not affect CPM of the NFR, increased cognitive interference is associated with reduced NFR inhibition. DISCUSSION The present review demonstrates that certain types of nociceptive conditioning stimuli have the potential to depress, at the spinal level, nociceptive stimuli elicited from distant body regions. Although CPM of the NFR seems to be robust to the influence of several personal factors, it can be affected by cognitive influences.
Collapse
|
35
|
Mertens MGCAM, Hermans L, Crombez G, Goudman L, Calders P, Van Oosterwijck J, Meeus M. Comparison of five conditioned pain modulation paradigms and influencing personal factors in healthy adults. Eur J Pain 2020; 25:243-256. [DOI: 10.1002/ejp.1665] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 08/14/2020] [Accepted: 09/16/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Michel GCAM Mertens
- Research Group MOVANT Department of Rehabilitation Sciences and Physiotherapy (REVAKI) University of Antwerp Wilrijk Belgium
- Pain in Motion research group http://www.paininmotion.be/ Belgium
| | - Linda Hermans
- Pain in Motion research group http://www.paininmotion.be/ Belgium
- Department of Rehabilitation Sciences and Physiotherapy Faculty of Medicine and Health Sciences Ghent University Ghent Belgium
| | - Geert Crombez
- Department of Experimental Clinical and Health Psychology Ghent University Ghent Belgium
| | - Lisa Goudman
- Departments of Physiotherapy and Human Physiology Faculty of Physical Education & Physiotherapy Vrije Universiteit Brussel Ixelles Belgium
- Department of Neurosurgery University Hospital Brussels Jette Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences and Physiotherapy Faculty of Medicine and Health Sciences Ghent University Ghent Belgium
| | - Jessica Van Oosterwijck
- Research Group MOVANT Department of Rehabilitation Sciences and Physiotherapy (REVAKI) University of Antwerp Wilrijk Belgium
- Pain in Motion research group http://www.paininmotion.be/ Belgium
- Department of Rehabilitation Sciences and Physiotherapy Faculty of Medicine and Health Sciences Ghent University Ghent Belgium
- Research Foundation – Flanders (FWO) Brussels Belgium
| | - Mira Meeus
- Research Group MOVANT Department of Rehabilitation Sciences and Physiotherapy (REVAKI) University of Antwerp Wilrijk Belgium
- Pain in Motion research group http://www.paininmotion.be/ Belgium
- Department of Rehabilitation Sciences and Physiotherapy Faculty of Medicine and Health Sciences Ghent University Ghent Belgium
| |
Collapse
|
36
|
Nishihara C, Watanabe K, Ozasa K, Khan J, Eliav E, Imamura Y, Noma N. Altered pain modulation to noxious heat thermal stimuli in burning mouth syndrome. Oral Dis 2020; 26:1777-1782. [DOI: 10.1111/odi.13486] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 04/16/2020] [Accepted: 04/19/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Chisa Nishihara
- Department of Oral Diagnostic Sciences Nihon University School of Dentistry Tokyo Japan
| | - Kosuke Watanabe
- Department of Oral Diagnostic Sciences Nihon University School of Dentistry Tokyo Japan
| | - Kana Ozasa
- Department of Oral Diagnostic Sciences Nihon University School of Dentistry Tokyo Japan
| | - Junad Khan
- Eastman Institute for Oral Health University of Rochester NY USA
| | - Eli Eliav
- Eastman Institute for Oral Health University of Rochester NY USA
| | - Yoshiki Imamura
- Department of Oral Diagnostic Sciences Nihon University School of Dentistry Tokyo Japan
- Clinical Research Division Dental Research Institute Nihon University Tokyo Japan
| | - Noboru Noma
- Department of Oral Diagnostic Sciences Nihon University School of Dentistry Tokyo Japan
- Clinical Research Division Dental Research Institute Nihon University Tokyo Japan
| |
Collapse
|
37
|
Toledo TA, Kuhn BL, Payne MF, Lannon EW, Palit S, Sturycz CA, Hellman N, Güereca YM, Demuth MJ, Huber F, Shadlow JO, Rhudy JL. The Effect of Pain Catastrophizing on Endogenous Inhibition of Pain and Spinal Nociception in Native Americans: Results From the Oklahoma Study of Native American Pain Risk. Ann Behav Med 2020; 54:575-594. [PMID: 32073117 PMCID: PMC7414293 DOI: 10.1093/abm/kaaa004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Conditioned pain modulation (CPM) is a task that involves measuring pain in response to a test stimulus before and during a painful conditioning stimulus (CS). The CS pain typically inhibits pain elicited by the test stimulus; thus, this task is used to assess endogenous pain inhibition. Moreover, less efficient CPM-related inhibition is associated with chronic pain risk. Pain catastrophizing is a cognitive-emotional process associated with negative pain sequelae, and some studies have found that catastrophizing reduces CPM efficiency. PURPOSE The current study examined the relationship between catastrophizing (dispositional and situation specific) and CPM-related inhibition of pain and the nociceptive flexion reflex (NFR; a marker of spinal nociception) to determine whether the catastrophizing-CPM relationship might contribute to the higher risk of chronic pain in Native Americans (NAs). METHODS CPM of pain and NFR was assessed in 124 NAs and 129 non-Hispanic Whites. Dispositional catastrophizing was assessed at the beginning of the test day, whereas situation-specific catastrophizing was assessed in response to the CS, as well as painful electric stimuli. RESULTS Situation-specific, but not dispositional, catastrophizing led to less NFR inhibition but more pain inhibition. These effects were not moderated by race, but mediation analyses found that: (a) the NA race was associated with greater situation-specific catastrophizing, which led to less NFR inhibition and more pain inhibition, and (b) situation-specific catastrophizing was associated with greater CS pain, which led to more pain inhibition. CONCLUSIONS Catastrophizing may contribute to NA pain risk by disrupting descending inhibition.
Collapse
Affiliation(s)
- Tyler A Toledo
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Bethany L Kuhn
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Michael F Payne
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Edward W Lannon
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Shreela Palit
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | | | - Natalie Hellman
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Yvette M Güereca
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Mara J Demuth
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Felicitas Huber
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Joanna O Shadlow
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Jamie L Rhudy
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| |
Collapse
|
38
|
Firouzian S, Osborne NR, Cheng JC, Kim JA, Bosma RL, Hemington KS, Rogachov A, Davis KD. Individual variability and sex differences in conditioned pain modulation and the impact of resilience, and conditioning stimulus pain unpleasantness and salience. Pain 2020; 161:1847-1860. [PMID: 32701844 DOI: 10.1097/j.pain.0000000000001863] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Distinct pain experiences are shaped both by personal attributes and characteristics of noxious stimuli. An Individual's capacity for endogenous pain inhibition (reflected by conditioned pain modulation [CPM]), their resilience, and the pain unpleasantness and salience of painful stimuli can impact their pain perception. Here, we aimed to determine how individual variability in CPM relates to sex and resilience as personal attributes, and pain unpleasantness and salience of the CPM conditioning stimulus (CS). We evaluated CPM in 106 healthy participants (51 female and 55 male) based on the change in test stimulus pain applied concurrently with a painful CS, both delivered by painful heat. The CS reduced test stimulus pain in only half of the participants (CPM subgroup), but did not do so for the other half (no-CPM subgroup), many who exhibited pain facilitation. A regression model explained CPM effects after accounting for sex, resilience, CS pain unpleasantness and salience. In the CPM subgroup regression model, the CPM effect was positively related to CS pain unpleasantness, while the CPM effect was not related to any variable in the no-CPM subgroup model. Correlation analyses revealed that the CPM effect was anticorrelated with resilience in males with no-CPM. The CPM effect was correlated with CS pain unpleasantness in males with CPM and in females with no-CPM. The CPM effect and CS salience were correlated in the whole group more strongly than in the subgroups. These data reveal that the complexity of contributors to CPM variability include both personal attributes and attributes of the CS.
Collapse
Affiliation(s)
- Shahrzad Firouzian
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Natalie R Osborne
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Joshua C Cheng
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Junseok A Kim
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Rachael L Bosma
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Kasey S Hemington
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Anton Rogachov
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Karen D Davis
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
39
|
Hilton E, Satia I, Holt K, Woodcock AA, Belcher J, Smith JA. The Effect of Pain Conditioning on Experimentally Evoked Cough: Evidence of Impaired Endogenous Inhibitory Control Mechanisms in Refractory Chronic Cough. Eur Respir J 2020; 56:2001387. [PMID: 32703776 DOI: 10.1183/13993003.01387-2020] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/28/2020] [Indexed: 01/31/2023]
Abstract
The pathophysiology of refractory chronic cough (RCC) is unclear. We hypothesised that endogenous inhibitory control mechanisms, such as those activated by noxiousstimuli inducing pain (conditioned pain modulation (CPM)), may be capable of inhibiting coughing and urge to cough evoked by inhaled capsaicin. Furthermore, these mechanisms may be impaired in patients with RCC.The objective was to investigate the effects of pain on cough and urge to cough (UTC) in healthy volunteers (HV) and RCC. HV and RCC patients underwent a randomised, controlled, 4-way cross-over study comparing the effect of 4 interventions on capsaicin evoked coughing and UTC. The interventions comprised immersing a hand in i) noxious cold-water, ii) warm water, iii) warm water but instructed to voluntarily supress coughing and iv) no intervention. The co-primary outcomes were numbers of evoked coughs and UTC scores.Twenty HV (mean age 50.1(±SD14.2), M:F 10:10) and 20 RCC (age 60.1(±7.9), M:F 9:11) participated. Overall, noxious cold water reduced capsaicin evoked UTC scores and cough numbers compared with warm water (1.6 (95% C.I. 1.3-2.0) versus 2.2 (1.8-2.6) p<0.001; 4.8 coughs (3.7-6.2) versus 7.9 coughs (6.7-9.5) p<0.001, respectively). HV and RCC demonstrated similar reductions in the UTC during noxious cold-water immersion, but noxious cold water and voluntary suppression interventions were less effective in RCC than HV in reducing capsaicin evoked cough (p=0.041).Endogenous inhibitory control mechanisms, specifically those activated by pain, can reduce both coughing and the UTC. Impairment of endogenous inhibitory control mechanisms may contribute to excessive coughing in RCC.
Collapse
Affiliation(s)
- Emma Hilton
- Division of Infection, Immunity and Respiratory Medicine, and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Equal contributors
| | - Imran Satia
- Division of Infection, Immunity and Respiratory Medicine, and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Department of Medicine, Division of Respirology, McMaster University, Hamilton, Canada
- Equal contributors
| | - Kimberley Holt
- Division of Infection, Immunity and Respiratory Medicine, and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Ashley A Woodcock
- Division of Infection, Immunity and Respiratory Medicine, and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - John Belcher
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| |
Collapse
|
40
|
Nuwailati R, Curatolo M, LeResche L, Ramsay DS, Spiekerman C, Drangsholt M. Reliability of the conditioned pain modulation paradigm across three anatomical sites. Scand J Pain 2020; 20:283-296. [PMID: 31812949 DOI: 10.1515/sjpain-2019-0080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 10/24/2019] [Indexed: 01/08/2023]
Abstract
Background and aims Conditioned Pain Modulation (CPM) is a measure of pain inhibition-facilitation in humans that may elucidate pain mechanisms and potentially serve as a diagnostic test. In laboratory settings, the difference between two pain measures [painful test stimulus (TS) without and with the conditioning stimulus (CS) application] reflects the CPM magnitude. Before the CPM test can be used as a diagnostic tool, its reliability on the same day (intra-session) and across multiple days (inter-session) needs to be known. Furthermore, it is important to determine the most reliable anatomical sites for both the TS and the CS. This study aimed to measure the intra-session and inter-session reliability of the CPM test paradigm in healthy subjects with the TS (pressure pain threshold-PPT) applied to three test sites: the face, hand, and dorsum of the foot, and the CS (cold pressor test-CPT) applied to the contralateral hand. Methods Sixty healthy participants aged 18-65 were tested by the same examiner on 3 separate days, with an interval of 2-7 days. On each day, testing was comprised of two identical experimental sessions in which the PPT test was performed on each of the three dominant anatomical sites in randomized order followed by the CPM test (repeating the PPT with CPT on the non-dominant hand). CPM magnitude was calculated as the percent change in PPT. The Intraclass Correlation Coefficient (ICC), Coefficient of Variation (CV), and Bland-Altman analyses were used to assess reliability. Results PPT relative reliability ranged from good to excellent at all three sites; the hand showed an intra-session ICC of 0.90 (0.84, 0.94) before CPT and ICC of 0.89 (0.83, 0.92) during CPT. The PPT absolute reliability was also high, showing a low bias and small variability when performed on all three sites; for example, CV of the hand intra-session was 8.0 before CPT and 8.1 during CPT. The relative reliability of the CPM test, although only fair, was most reliable when performed during the intra-session visits on the hand; ICC of 0.57 (0.37, 0.71) vs. 0.20 (0.03, 0.39) for the face, and 0.22 (0.01, 0.46) for the foot. The inter-session reliability was lower in all three anatomical sites, with the best reliability on the hand with an ICC of 0.40 (0.23, 0.55). The pattern of absolute reliability of CPM was similar to the relative reliability findings, with the reliability best on the hand, showing lower intra-session and inter-session variability (CV% = 43.5 and 51.5, vs. 70.1 and 73.1 for the face, and 75.9 and 78.9 for the foot). The CPM test was more reliable in women than in men, and in older vs. younger participants. Discussion The CPM test was most reliable when the TS was applied to the dominant hand and CS performed on the contralateral hand. These data indicate that using the CS and TS in the same but contralateral dermatome in CPM testing may create the most reliable results.
Collapse
Affiliation(s)
- Rania Nuwailati
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
| | - Michele Curatolo
- Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA, USA.,Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Linda LeResche
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA.,Department of Oral Medicine, University of Washington, Seattle, WA, USA
| | - Douglas S Ramsay
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA.,Department of Orthodontics, University of Washington, Seattle, WA, USA.,Department of Pediatric Dentistry, University of Washington, Seattle, WA, USA
| | - Charles Spiekerman
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA.,Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
| | - Mark Drangsholt
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA.,Department of Oral Medicine, University of Washington, Seattle, WA, USA
| |
Collapse
|
41
|
Støve MP, Hirata RP, Palsson TS. Muscle stretching - the potential role of endogenous pain inhibitory modulation on stretch tolerance. Scand J Pain 2020; 19:415-422. [PMID: 30699073 DOI: 10.1515/sjpain-2018-0334] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 12/18/2018] [Indexed: 11/15/2022]
Abstract
Background and aims The effect of stretching on joint range of motion is well documented and is primarily related to changes in the tolerance to stretch, but the mechanisms underlying this change are still largely unknown. The aim of this study was to investigate the influence of a remote, painful stimulus on stretch tolerance. Methods Thirty-four healthy male subjects were recruited and randomly assigned to an experimental pain group (n=17) or a control group (n=17). Passive knee extension range of motion, the activity of hamstring muscles and passive resistive torque were measured with subjects in a seated position. Three consecutive measures were performed with a 5-min interval between. A static stretch protocol was utilized in both groups to examine the effect of stretching and differences in stretch tolerance between groups. Following this, the pain-group performed a cold pressor test which is known to engage the endogenous pain inhibitory system after which measurements were repeated. Results A significant increase in knee extension range of motion was found in the pain group compared with controls (ANCOVA: p<0.05). No difference was found in muscle activity or passive resistive torque between groups (ANCOVA p>0.091). Conclusions Passive knee extension range of motion following stretching increased when following a distant, painful stimulus, potentially engaging the endogenous pain inhibitory systems. Current findings indicate a link between increased tolerance to stretch and endogenous pain inhibition. Implications The current findings may have implications for clinical practice as they indicate that a distant painful stimulus can influence range of motion in healthy individuals. This implies that the modulation of pain has significance for the efficacy of stretching which is important knowledge when prescribing stretching as part of rehabilitation.
Collapse
Affiliation(s)
- Morten Pallisgaard Støve
- Department of Physiotherapy, University College of Northern Denmark (UCN), Selma Lagerløfs Vej 2, 9220 Aalborg East, Denmark, Phone: 004522980862
| | - Rogerio Pessoto Hirata
- SMI® , Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg East, Denmark
| | - Thorvaldur Skuli Palsson
- SMI® , Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg East, Denmark
| |
Collapse
|
42
|
Mastilović G, Konstantinović U, Đorđević O. Human experimental pain models. MEDICINSKI PODMLADAK 2020. [DOI: 10.5937/mp71-27417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Pain is an unpleasant sensory experience, associated with existing or potential tissue damage. It has also strong cognitive and emotional components. Stimuli that causes pain goes through process of nociception, which includes transduction, transmission, modulation and perception of said stimuli. Depending on the type of stimuli, we can classify human experimental pain models into mechanical, electrical, thermal and chemical. Information about pain mechanisms can be obtained from the following: 1) in vitro studies, 2) animal experiments, 3) human experimental pain studies and 4) clinical studies. Chosing the appropriate method for pain evaluation is a key step in the design of pain studies. Combining it with different electro-physiological and imaging methods, it can provide better objectivity and quantification of pain mechanisms. Focus in experimental pain studies is slowly shifting from static parameters of pain, such as pain threshold and maximum tolerance, to dynamic parameters, which can give us valuable insight in function of endogenous analgesic systems. This can be done using conditioned pain modulation. Using experimental pain on healthy voulenteers is key step in switching from animal models to clinical studies, foremost for validization of data from animals, making them important in translational research. Results from experimental pain studies can help us in understanding nociceptive mechanisms of acute and chronic pain, alongside development of new therapeutic modalities.
Collapse
|
43
|
|
44
|
Torta DM, Jure FA, Andersen OK, Biurrun Manresa JA. Intense and sustained pain reduces cortical responses to auditory stimuli: Implications for the interpretation of the effects of heterotopic noxious conditioning stimulation in humans. Eur J Neurosci 2019; 50:3934-3943. [DOI: 10.1111/ejn.14546] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/24/2019] [Accepted: 08/06/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Diana M. Torta
- Health Psychology Faculty of Psychology and Educational Sciences KU Leuven Leuven Belgium
- Institute of Neuroscience UC Louvain Brussels Belgium
| | - Fabricio A. Jure
- Center for Neuroplasticity and Pain SMI® Department of Health Science and Technology Aalborg University Aalborg Denmark
| | - Ole K. Andersen
- Center for Neuroplasticity and Pain SMI® Department of Health Science and Technology Aalborg University Aalborg Denmark
| | - José A.B. Biurrun Manresa
- Center for Neuroplasticity and Pain SMI® Department of Health Science and Technology Aalborg University Aalborg Denmark
- Institute for Research and Development in Bioengineering and Bioinformatics (IBB) CONICET‐UNER Entre Ríos Argentina
| |
Collapse
|
45
|
Boggero IA, Segerstrom SC. Self-regulatory ability, fatigue, and the experience of pain: Mechanistic insights from pain-free undergraduates. Psychophysiology 2019; 56:e13388. [PMID: 31049991 PMCID: PMC6699908 DOI: 10.1111/psyp.13388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 12/19/2018] [Accepted: 02/01/2019] [Indexed: 11/29/2022]
Abstract
Self-regulatory (SR) ability is an important resource for managing pain, but chronic pain patients experience chronic self-regulatory fatigue even when they are not in pain. Pressure pain thresholds (PPT) and pain inhibition are two mechanisms that differentiate people with and without chronic pain. It was hypothesized that trait SR ability would be associated with higher PPT and better pain inhibition and that PPT and pain inhibition would be lower following high versus low SR fatigue. Three studies tested these hypotheses. Study 1 had 240 pain-free undergraduates complete measures of trait SR ability and PPT; 122 also provided data on pain inhibition. Study 2 had 38 of Study 1's participants return for two additional sessions in which they underwent PPT testing under conditions of high or low SR fatigue (within-person, counterbalanced). Study 3 repeated these procedures with pain inhibition as the outcome (n = 39). Results revealed that individual differences in SR ability were not associated with PPT or pain inhibition (all ps > 0.05). Within people, neither PPT (F(1, 36) = 1.57, p = 0.22) nor pain inhibition (F(1, 37) = 1.79, p = 0.19) were significantly different under conditions of low versus high SR fatigue. Results do not support the hypotheses that PPT or pain inhibition associate with individual differences in trait SR ability or transient changes in state SR fatigue in the absence of pain. Instead, the SR deficits in chronic pain patients may arise from the experience of chronic pain.
Collapse
Affiliation(s)
- Ian A. Boggero
- University of Kentucky, Department of Psychology
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology
| | | |
Collapse
|
46
|
Hoegh M, Seminowicz DA, Graven-Nielsen T. Delayed effects of attention on pain sensitivity and conditioned pain modulation. Eur J Pain 2019; 23:1850-1862. [PMID: 31343803 DOI: 10.1002/ejp.1458] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 07/09/2019] [Accepted: 07/20/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Efficacy of pain modulation is assessed as the difference in pain sensitivity during a painful conditioning, compared to before (conditioning pain modulation, CPM). Attention can be assessed with the Stroop task, in which participants report the number of words on a screen; either congruent or incongruent with the value of the words. Attention away from painful stimuli during CPM enhances the CPM effect. However, it is unknown if attention influences CPM effects when the two are done in sequence. METHODS Healthy men (n = 25) underwent cuff algometry CPM-assessment where the pressure-pain detection and tolerance thresholds (PTT) were recorded on one leg with and without contralateral conditioning. Two identical sessions of four test stimuli equal to PTT (5 s, 1-min interval, scored on a visual analogue scale, VAS) with a painful conditioning from the second to the last test-stimulus were performed. Stroop sessions were followed by test stimuli with or without painful conditioning. RESULTS The VAS scores in the first two sessions showed excellent reliability (ICC = 0.92). VAS scores were lower in sessions with Stroop compared to sessions without Stroop (p = .05) indicating an analgesic effect of Stroop. Participants were subgrouped into CPM responders and CPM non-responders according to CPM effects in the first two sessions. CPM non-responders (n = 13) showed facilitation to repeated noxious stimuli in all sessions with no effect of conditioning or Stroop (p = .02). CONCLUSION Attention and CPM both modulate pain in healthy men. Attention-induced analgesia works in CPM non-responders. Results indicate that attention and CPM are not the same and that they do not demonstrate additive effects when applied in sequence. SIGNIFICANCE Pain sensitivity is reduced after an attention task in healthy men. The delayed effects from attention only have minor effects on Conditioned Pain Modulation (CPM), and results support that attention-driven analgesia works independently of CPM. Results indicate that individual strategies for pain inhibition exist and that an overlap between the mechanisms of CPM and selective attention is limited. Moreover, painful phasic stimuli may increase the number of healthy volunteers with negative CPM effects.
Collapse
Affiliation(s)
- Morten Hoegh
- Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Aalborg, Denmark
| | - David A Seminowicz
- Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Aalborg, Denmark.,Department of Neural and Pain Sciences, Center to Advance Chronic Pain Research, School of Dentistry, University of Maryland, Baltimore, MD, USA
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Aalborg, Denmark
| |
Collapse
|
47
|
Williams AE, Miller MM, Bartley EJ, McCabe KM, Kerr KL, Rhudy JL. Impairment of Inhibition of Trigeminal Nociception via Conditioned Pain Modulation in Persons with Migraine Headaches. PAIN MEDICINE (MALDEN, MASS.) 2019; 20:1600-1610. [PMID: 30690591 PMCID: PMC7963204 DOI: 10.1093/pm/pny305] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To assess conditioned pain modulation efficiency in persons with and without migraine headaches. DESIGN Cross-sectional assessment of experimental pain. SETTING University campus and surrounding community in a large Midwestern US city. SUBJECTS Twenty-three adults with and 32 without a history of migraine headaches participated in the study. Participants were mostly female (N = 40) with an average age of 23 years. METHODS Four electrocutaneous stimulations of the supraorbital branch of the left trigeminal nerve were delivered at 150% of an individually determined pain threshold. Conditioned pain modulation was assessed by applying a noxious counterstimulus (forearm ischemia) and delivering four more electrocutaneous stimulations. After each stimulation, pain and the nociceptive blink reflex were assessed. Depression and pain catastrophizing were assessed to control for the potential influence of these variables on pain modulation. RESULTS Participants with and without migraine headaches had similar baseline pain responsivity, without significant differences in pain report or nociceptive blink reflexes. Pain report was inhibited by conditioned pain modulation in both the migraine and control groups. However, unlike nonmigraine controls, participants with migraines did not exhibit an inhibition of nociceptive blink reflexes during the ischemia task. This pattern persisted after controlling for level of pain catastrophizing and depression. CONCLUSIONS Migraine sufferers exhibited impaired conditioned pain modulation of the nociceptive blink reflex, suggesting a deficiency in inhibition of trigeminal nociception, which may contribute to the development of migraine headaches.
Collapse
Affiliation(s)
- Amy E Williams
- Department of Psychiatry, Riley Child and Adolescent Psychiatry Clinic, Indiana University School of Medicine, Indiana University Health Physicians, Indianapolis, Indiana
| | - Megan M Miller
- Department of Psychology, Indiana University–Purdue University Indianapolis, Indianapolis, Indiana
| | - Emily J Bartley
- Department of Community Dentistry and Behavioral Science, Pain Research & Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Klanci M McCabe
- Section of Psychology, Division of Developmental and Behavioral Sciences, Children’s Mercy Kansas City, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Kara L Kerr
- Department of Human Development and Family Science, Oklahoma State University, Tulsa, Oklahoma
- Laureate Institute for Brain Research, Tulsa, Oklahoma
| | - Jamie L Rhudy
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma, USA
| |
Collapse
|
48
|
|
49
|
Goudman L, Huysmans E, Ickmans K, Nijs J, Moens M, Putman K, Buyl R, Louw A, Logghe T, Coppieters I. A Modern Pain Neuroscience Approach in Patients Undergoing Surgery for Lumbar Radiculopathy: A Clinical Perspective. Phys Ther 2019; 99:933-945. [PMID: 30921465 DOI: 10.1093/ptj/pzz053] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 09/16/2018] [Indexed: 12/11/2022]
Abstract
Around 20% of patients undergoing surgery for lumbar radiculopathy develop chronic pain after surgery, leading to high socioeconomic burden. Current perioperative interventions, including education and rehabilitation, are not always effective in preventing prolonged or chronic postoperative pain and disability. Here, a shift in educational intervention from a biomedical towards a biopsychosocial approach for people scheduled for lumbar surgery is proposed. Pain neuroscience education (PNE) is a biopsychosocial approach that aims to decrease the threat value of pain by reconceptualizing pain and increasing the patient's knowledge about pain. This paper provides a clinical perspective for the provision of perioperative PNE, specifically developed for patients undergoing surgery for lumbar radiculopathy. Besides the general goals of PNE, perioperative PNE aims to prepare the patient for postsurgical pain and how to cope with it.
Collapse
Affiliation(s)
- Lisa Goudman
- Pain in Motion International Research Group; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy (KIMA), Vrije Universiteit Brussel; and Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Eva Huysmans
- Pain in Motion International Research Group; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy (KIMA), Vrije Universiteit Brussel, Building F-KIMA, Laarbeeklaan 103, BE-1090 Brussels, Belgium; I-CHER, Interuniversity Center for Health Economics Research; Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel; and Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel
| | - Kelly Ickmans
- Pain in Motion International Research Group; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy (KIMA), Vrije Universiteit Brussel; and Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel
| | - Jo Nijs
- Pain in Motion International Research Group; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy (KIMA), Vrije Universiteit Brussel; and Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel; Center for Neurosciences, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel; and Department of Manual Therapy (MANU), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel
| | - Koen Putman
- Interuniversity Center for Health Economics Research, Vrije Universiteit Brussel and Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel
| | - Ronald Buyl
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel and Department of Biostatistics and Medical Informatics, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel
| | - Adriaan Louw
- International Spine and Pain Institute, Story City, Iowa
| | - Tine Logghe
- Department of Physical Medicine and Revalidation, Sint-Dimpna Ziekenhuis Geel, Geel, Belgium
| | - Iris Coppieters
- Pain in Motion International Research Group and Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy (KIMA), Vrije Universiteit Brussel, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University
| |
Collapse
|
50
|
Albu S, Meagher MW. Divergent effects of conditioned pain modulation on subjective pain and nociceptive-related brain activity. Exp Brain Res 2019; 237:1735-1744. [PMID: 31030281 DOI: 10.1007/s00221-019-05545-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 04/24/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Pain is a complex experience involving both nociceptive and affective-cognitive mechanisms. The present study evaluated whether modulation of pain perception, employing a conditioned pain modulation (CPM) paradigm, is paralleled by changes in contact heat-evoked potentials (CHEPs), a brain response to nociceptive stimuli. METHODS Participants were 25 healthy, pain-free, college students (12 males, 13 females, mean age 19.24 ± 0.97 years). Twenty computer-controlled heat stimuli were delivered to the non-dominant forearm and CHEPs were recorded at Cz using a 32-channel EEG system. After each stimulus, participants rated the intensity of the heat pain using the 0-100 numerical rating scale. The latency and amplitude of N2, P2 components as well as single-sweep spectral analysis of individual CHEPs were measured offline. For CPM, participants had to submerge their dominant foot into a neutral (32 °C) or noxious (0 °C) water bath. CHEPs and heat pain ratings were recorded in 3 different conditions: without CPM, after neutral CPM (32 °C) and after noxious CPM (0 °C). RESULTS The noxious CPM induced a facilitatory pain response (p = 0.001) with an increase in heat pain following noxious CPM compared to neutral CPM (p = 0.001) and no CPM (p = 0.001). Changes in CHEPs did not differ between conditions when measured as N2-P2 peak-to-peak amplitude (p = 0.33) but the CPM significantly suppressed the CHEPs-related delta power (p = 0.03). Changes in heat pain in the noxious CPM were predicted by trait catastrophizing variables (p = 0.04). CONCLUSION The current study revealed that pain facilitatory CPM is related to suppression of CHEPs delta power which could be related to dissociation between brain responses to noxious heat and pain perception.
Collapse
Affiliation(s)
- Sergiu Albu
- Institute Guttmann, Neurorehabilitation Hospital, Camí Can Ruti s/n, Badalona, 08916, Barcelona, Spain.
| | - Mary W Meagher
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, 77843, USA
| |
Collapse
|