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Cosentino G, Antoniazzi E, Cavigioli C, Tang V, Tammam G, Zaffina C, Tassorelli C, Todisco M. Repetitive Transcranial Magnetic Stimulation of the Human Motor Cortex Modulates Processing of Heat Pain Sensation as Assessed by the Offset Analgesia Paradigm. J Clin Med 2023; 12:7066. [PMID: 38002678 PMCID: PMC10672427 DOI: 10.3390/jcm12227066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/26/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Offset analgesia (OA), which is defined as a disproportionately large reduction in pain perception following a small decrease in a heat stimulus, quantifies temporal aspects of endogenous pain modulation. In this study on healthy subjects, we aimed to (i) determine the Heat Pain Threshold (HPT) and the response to constant and dynamic heat stimuli assessing sensitization, adaptation and OA phenomena at the thenar eminence; (ii) evaluate the effects of high-frequency repetitive Transcranial Magnetic Stimulation (rTMS) of the primary motor cortex (M1) on these measures. Twenty-four healthy subjects underwent quantitative sensory testing before and after active or sham 10 Hz rTMS (1200 stimuli) of the left M1, during separate sessions. We did not observe any rTMS-related changes in the HPT or visual analogue scale (VAS) values recorded during the constant trial. Of note, at baseline, we did not find OA at the thenar eminence. Only after active rTMS did we detect significantly reduced VAS values during dynamic heat stimuli, indicating a delayed and attenuated OA phenomenon. rTMS of the left M1 may activate remote brain areas that belong to the descending pain modulatory and reward systems involved in the OA phenomenon. Our findings provide insights into the mechanisms by which rTMS of M1 could exert its analgesic effects.
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Affiliation(s)
- Giuseppe Cosentino
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Elisa Antoniazzi
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Camilla Cavigioli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Vanessa Tang
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Giulia Tammam
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Chiara Zaffina
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Massimiliano Todisco
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy
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Szikszay TM, Adamczyk WM, Panskus J, Heimes L, David C, Gouverneur P, Luedtke K. Psychological mechanisms of offset analgesia: The effect of expectancy manipulation. PLoS One 2023; 18:e0280579. [PMID: 36649306 PMCID: PMC9844857 DOI: 10.1371/journal.pone.0280579] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023] Open
Abstract
A frequently used paradigm to quantify endogenous pain modulation is offset analgesia, which is defined as a disproportionate large reduction in pain following a small decrease in a heat stimulus. The aim of this study was to determine whether suggestion influences the magnitude of offset analgesia in healthy participants. A total of 97 participants were randomized into three groups (hypoalgesic group, hyperalgesic group, control group). All participants received four heat stimuli (two constant trials and two offset trials) to the ventral, non-dominant forearm while they were asked to rate their perceived pain using a computerized visual analogue scale. In addition, electrodermal activity was measured during each heat stimulus. Participants in both intervention groups were given a visual and verbal suggestion about the expected pain response in an hypoalgesic and hyperalgesic manner. The control group received no suggestion. In all groups, significant offset analgesia was provoked, indicated by reduced pain ratings (p < 0.001) and enhanced electrodermal activity level (p < 0.01). A significant group difference in the magnitude of offset analgesia was found between the three groups (F[2,94] = 4.81, p < 0.05). Participants in the hyperalgesic group perceived significantly more pain than the hypoalgesic group (p = 0.031) and the control group (p < 0.05). However, the electrodermal activity data did not replicate this trend (p > 0.05). The results of this study indicate that suggestion can be effective to reduce but not increase endogenous pain modulation quantified by offset analgesia in healthy participants.
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Affiliation(s)
- Tibor M Szikszay
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universität zu Lübeck, Luebeck, Germany
| | - Waclaw M Adamczyk
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universität zu Lübeck, Luebeck, Germany.,Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Janina Panskus
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universität zu Lübeck, Luebeck, Germany
| | - Lotte Heimes
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universität zu Lübeck, Luebeck, Germany
| | - Carolin David
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universität zu Lübeck, Luebeck, Germany
| | - Philip Gouverneur
- Institute of Medical Informatics, University of Luebeck, Luebeck, Germany
| | - Kerstin Luedtke
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Universität zu Lübeck, Luebeck, Germany
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Li T, Zhang S, Ikeda E, Kobinata H. Functional connectivity modulations during offset analgesia in chronic pain patients: an fMRI study. Brain Imaging Behav 2022; 16:1794-1802. [PMID: 35314949 DOI: 10.1007/s11682-022-00652-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 11/02/2022]
Abstract
Patients with neuropathic pain and fibromyalgia showed reduced or absent offset analgesia (OA) response and attenuated cerebral activity in descending pain modulatory and reward systems in patients. However, neural network modifications of OA in chronic pain have not been determined. We enrolled 23 patients with various chronic pain and 17 age- and gender- matched healthy controls. All participants were given OA-related noxious thermal stimuli, including 3 repeats of offset analgesia paradigm at 46-47-46 °C and constant paradigm at 46 °C on the left volar forearm under whole-brain functional magnitude resonance imaging (fMRI). We evaluated magnitude of OA, examined OA modulated functional connectivity using psychophysiological interaction analysis and resting-state functional connectivity analysis and explored their behavioral correlations in patients compared with controls.Compared to controls, chronic pain patients showed smaller magnitude of OA (P = 0.047). OA modulated connectivity decreased between posterior cingulate cortex (PCC) and right medial prefrontal cortex (MPFC) in proportion to current chronic pain (P = 0.018); decreased between right pallidum and right thalamus, and increased between right caudate nucleus and left primary somatosensory cortex (P FDR < 0.05).The impaired PCC-MPFC connectivity might play an important role in dysfunction of OA and contribute to pain chronification.
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Affiliation(s)
- Tianjiao Li
- Department of Anesthesiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Shuo Zhang
- Department of Anesthesiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eri Ikeda
- Department of Anesthesiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroyuki Kobinata
- Department of Anesthesiology, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
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Larsen DB, Uth XJ, Arendt-Nielsen L, Petersen KK. Modulation of offset analgesia in patients with chronic pain and healthy subjects - a systematic review and meta-analysis. Scand J Pain 2022; 22:14-25. [PMID: 34644466 DOI: 10.1515/sjpain-2021-0137] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/21/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Offset analgesia (OA) induces a brief pain inhibition and studies suggest OA impairment in patients with chronic pain when compared to healthy subjects. Conditioned pain modulation remains the most studied descending pain inhibitory control mechanism and is modulated by centrally-acting analgesics. Since OA may be mediated by similar neural substrates as conditioned pain modulation, understanding if OA is a peripheral or central proxy of pain modulation is important. The modulatory effect of centrally-acting drugs on OA in healthy and chronic pain populations has not yet been systematically reviewed and meta-analyzed, and this systematic review and meta-analysis aimed to identify studies employing interventions for modulating OA magnitude. METHODS A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library yielded 146 records of which 11 (172 healthy pain-free subjects, 106 chronic pain patients) were eligible for qualitative synthesis, and 10 for meta-analysis on overall modulatory effect of interventions on OA, and subgroup analysis of patients and healthy pain-free subjects. RESULTS Risk of bias was evident for study participation and study confounding in the included studies. Several different methods for assessing and calculating OA magnitude were identified, which may affect interpretability of findings and warrants standardization. The meta-analysis showed no modulatory effects on OA overall (standardized mean difference (SMD) [95%CI]: 0.04 [-0.22, 0.30], Z=0.29, p=0.77), or in the subgroup analysis for patients (SMD [95%CI]: -0.04 [-0.63, 0.71], Z=0.13, p=0.90) or healthy pain-free subjects (SMD [95%CI]: 0.01 [-0.21, 0.24], Z=0.11, p=0.91). Moderate to substantial heterogeneity was found for the overall analysis (I2=47%, p=0.03) and patient subgroup analysis (I2=75%, p=0.003). CONCLUSIONS The current systematic review and meta-analysis conclude that centrally-acting drugs and exercise do not influence OA. Evidence on the peripheral contribution to OA response requires further investigations. Preclinical models of OA should be established to identify the neurophysiology and -biology behind OA.
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Affiliation(s)
- Dennis Boye Larsen
- Department of Health Science and Technology, Centre for Neuroplasticity and Pain, School of Medicine, Aalborg University, Aalborg, Denmark
| | - Xenia Jørgensen Uth
- Department of Health Science and Technology, Centre for Neuroplasticity and Pain, School of Medicine, Aalborg University, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Centre for Neuroplasticity and Pain, School of Medicine, Aalborg University, Aalborg, Denmark
| | - Kristian Kjær Petersen
- Department of Health Science and Technology, Centre for Neuroplasticity and Pain, School of Medicine, Aalborg University, Aalborg, Denmark
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Alter BJ, Santosa H, Nguyen QH, Huppert TJ, Wasan AD. Offset analgesia is associated with opposing modulation of medial versus dorsolateral prefrontal cortex activations: A functional near-infrared spectroscopy study. Mol Pain 2022; 18:17448069221074991. [PMID: 35083928 PMCID: PMC9047820 DOI: 10.1177/17448069221074991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/20/2021] [Accepted: 12/29/2021] [Indexed: 12/02/2022] Open
Abstract
Offset analgesia is defined by a dramatic drop in perceived pain intensity with a relatively small decrease in noxious input. Although functional magnetic resonance imaging studies implicate subcortical descending inhibitory circuits during offset analgesia, the role of cortical areas remains unclear. The current study identifies cortical correlates of offset analgesia using functional near infrared spectroscopy (fNIRS). Twenty-four healthy volunteers underwent fNIRS scanning during offset (OS) and control (Con) heat stimuli applied to the forearm. After controlling for non-neural hemodynamic responses in superficial tissues, widespread increases in cortical oxygenated hemoglobin concentration were observed, reflecting cortical activation during heat pain. OS-Con contrasts revealed deactivations in bilateral medial prefrontal cortex (mPFC) and bilateral somatosensory cortex (SSC) associated with offset analgesia. Right dorsolateral prefrontal cortex (dlPFC) showed activation only during OS. These data demonstrate opposing cortical activation patterns during offset analgesia and support a model in which right dlPFC underlies ongoing evaluation of pain intensity change. With predictions of decreasing pain intensity, right dlPFC activation likely inhibits ascending noxious input via subcortical pathways resulting in SSC and mPFC deactivation. This study identifies cortical circuitry underlying offset analgesia and introduces the use of fNIRS to study pain modulation in an outpatient clinical environment.
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Affiliation(s)
- Benedict J. Alter
- Department of Anesthesiology and
Perioperative Medicine, University of
Pittsburgh, Pittsburgh, PA, USA
| | - Hendrik Santosa
- Department of Radiology, University of
Pittsburgh, Pittsburgh, PA, USA
| | - Quynh H. Nguyen
- Department of Anesthesiology and
Perioperative Medicine, University of
Pittsburgh, Pittsburgh, PA, USA
| | - Theodore J. Huppert
- Department of Electrical and
Computer Engineering, University of
Pittsburgh, Pittsburgh, PA, USA
| | - Ajay D. Wasan
- Department of Anesthesiology and
Perioperative Medicine, University of
Pittsburgh, Pittsburgh, PA, USA
- Department of Psychiatry, University of
Pittsburgh, Pittsburgh, PA, USA
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Meeker TJ, Schmid AC, Liu Y, Keaser ML, Dorsey SG, Seminowicz DA, Greenspan JD. During capsaicin-induced central sensitization, brush allodynia is associated with baseline warmth sensitivity, whereas mechanical hyperalgesia is associated with painful mechanical sensibility, anxiety and somatization. Eur J Pain 2021; 25:1971-1993. [PMID: 34051016 DOI: 10.1002/ejp.1815] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 05/23/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Mechanical hyperalgesia and allodynia incidence varies considerably amongst neuropathic pain patients. This study explored whether sensory or psychological factors associate with mechanical hyperalgesia and brush allodynia in a human experimental model. METHODS Sixty-six healthy volunteers (29 male) completed psychological questionnaires and participated in two quantitative sensory testing (QST) sessions. Warmth detection threshold (WDT), heat pain threshold (HPT) and suprathreshold mechanical pain (STMP) ratings were measured before exposure to a capsaicin-heat pain model (C-HP). After C-HP exposure, brush allodynia and STMP were measured in one session, whilst mechanical hyperalgesia was measured in another session. RESULTS WDT and HPT measured in sessions separated by 1 month demonstrated significant but moderate levels of reliability (WDT: ICC = 0.5, 95%CI [0.28, 0.77]; HPT: ICC = 0.62, 95%CI [0.40, 0.77]). Brush allodynia associated with lower WDT (z = -3.06, p = 0.002; ϕ = 0.27). Those with allodynia showed greater hyperalgesia intensity (F = 7.044, p = 0.010, ηp 2 = 0.107) and area (F = 9.319, p = 0.004, ηp 2 = 0.163) than those without allodynia. No psychological self-report measures were significantly different between allodynic and nonallodynic groups. Intensity of hyperalgesia in response to lighter mechanical stimuli was associated with lower HPT, higher STMP ratings and higher Pain Sensitivity Questionnaire scores at baseline. Hyperalgesia to heavier probe stimuli associated with state anxiety and to a lesser extent somatic awareness. Hyperalgesic area associated with lower baseline HPT and higher STMP ratings. Hyperalgesic area was not correlated with allodynic area across individuals. CONCLUSIONS These findings support research in neuropathic pain patients and human experimental models that peripheral sensory input and individual sensibility are related to development of mechanical allodynia and hyperalgesia during central sensitization, whilst psychological factors play a lesser role. SIGNIFICANCE We evaluated differential relationships of psychological and perceptual sensitivity to the development of capsaicin-induced mechanical allodynia and hyperalgesia. Fifty percent of healthy volunteers failed to develop mechanical allodynia. Baseline pain sensitivity was greater in those developing allodynia and was related to the magnitude and area of hyperalgesia. State psychological factors, whilst unrelated to allodynia, were related to mechanical hyperalgesia. This supports that the intensity of peripheral sensory input and individual sensibility are related to development of mechanical allodynia and hyperalgesia during central sensitization, whilst psychological factors play a lesser role.
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Affiliation(s)
- Timothy J Meeker
- Department of Neural and Pain Sciences, School of Dentistry and Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - Anne-Christine Schmid
- Department of Neural and Pain Sciences, School of Dentistry and Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Clinical Neuroengineering, BrainMind Institute and Centre of Neuroprosthetics (CNP), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland.,Swiss Federal Institute of Technology Valais (EPFL Valais), Sion, Switzerland.,WyssCenter of Bio and Neuroengineering, Geneva, Switzerland
| | - Yiming Liu
- Department of Neural and Pain Sciences, School of Dentistry and Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA.,Department of Pain Medicine, Peking University People's Hospital, Beijing, China
| | - Michael L Keaser
- Department of Neural and Pain Sciences, School of Dentistry and Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA
| | - Susan G Dorsey
- Department of Pain and Translational Symptom Science, School of Nursing and Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA
| | - David A Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry and Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA
| | - Joel D Greenspan
- Department of Neural and Pain Sciences, School of Dentistry and Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA
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Szikszay TM, Adamczyk WM, Hoegner A, Woermann N, Luedtke K. The effect of acute-experimental pain models on offset analgesia. Eur J Pain 2021; 25:1150-1161. [PMID: 33533139 DOI: 10.1002/ejp.1740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Offset analgesia (OA) is characterized by a disproportionately large decrease in pain perception after a slight decrease in noxious stimulation. In patients with ongoing pain, this response is reduced. The effect is pronounced in painful body areas. The influence of acute pain has not been sufficiently investigated. The aim of this study was to investigate the influence of two experimental acute pain models, measured within the area of acute pain and on the non-affected opposite side, thereby considering the possible somatotopic nature of OA. METHODS Healthy, pain-free volunteers (n = 75) were randomly assigned to one of three groups (cold water, exercise and control group). The 'cold water group' immersed one hand into cold water for 3 min (Cold Pressor Task), while the 'exercise group' performed an isometric grip exercise for 3 min. There was no manipulation in the control group. Each experimental pain stimulus was performed at both (dominant, non-dominant) forearms. The individualized OA paradigm consisted of offset and constant temperature trials. Offset analgesia was measured immediately before, during and after the experimental pain stimuli. RESULTS A significant difference in OA was shown during experimental pain when compared to the control condition (exercise vs. control: p < 0.001, cold vs. control: p = 0.001), with no difference between the experimental conditions (p > 0.05). Immediately following the pain stimulation, results were marginally non-significant (p = 0.05). CONCLUSIONS Experimental painful stimulation reduced OA. This result should be interpreted with caution due to potential influences of conditioned pain modulation or exercise-induced hypoalgesia as well as possible floor effects. SIGNIFICANCE Temporal contrast of pain perception is inhibited in acute pain states. This study showed that reduced offset analgesia is observed when pain is experimentally induced using noxious cold and exercise stimuli.
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Affiliation(s)
- Tibor M Szikszay
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P. E. R. L.), Institute of Health Sciences, University of Luebeck, Luebeck, Germany.,Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Waclaw M Adamczyk
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P. E. R. L.), Institute of Health Sciences, University of Luebeck, Luebeck, Germany.,Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Alexandra Hoegner
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P. E. R. L.), Institute of Health Sciences, University of Luebeck, Luebeck, Germany
| | - Nele Woermann
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P. E. R. L.), Institute of Health Sciences, University of Luebeck, Luebeck, Germany
| | - Kerstin Luedtke
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P. E. R. L.), Institute of Health Sciences, University of Luebeck, Luebeck, Germany.,Laboratory of Pain Research, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
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8
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Alter BJ, Aung MS, Strigo IA, Fields HL. Onset hyperalgesia and offset analgesia: Transient increases or decreases of noxious thermal stimulus intensity robustly modulate subsequent perceived pain intensity. PLoS One 2020; 15:e0231124. [PMID: 33290407 PMCID: PMC7723268 DOI: 10.1371/journal.pone.0231124] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 11/06/2020] [Indexed: 12/17/2022] Open
Abstract
Reported pain intensity depends not only on stimulus intensity but also on previously experienced pain. A painfully hot temperature applied to the skin evokes a lower subjective pain intensity if immediately preceded by a higher temperature, a phenomenon called offset analgesia. Previous work indicated that prior pain experience can also increase subsequent perceived pain intensity. Therefore, we examined whether a given noxious stimulus is experienced as more intense when it is preceded by an increase from a lower temperature. Using healthy volunteer subjects, we observed a disproportionate increase in pain intensity at a given stimulus intensity when this intensity is preceded by a rise from a lower intensity. This disproportionate increase is similar in magnitude to that of offset analgesia. We call this effect onset hyperalgesia. Control stimuli, in which a noxious temperature is held constant, demonstrate that onset hyperalgesia is distinct from receptor or central sensitization. The absolute magnitudes of offset analgesia and onset hyperalgesia correlate with each other but not with the noxious stimulus temperature. Finally, the magnitude of both offset analgesia and onset hyperalgesia depends on preceding temperature changes. Overall, this study demonstrates that the perceptual effect of a noxious thermal stimulus is influenced in a bidirectional manner depending upon both the intensity and direction of change of the immediately preceding thermal stimulus.
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Affiliation(s)
- Benedict J. Alter
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, United States of America
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
| | - Mya Sandi Aung
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, United States of America
| | - Irina A. Strigo
- San Francisco VA Health Care System & Department of Psychiatry, University of California San Francisco, San Francisco, California, United States of America
| | - Howard L. Fields
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
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9
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Pain inhibition is not affected by exercise-induced pain. Pain Rep 2020; 5:e817. [PMID: 32440610 PMCID: PMC7209813 DOI: 10.1097/pr9.0000000000000817] [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: 09/03/2019] [Revised: 11/06/2019] [Accepted: 12/02/2019] [Indexed: 01/03/2023] Open
Abstract
Introduction: Offset analgesia (OA) and conditioned pain modulation (CPM) are frequently used paradigms to assess the descending pain modulation system. Recently, it was shown that both paradigms are reduced in chronic pain, but the influence of acute pain has not yet been adequately examined. Objectives: The aim of this study is to investigate OA and CPM after exercise-induced pain to evaluate whether these tests can be influenced by delayed-onset muscle soreness (DOMS) at a local or remote body site. Methods: Forty-two healthy adults were invited to 3 separate examination days: a baseline appointment, the consecutive day, and 7 days later. Participants were randomly divided into a rest (n = 21) and an exercise group (n = 21). The latter performed a single intensive exercise for the lower back. Before, immediately after, and on the following examination days, OA and CPM were measured at the forearm and the lower back by blinded assessor. Results: The exercise provoked a moderate pain perception and a mild delayed-onset muscle soreness on the following day. Repeated-measurements analysis of variance showed no statistically significant main effect for either OA or CPM at the forearm or lower back (P > 0.05). Conclusion: Delayed-onset muscle soreness was shown to have no effect on the inhibitory pain modulation system neither locally (at the painful body part), nor remotely. Thus, OA and CPM are robust test paradigms that probably require more intense, different, or prolonged pain to be modulated.
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10
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11
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Derbyshire SWG, Long VJE, Asplund CL. Stepwise increasing sequential offsets cannot be used to deliver high thermal intensities with little or no perception of pain. J Neurophysiol 2019; 122:729-736. [PMID: 31242398 DOI: 10.1152/jn.00007.2019] [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: 11/22/2022] Open
Abstract
Offset analgesia (OA) is the disproportionate decrease in pain experience following a slight decrease in noxious heat stimulus intensity. We tested whether sequential offsets would allow noxious temperatures to be reached with little or no perception of pain. Forty-eight participants continuously rated their pain experience during trials containing trains of heat stimuli delivered by Peltier thermode. Stimuli were adjusted through either stepwise sequential increases of 2°C and decreases of 1°C or direct step increases of 1°C up to a maximum of 46°C. Step durations (1, 2, 3, or 6 s) varied by trial. Pain ratings generally followed presented temperature, regardless of step condition or duration. For 6-s steps, OA was observed after each decrease, but the overall pain trajectory was unchanged. We found no evidence that sequential offsets could allow for little pain perception during noxious temperature presentation.NEW & NOTEWORTHY Offset analgesia is the disproportionate decrease in pain experience following a slight decrease in noxious heat stimulus intensity. We tested whether sequential offsets would allow noxious temperatures to be reached with little or no perception of pain. We found little evidence of such overall analgesia. In contrast, we observed analgesic effects after each offset with long-duration stimuli, even with relatively low-temperature noxious stimuli.
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Affiliation(s)
- Stuart W G Derbyshire
- Department of Psychology, National University of Singapore, Singapore.,Clinical Imaging Research Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Victoria Jane En Long
- Division of Social Sciences, Yale-NUS College, National University of Singapore, Singapore
| | - Christopher L Asplund
- Department of Psychology, National University of Singapore, Singapore.,Clinical Imaging Research Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Social Sciences, Yale-NUS College, National University of Singapore, Singapore.,N.1 Institute for Health, National University of Singapore, Singapore
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12
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Moana‐Filho EJ, Herrero Babiloni A, Nisley A. Endogenous pain modulation assessed with offset analgesia is not impaired in chronic temporomandibular disorder pain patients. J Oral Rehabil 2019; 46:1009-1022. [DOI: 10.1111/joor.12832] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 04/29/2019] [Accepted: 06/09/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Estephan Jose Moana‐Filho
- Division of TMD and Orofacial Pain, School of Dentistry University of Minnesota Minneapolis Minnesota USA
| | - Alberto Herrero Babiloni
- Division of TMD and Orofacial Pain, School of Dentistry University of Minnesota Minneapolis Minnesota USA
| | - Aaron Nisley
- Division of TMD and Orofacial Pain, School of Dentistry University of Minnesota Minneapolis Minnesota USA
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Beck B, Gnanasampanthan S, Iannetti GD, Haggard P. No temporal contrast enhancement of simple decreases in noxious heat. J Neurophysiol 2019; 121:1778-1786. [PMID: 30840535 PMCID: PMC6589718 DOI: 10.1152/jn.00335.2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Offset analgesia (OA) studies have found that small decreases in the intensity of a tonic noxious heat stimulus yield a disproportionately large amount of pain relief. In the classic OA paradigm, the decrease in stimulus intensity is preceded by an increase of equal size from an initial noxious level. Although the majority of researchers believe this temporal sequence of two changes is important for eliciting OA, it has also been suggested that the temporal contrast mechanism underlying OA may enhance detection of simple, isolated decreases in noxious heat. To test whether decreases in noxious heat intensity, by themselves, are perceived better than increases of comparable sizes, we used an adaptive two-interval alternative forced choice task to find perceptual thresholds for increases and decreases in radiant and contact heat. Decreases in noxious heat were more difficult to perceive than increases of comparable sizes from the same initial temperature of 45°C. In contrast, decreases and increases were perceived equally well within a common range of noxious temperatures (i.e., when increases started from 45°C and decreases started from 47°C). In another task, participants rated the pain intensity of heat stimuli that randomly and unpredictably increased, decreased, or remained constant. Ratings of unpredictable stimulus decreases also showed no evidence of perceptual enhancement. Our results demonstrate that there is no temporal contrast enhancement of simple, isolated decreases in noxious heat intensity. Combined with previous OA findings, they suggest that long-lasting noxious stimuli that follow an increase-decrease pattern may be important for eliciting the OA effect. NEW & NOTEWORTHY Previous research suggested that a small decrease in noxious heat intensity feels surprisingly large because of sensory enhancement of noxious stimulus offsets (a simplified form of “offset analgesia”). Using a two-alternative forced choice task where participants detected simple increases or decreases in noxious heat, we showed that decreases in noxious heat, by themselves, are no better perceived than increases of comparable sizes. This suggests that a decrease alone is not sufficient to elicit offset analgesia.
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Affiliation(s)
- Brianna Beck
- Institute of Cognitive Neuroscience, University College London , London , United Kingdom
| | | | - Gian Domenico Iannetti
- Department of Neuroscience, Physiology and Pharmacology, University College London , London , United Kingdom
| | - Patrick Haggard
- Institute of Cognitive Neuroscience, University College London , London , United Kingdom
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14
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Abstract
Chronic pain may alter both affect- and value-related behaviors, which represents a potentially treatable aspect of chronic pain experience. Current understanding of how chronic pain influences the function of brain reward systems, however, is limited. Using a monetary incentive delay task and functional magnetic resonance imaging (fMRI), we measured neural correlates of reward anticipation and outcomes in female participants with the chronic pain condition of fibromyalgia (N = 17) and age-matched, pain-free, female controls (N = 15). We hypothesized that patients would demonstrate lower positive arousal, as well as altered reward anticipation and outcome activity within corticostriatal circuits implicated in reward processing. Patients demonstrated lower arousal ratings as compared with controls, but no group differences were observed for valence, positive arousal, or negative arousal ratings. Group fMRI analyses were conducted to determine predetermined region of interest, nucleus accumbens (NAcc) and medial prefrontal cortex (mPFC), responses to potential gains, potential losses, reward outcomes, and punishment outcomes. Compared with controls, patients demonstrated similar, although slightly reduced, NAcc activity during gain anticipation. Conversely, patients demonstrated dramatically reduced mPFC activity during gain anticipation-possibly related to lower estimated reward probabilities. Further, patients demonstrated normal mPFC activity to reward outcomes, but dramatically heightened mPFC activity to no-loss (nonpunishment) outcomes. In parallel to NAcc and mPFC responses, patients demonstrated slightly reduced activity during reward anticipation in other brain regions, which included the ventral tegmental area, anterior cingulate cortex, and anterior insular cortex. Together, these results implicate altered corticostriatal processing of monetary rewards in chronic pain.
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15
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The Magnitude of Offset Analgesia as a Measure of Endogenous Pain Modulation in Healthy Participants and Patients With Chronic Pain. Clin J Pain 2019; 35:189-204. [DOI: 10.1097/ajp.0000000000000657] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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16
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Zhang S, Li T, Kobinata H, Ikeda E, Ota T, Kurata J. Attenuation of offset analgesia is associated with suppression of descending pain modulatory and reward systems in patients with chronic pain. Mol Pain 2018; 14:1744806918767512. [PMID: 29592786 PMCID: PMC5882045 DOI: 10.1177/1744806918767512] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Offset analgesia is a disproportionate decrease of pain perception following a slight decrease of noxious thermal stimulus and attenuated in patients with neuropathic pain. We examined offset analgesia in patients with heterogeneous chronic pain disorders and used functional magnetic resonance imaging to explore modification of cerebral analgesic responses in comparison with healthy controls. Results We recruited seventeen patients with chronic pain and seventeen age-, sex-matched healthy controls. We gave a noxious thermal stimulation paradigm including offset analgesia and control stimuli on the left volar forearm, while we obtained a real-time continuous pain rating and a whole-brain functional magnetic resonance imaging. Baseline, first plateau (5 s), increment (5 s), and second plateau (20 s) temperatures of offset analgesia stimulus were set at 32°C, 46°C, 47°C, and 46°C, respectively. Control stimulus included 30-s 46°C stimulus or only the first 10 s of offset analgesia stimulus. We evaluated magnitude of offset analgesia, analyzed cerebral activation by thermal stimulation, and further compared offset analgesia-related activation between the groups. Magnitude of offset analgesia was larger in controls than in patients (median: 28.9% (interquartile range: 11.0–56.0%) vs. 19.0% (4.2–48.7%), p = 0.047). During the second plateau, controls showed a larger blood oxygenation level-dependent activation than patients at the putamen, anterior cingulate, dorsolateral prefrontal cortices, nucleus accumbens, brainstem, and medial prefrontal cortex (p < 0.05), which are known to mediate either of descending pain modulation or reward responses. Offset analgesia-related activity at the anterior cingulate cortex was negatively correlated with neuropathic component of pain in patients with chronic pain (p = 0.004). Conclusions Attenuation of offset analgesia was associated with suppressed activation of the descending pain modulatory and reward systems in patients with chronic pain, at least in the studied cohort. The present findings might implicate both behavioral and cerebral plastic alterations contributing to chronification of pain. Clinical trial registry: The Japanese clinical trials registry (UMIN-CTR, No. UMIN000011253; http://www.umin.ac.jp/ctr/)
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Affiliation(s)
- Shuo Zhang
- 1 Department of Anesthesiology, 92190 Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences , Japan
| | - Tianjiao Li
- 1 Department of Anesthesiology, 92190 Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences , Japan
| | - Hiroyuki Kobinata
- 1 Department of Anesthesiology, 92190 Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences , Japan
| | - Eri Ikeda
- 1 Department of Anesthesiology, 92190 Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences , Japan
| | - Takashi Ota
- 1 Department of Anesthesiology, 92190 Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences , Japan
| | - Jiro Kurata
- 2 Department of Anesthesiology and Pain Clinic, 13100 Tokyo Medical and Dental University Hospital of Medicine, Japan
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17
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Sprenger C, Stenmans P, Tinnermann A, Büchel C. Evidence for a spinal involvement in temporal pain contrast enhancement. Neuroimage 2018; 183:788-799. [PMID: 30189340 DOI: 10.1016/j.neuroimage.2018.09.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 08/19/2018] [Accepted: 09/02/2018] [Indexed: 12/25/2022] Open
Abstract
Spatiotemporal filtering and amplification of sensory information at multiple levels during the generation of perceptual representations is a fundamental processing principle of the nervous system. While for the visual and auditory system temporal filtering of sensory signals has been noticed for a long time, respective contrast mechanisms within the nociceptive system became only recently subject of investigations, mainly in the context of offset analgesia (OA) subsequent to noxious stimulus decreases. In the present study we corroborate in a first experiment the assumption that offset analgesia involves a central component by showing that an OA-like effect accounting for 74% of a corresponding OA reference can be evoked by decomposing the stimulus offset into two separate box-car stimuli applied within the same dermatome but to separate populations of primary afferent neurons. In order to draw conclusions about the levels of the CNS at which temporal filtering of nociceptive information takes place during OA we investigate in a second experiment neuronal activity in the spinal cord during a painful thermal stimulus offset employing high-resolution fMRI in healthy volunteers. Pain-related BOLD responses in the spinal cord were significantly reduced during OA and their time course followed widely behavioral hypoalgesia, but not the thermal stimulation profile. In summary, the results suggest that temporal pain contrast enhancement during OA comprises a central mechanism and this mechanism becomes already effective at the level of the spinal cord.
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Affiliation(s)
- Christian Sprenger
- Department of Systems Neuroscience, University-Medical-Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Philip Stenmans
- Department of Systems Neuroscience, University-Medical-Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Alexandra Tinnermann
- Department of Systems Neuroscience, University-Medical-Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Christian Büchel
- Department of Systems Neuroscience, University-Medical-Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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18
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Olesen AE, Nissen TD, Nilsson M, Lelic D, Brock C, Christrup LL, Drewes AM. Offset Analgesia and The Impact of Treatment with Oxycodone and Venlafaxine: A Placebo-Controlled, Randomized Trial in Healthy Volunteers. Basic Clin Pharmacol Toxicol 2018; 123:727-731. [DOI: 10.1111/bcpt.13078] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/20/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Anne E. Olesen
- Mech-Sense; Department of Gastroenterology & Hepatology; Aalborg University Hospital; Aalborg Denmark
- Department of Clinical Medicine; Aalborg University; Aalborg Denmark
- Department of Drug Design and Pharmacology; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Thomas D. Nissen
- Mech-Sense; Department of Gastroenterology & Hepatology; Aalborg University Hospital; Aalborg Denmark
| | - Matias Nilsson
- Mech-Sense; Department of Gastroenterology & Hepatology; Aalborg University Hospital; Aalborg Denmark
| | - Dina Lelic
- Mech-Sense; Department of Gastroenterology & Hepatology; Aalborg University Hospital; Aalborg Denmark
| | - Christina Brock
- Mech-Sense; Department of Gastroenterology & Hepatology; Aalborg University Hospital; Aalborg Denmark
- Department of Clinical Medicine; Aalborg University; Aalborg Denmark
- Department of Drug Design and Pharmacology; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Lona L. Christrup
- Department of Drug Design and Pharmacology; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Asbjørn M. Drewes
- Mech-Sense; Department of Gastroenterology & Hepatology; Aalborg University Hospital; Aalborg Denmark
- Department of Clinical Medicine; Aalborg University; Aalborg Denmark
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19
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Petersen K, Mørch C, Ligato D, Arendt-Nielsen L. Electrical stimulation for evoking offset analgesia: A human volunteer methodological study. Eur J Pain 2018; 22:1678-1684. [DOI: 10.1002/ejp.1250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2018] [Indexed: 11/05/2022]
Affiliation(s)
- K.K. Petersen
- SMI; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Denmark
| | - C.D. Mørch
- SMI; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Denmark
| | - D. Ligato
- SMI; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Denmark
| | - L. Arendt-Nielsen
- SMI; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Denmark
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20
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Abstract
Offset analgesia (OA) represents a disproportionately large decrease of pain perception after a brief, temporary increment of thermal pain stimulus and was reported attenuated in patients with neuropathic pain. We examined whether OA depends on the increment duration before offset, and whether individual features of OA distinguish patients with chronic pain and healthy controls. We used a Peltier-type thermal stimulator and OA paradigms including 5-, 10-, or 15-s duration of 1°C-increment (T2) over 45°C. We first examined OA response, on the left volar forearm, at 3 different T2's in 40 healthy volunteers, and OA and constant stimulus responses in 12 patients with chronic pain and 12 matched healthy controls. We measured magnitude of OA ([INCREMENT]OA) and maximum visual analogue scale (VAS) latency (time to peak VAS) during constant stimulus for each individual. Pain perception kinetics were compared with analysis of variance and sought for correlations with psychophysical parameters with a significance threshold at P < 0.05. In healthy controls, longer T2 at 10 or 15 seconds resulted in larger [INCREMENT]OA compared with T2 at 5 seconds (P = 0.04). In patients, [INCREMENT]OA was significantly smaller than controls at T2 = 5 or 10 seconds (P < 0.05) but grew comparable at T2 = 15 seconds with controls. Maximum VAS latency was longer in patients than in controls and negatively correlated with [INCREMENT]OA in patients. An OA index ([INCREMENT]OA/[maximum VAS latency]) proved diagnostic of chronic pain with an area under the receiver operating characteristic curve at 0.897. Patients with chronic pain showed impairment of OA and reduced temporal sharpening of pain perception, which might imply possible disturbance of the endogenous pain modulatory system.
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21
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Harris S, Sterling M, Farrell SF, Pedler A, Smith AD. The influence of isometric exercise on endogenous pain modulation: comparing exercise-induced hypoalgesia and offset analgesia in young, active adults. Scand J Pain 2018; 18:513-523. [DOI: 10.1515/sjpain-2017-0177] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/06/2018] [Indexed: 12/28/2022]
Abstract
Abstract
Background and aims
Impairment of endogenous analgesia has been associated with the development, maintenance and persistence of pain. Endogenous analgesia can be evaluated using exercise-induced hypoalgesia (EIH) and offset analgesia (OffA) paradigms, which measure temporal filtering of sensory information. It is not clear if these paradigms are underpinned by common mechanisms, as EIH and OffA have not previously been directly compared. A further understanding of the processes responsible for these clinically relevant phenomena may have future diagnostic and therapeutic utility in management of individuals with persistent pain conditions. The primary aim of this study was to investigate if there is a correlation between the magnitudes of EIH and OffA. The secondary aim of the study was to examine whether exercise influences OffA.
Methods
Thirty-six healthy, pain-free participants were recruited. EIH was evaluated using pressure pain thresholds (PPT) and pain ratings to suprathreshold pressure stimuli over tibialis anterior and the cervical spine. OffA evaluation utilised a three-step protocol, whereby individualised heat pain thermal stimuli [Numerical Rating Scale (NRS)=50/100] were applied (T1), before increasing 1 °C (T2), followed by 1 °C reduction (T3). The magnitude of OffA was calculated as the percentage reduction in the NRS from T2 to T3. PPT/suprathreshold pain ratings and OffA measures were recorded, before and after 5 min of isometric quadriceps exercise performed at 20–25% maximum voluntary contraction (MVC); and following a 15 min rest period. Data were analysed using repeated measures (RM) ANCOVA and correlational analyses.
Results
There was no correlation between EIH measures (PPTs or pain ratings to suprathreshold pressure stimuli over tibialis anterior or the cervical spine) and OffA (p>0.11 for all). OffA was induced and not modulated by exercise (p=0.28).
Conclusions
Five minutes of 20–25% MVC lower limb isometric exercise provided non-pharmacological pain modulation in young, active adults. Magnitude of EIH was not correlated with that of OffA, and exercise did not influence magnitude of OffA.
Implications
These results suggest that in young, pain-free individuals, separate testing of these two paradigms is required to comprehensively evaluate efficacy of endogenous analgesia. If these results are replicated in patient populations, alternative or complementary methods to exercise interventions may be required to modulate impaired OffA.
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Affiliation(s)
- Samuel Harris
- School of Allied Health Sciences , Griffith University , Gold Coast, QLD , Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMRC Centre for Research Excellence in Recovery Following Road Traffic Injuries , The University of Queensland , Brisbane , Australia
- Menzies Health Institute Queensland , Griffith University , Gold Coast , Australia
| | - Scott F. Farrell
- RECOVER Injury Research Centre, NHMRC Centre for Research Excellence in Recovery Following Road Traffic Injuries , The University of Queensland , Brisbane , Australia
- Menzies Health Institute Queensland , Griffith University , Gold Coast , Australia
| | - Ashley Pedler
- RECOVER Injury Research Centre, NHMRC Centre for Research Excellence in Recovery Following Road Traffic Injuries , The University of Queensland , Brisbane , Australia
| | - Ashley D. Smith
- School of Allied Health Sciences , Griffith University, 58 Parklands Dr , Southport, Gold Coast, QLD 4215 , Australia , Phone: +1 403 281 7264
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22
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Ligato D, Petersen K, Mørch C, Arendt-Nielsen L. Offset analgesia: The role of peripheral and central mechanisms. Eur J Pain 2018; 22:142-149. [DOI: 10.1002/ejp.1110] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- D. Ligato
- Center for Sensory-Motor Interaction (SMI); Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Denmark
| | - K.K. Petersen
- Center for Sensory-Motor Interaction (SMI); Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Denmark
| | - C.D. Mørch
- Center for Sensory-Motor Interaction (SMI); Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Denmark
| | - L. Arendt-Nielsen
- Center for Sensory-Motor Interaction (SMI); Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Denmark
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23
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Van Den Houte M, Van Oudenhove L, Bogaerts K, Van Diest I, Van den Bergh O. Endogenous Pain Modulation: Association with Resting Heart Rate Variability and Negative Affectivity. PAIN MEDICINE 2017; 19:1587-1596. [DOI: 10.1093/pm/pnx165] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | - Lukas Van Oudenhove
- Translational Research Center for Gastrointestinal Disorders (TARGID), Faculty of Medicine, University of Leuven, Leuven, Belgium
| | - Katleen Bogaerts
- Health Psychology, Faculty of Psychology and Educational Sciences
| | - Ilse Van Diest
- Health Psychology, Faculty of Psychology and Educational Sciences
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24
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Abstract
Pain perception temporarily exaggerates abrupt thermal stimulus changes revealing a mechanism for nociceptive temporal contrast enhancement (TCE). Although the mechanism is unknown, a non-linear model with perceptual feedback accurately simulates the phenomenon. Here we test if a mechanism in the central nervous system underlies thermal TCE. Our model successfully predicted an optimal stimulus, incorporating a transient temperature offset (step-up/step-down), with maximal TCE, resulting in psychophysically verified large decrements in pain response ("offset-analgesia"; mean analgesia: 85%, n = 20 subjects). Next, this stimulus was delivered using two thermodes, one delivering the longer duration baseline temperature pulse and the other superimposing a short higher temperature pulse. The two stimuli were applied simultaneously either near or far on the same arm, or on opposite arms. Spatial separation across multiple peripheral receptive fields ensures the composite stimulus timecourse is first reconstituted in the central nervous system. Following ipsilateral stimulus cessation on the high temperature thermode, but before cessation of the low temperature stimulus properties of TCE were observed both for individual subjects and in group-mean responses. This demonstrates a central integration mechanism is sufficient to evoke painful thermal TCE, an essential step in transforming transient afferent nociceptive signals into a stable pain perception.
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25
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Taub CJ, Sturgeon JA, Johnson KA, Mackey SC, Darnall BD. Effects of a Pain Catastrophizing Induction on Sensory Testing in Women with Chronic Low Back Pain: A Pilot Study. Pain Res Manag 2017; 2017:7892494. [PMID: 28348505 PMCID: PMC5350337 DOI: 10.1155/2017/7892494] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/01/2017] [Indexed: 12/30/2022]
Abstract
Pain catastrophizing, a pattern of negative cognitive-emotional responses to actual or anticipated pain, maintains chronic pain and undermines response to treatments. Currently, precisely how pain catastrophizing influences pain processing is not well understood. In experimental settings, pain catastrophizing has been associated with amplified pain processing. This study sought to clarify pain processing mechanisms via experimental induction of pain catastrophizing. Forty women with chronic low back pain were assigned in blocks to an experimental condition, either a psychologist-led 10-minute pain catastrophizing induction or a control (10-minute rest period). All participants underwent a baseline round of several quantitative sensory testing (QST) tasks, followed by the pain catastrophizing induction or the rest period, and then a second round of the same QST tasks. The catastrophizing induction appeared to increase state pain catastrophizing levels. Changes in QST pain were detected for two of the QST tasks administered, weighted pin pain and mechanical allodynia. Although there is a need to replicate our preliminary results with a larger sample, study findings suggest a potential relationship between induced pain catastrophizing and central sensitization of pain. Clarification of the mechanisms through which catastrophizing affects pain modulatory systems may yield useful clinical insights into the treatment of chronic pain.
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Affiliation(s)
- Chloe J. Taub
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Stanford University School of Medicine, 1070 Arastradero, Suite 200, MC 5596, Palo Alto, CA 94304-1336, USA
| | - John A. Sturgeon
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Stanford University School of Medicine, 1070 Arastradero, Suite 200, MC 5596, Palo Alto, CA 94304-1336, USA
| | - Kevin A. Johnson
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Stanford University School of Medicine, 1070 Arastradero, Suite 200, MC 5596, Palo Alto, CA 94304-1336, USA
| | - Sean C. Mackey
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Stanford University School of Medicine, 1070 Arastradero, Suite 200, MC 5596, Palo Alto, CA 94304-1336, USA
| | - Beth D. Darnall
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Systems Neuroscience and Pain Laboratory, Stanford University School of Medicine, 1070 Arastradero, Suite 200, MC 5596, Palo Alto, CA 94304-1336, USA
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26
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Maracle EC, Hung LY, Fell SI, Osmond MR, Brown SHM, Srbely JZ. A Comparison of the Sensitivity of Brush Allodynia and Semmes-Weinstein Monofilament Testing in the Detection of Allodynia Within Regions of Secondary Hyperalgesia in Humans. Pain Pract 2016; 17:16-24. [PMID: 26936430 DOI: 10.1111/papr.12418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/22/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Two of the most common Quantitative Sensory Techniques (QST) employed to detect allodynia include mechanical brush allodynia and Semmes-Weinstein monofilaments. However, their relative sensitivity at detecting allodynia is poorly understood. The purpose of this study was to compare the sensitivity of brush allodynia against Semmes-Weinstein monofilament technique for detecting allodynia within regions of secondary hyperalgesia in humans. METHODS Twenty subjects (10 males, 10 females; 21.1 ± 0.9 years) were recruited and randomly allocated to allodynia or monofilament groups. Topical capsaicin (Zostrix 0.075%) was applied to a target region defined by C4-C7 dermatomes. Allodynia testing was performed at 0- (baseline) and 10 minutes postcapsaicin. The Semmes-Weinstein group assessed changes in skin sensitivity 8 cm inferior to target region and 2 cm lateral to the spinous process, while brush allodynia was employed to detect the point inferior to the target region where subjects reported changes in skin sensitivity. The distance (cm) from this point to the inferior border of the target region was termed the Allodynia Score. RESULTS Statistically significant increases in the Allodynia Score were observed at 10 minutes postcapsaicin compared to baseline (P < 0.001). No differences in monofilament scores were observed between 10 minutes postcapsaicin and baseline (P = 0.125). Brush allodynia also demonstrated superior sensitivity, detecting allodynia in 100% of cases compared to 60% in the Semmes-Weinstein group. CONCLUSION Brush allodynia is more sensitive than Semmes-Weinstein monofilaments for detecting mechanical allodynia in regions of secondary hyperalgesia. Brush allodynia may be preferred over Semmes-Weinstein monofilaments for clinical applications requiring reliable detection of allodynia.
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Affiliation(s)
- Emmalee C Maracle
- Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Laurie Y Hung
- Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Sabrina I Fell
- Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Michael R Osmond
- Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Stephen H M Brown
- Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - John Z Srbely
- Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
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27
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Arendt-Nielsen L, Skou ST, Nielsen TA, Petersen KK. Altered Central Sensitization and Pain Modulation in the CNS in Chronic Joint Pain. Curr Osteoporos Rep 2015; 13:225-34. [PMID: 26026770 DOI: 10.1007/s11914-015-0276-x] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Musculoskeletal pain disorders are the second largest contributor to global disability underlining the significance of effective treatments. However, treating chronic musculoskeletal pain, and chronic joint pain (osteoarthritis (OA)) in particular, is challenging as the underlying peripheral and central pain mechanisms are not fully understood, and safe and efficient analgesic drugs are not available. The pain associated with joint pain is highly individual, and features from radiological imaging have not demonstrated robust associations with the pain manifestations. In recent years, a variety of human quantitative pain assessment tools (quantitative sensory testing (QST)) have been developed providing new opportunities for profiling patients and reaching a greater understanding of the mechanisms involved in chronic joint pain. As joint pain is a complex interaction between many different pain mechanisms, available tools are important for patent profiling and providing the basic knowledge for development of new drugs and for developing pain management regimes.
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Affiliation(s)
- Lars Arendt-Nielsen
- Center for Sensory-Motor Interaction (SMI), Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7D3, 9220, Aalborg E, Denmark,
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28
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Abstract
It is evident that chronic pain can modify the excitability of central nervous system which imposes a specific challenge for the management and for the development of new analgesics. The central manifestations can be difficult to quantify using standard clinical examination procedures, but quantitative sensory testing (QST) may help to quantify the degree and extend of the central reorganization and effect of pharmacological interventions. Furthermore, QST may help in optimizing the development programs for new drugs.Specific translational mechanistic QST tools have been developed to quantify different aspects of central sensitization in pain patients such as threshold ratios, provoked hyperalgesia/allodynia, temporal summation (wind-up like pain), after sensation, spatial summation, reflex receptive fields, descending pain modulation, offset analgesia, and referred pain areas. As most of the drug development programs in the area of pain management have not been very successful, the pharmaceutical industry has started to utilize the complementary knowledge obtained from QST profiling. Linking patients QST profile with drug efficacy profile may provide the fundamentals for developing individualized, targeted pain management programs in the future. Linking QST-assessed pain mechanisms with treatment outcome provides new valuable information in drug development and for optimizing the management regimes for chronic pain.
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Affiliation(s)
- Lars Arendt-Nielsen
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, School of Medicine, Aalborg University, Fredrik Bajers Vej 7-D3, 9220, Aalborg, Denmark,
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Nilsson M, Piasco A, Nissen T, Graversen C, Gazerani P, Lucas MF, Dahan A, Drewes A, Brock C. Reproducibility of psychophysics and electroencephalography during offset analgesia. Eur J Pain 2013; 18:824-34. [DOI: 10.1002/j.1532-2149.2013.00424.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2013] [Indexed: 12/29/2022]
Affiliation(s)
- M. Nilsson
- Mech-Sense; Department of Gastroenterology and Hepatology; Aalborg University Hospital; Denmark
- Center for Sensory-Motor Interactions (SMI); Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Denmark
| | | | - T.D. Nissen
- Mech-Sense; Department of Gastroenterology and Hepatology; Aalborg University Hospital; Denmark
| | - C. Graversen
- Mech-Sense; Department of Gastroenterology and Hepatology; Aalborg University Hospital; Denmark
- Mech-Sense; Department of Radiology; Aalborg University Hospital; Denmark
- Department of Neurorehabilitation Engineering; Bernstein Center for Computational Neuroscience; University Medical Center Göttingen, Georg-August University; Göttingen Germany
| | - P. Gazerani
- Center for Sensory-Motor Interactions (SMI); Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Denmark
| | | | - A. Dahan
- Department of Anaesthesiology; Leiden University Medical Center; The Netherlands
| | - A.M. Drewes
- Mech-Sense; Department of Gastroenterology and Hepatology; Aalborg University Hospital; Denmark
- Center for Sensory-Motor Interactions (SMI); Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Denmark
| | - C. Brock
- Mech-Sense; Department of Gastroenterology and Hepatology; Aalborg University Hospital; Denmark
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Naugle KM, Cruz-Almeida Y, Fillingim RB, Riley JL. Offset analgesia is reduced in older adults. Pain 2013; 154:2381-2387. [PMID: 23872117 DOI: 10.1016/j.pain.2013.07.015] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 06/27/2013] [Accepted: 07/12/2013] [Indexed: 11/17/2022]
Abstract
Recent studies indicate that aging is associated with dysfunctional changes in pain modulatory capacity, potentially contributing to increased incidence of pain in older adults. However, age-related changes in offset analgesia (offset), a form of temporal pain inhibition, remain poorly characterized. The purpose of this study was to investigate age differences in offset analgesia of heat pain in healthy younger and older adults. To explore the peripheral mechanisms underlying offset, an additional aim of the study was to test offset at 2 anatomical sites with known differences in nociceptor innervation. A total of 25 younger adults and 20 older adults completed 6 offset trials in which the experimental heat stimulus was presented to the volar forearm and glabrous skin of the palm. Each trial consisted of 3 continuous phases: an initial 15-second painful stimulus (T1), a slight increase in temperature from T1 for 5 seconds (T2), and a slight decrease back to the initial testing temperature for 10 seconds (T3). During each trial, subjects rated pain intensity continuously using an electronic visual analogue scale (0-100). Older adults demonstrated reduced offset compared to younger adults when tested on the volar forearm. Interestingly, offset analgesia was nonexistent on the palm for all subjects. The reduced offset found in older adults may reflect an age-related decline in endogenous inhibitory systems. However, although the exact mechanisms underlying offset remain unknown, the absence of offset at the palm suggests that peripheral mechanisms may be involved in initiating this phenomenon.
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Affiliation(s)
- Kelly M Naugle
- College of Dentistry, University of Florida, Gainesville, FL, USA Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
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Medici C, Barraza G, Castillo CD, Morales M, Schestatsky P, Casanova-Mollà J, Valls-Sole J. Disturbed sensory perception of changes in thermoalgesic stimuli in patients with small fiber neuropathies. Pain 2013; 154:2100-2107. [PMID: 23806653 DOI: 10.1016/j.pain.2013.06.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 06/04/2013] [Accepted: 06/19/2013] [Indexed: 10/26/2022]
Abstract
The assessment of functional deficits in small fibre neuropathies (SFN) requires using ancillary tests other than conventional neurophysiological techniques. One of the tests with most widespread use is thermal threshold determination, as part of quantitative sensory testing. Thermal thresholds typically reflect one point in the whole subjective experience elicited by a thermal stimulus. We reasoned that more information could be obtained by analyzing the subjective description of the ongoing sensation elicited by slow temperature changes (dynamic thermal testing, DTT). Twenty SFN patients and 20 healthy subjects were requested to describe, by using an electronic visual analog scale system, the sensation perceived when the temperature of a thermode was made to slowly change according to a predetermined pattern. The thermode was attached to the left ventral forearm or the distal third of the left leg and the stimulus was either a monophasic heat or cold stimuli that reached 120% of pain threshold and reversed to get back to baseline at a rate of 0.5 °C/s. Abnormalities seen in patients in comparison to healthy subjects were: (1) delayed perception of temperature changes, both at onset and at reversal, (2) longer duration of pain perception at peak temperature, and (3) absence of an overshoot sensation after reversal, ie, a transient perception of the opposite sensation before the temperature reached again baseline. The use of DTT increases the yield of thermal testing for clinical and physiological studies. It adds information that can be discriminant between healthy subjects and SFN patients and shows physiological details about the process of activation and inactivation of temperature receptors that may be abnormal in SFN.
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Affiliation(s)
- Conrado Medici
- Department of Neurology, Hospital Clinic, Barcelona, Spain Institut d'Investigació Augustí Pi i Sunyer, Facultat de Medicina, University of Barcelona, Barcelona, Spain Neurology Service, EMG Unit, Hospital de Clinicas, Porto Alegre, Brazil Neurology Service, Hospital Joan XXIII, Tarragona, Spain
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Hamaguchi T, Kano M, Kanazawa M, Itoh M, Yanai K, Fukudo S. Effects of preceding stimulation on brain activation in response to colonic distention in humans. Psychosom Med 2013; 75:453-62. [PMID: 23723361 DOI: 10.1097/psy.0b013e3182926682] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE It has been suggested that the pattern of distension (moderate following mild and vice versa) might influence brain activation and the experience of hypersensitivity, offset analgesia, and anticipation. Nevertheless, how the pattern of stimulation affects sensitization and/or desensitization to visceral stimulation remains unknown. METHODS In 45 nonclinical healthy participants (12 women, 33 men; 20-26 years old), brain processing of visceral sensation induced by colonic distension was examined using H2(15)O positron emission tomography. Subjective feelings regarding the stimuli were also measured. The descending colon was stimulated using six patterns of three bag pressures (0, 20, and 40 mm Hg). To evaluate the neural sensitization to visceral stimulation arising from the precedence effect, the effects of a 20- or 40-mm Hg distention after a sham or 20- or 40-mm Hg distension were analyzed using statistical parametric mapping. The level of significance was set at a voxelwise level of p < .0001, with cluster extent sizes of k > 50. RESULTS The midbrain, insula, and cerebellum, were more strongly activated by a 20-mm Hg distension with a preceding 40-mm Hg distention than by a 20-mm Hg distention without a preceding stimulation (p < .0001). Conversely, a sham stimulation after the experience of an intense stimulation activated the midcingulate cortex, compared with a sham stimulation without the experience of actual visceral stimulation (p < .0001). CONCLUSIONS By directly comparing different patterns of visceral stimuli, preceding visceral stimuli may affect neural sensitization and/or desensitization in humans, including elevated midbrain, insula, and midcingulate cortex.
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Affiliation(s)
- Toyohiro Hamaguchi
- Department of Behavioral Medicine, Graduate School of Medicine, Tohoku University, Aoba, Sendai, Japan
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Psychophysical testing of spatial and temporal dimensions of endogenous analgesia: conditioned pain modulation and offset analgesia. Exp Brain Res 2013; 228:493-501. [DOI: 10.1007/s00221-013-3580-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 05/15/2013] [Indexed: 10/26/2022]
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Abstract
BACKGROUND Sedation or anesthesia is used to facilitate many cases of an estimated 45 million diagnostic and therapeutic medical procedures in the United States. Preclinical studies have called attention to the possibility that sedative-hypnotic drugs can increase pain perception, but whether this observation holds true in humans and whether pain-modulating effects are agent-specific or characteristic of IV sedation in general remain unclear. METHODS To study this important clinical question, the authors recruited 86 healthy volunteers and randomly assigned them to receive one of three sedative drugs: midazolam, propofol, or dexmedetomidine. The authors asked participants to rate their pain in response to four experimental pain tasks (i.e., cold, heat, ischemic, or electrical pain) before and during moderate sedation. RESULTS Midazolam increased cold, heat, and electrical pain perception significantly (10-point pain rating scale change, 0.82 ± 0.29, mean ± SEM). Propofol reduced ischemic pain and dexmedetomidine reduced both cold and ischemic pain significantly (-1.58 ± 0.28, mean ± SEM). The authors observed a gender-by-race interaction for dexmedetomidine. In addition to these drug-specific effects, the authors observed gender effects on pain perception; female subjects rated identical experimental pain stimuli higher than male subjects. The authors also noted race-drug interaction effects for dexmedetomidine, with higher doses of drug needed to sedate Caucasians compared with African Americans. CONCLUSIONS The results of the authors' study call attention to the fact that IV sedatives may increase pain perception. The effect of sedation on pain perception is agent- and pain type-specific. Knowledge of these effects provides a rational basis for analgesia and sedation to facilitate medical procedures.
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Subjective experience of sensation in anorexia nervosa. Behav Res Ther 2013; 51:256-65. [PMID: 23523866 DOI: 10.1016/j.brat.2013.01.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 01/19/2013] [Accepted: 01/25/2013] [Indexed: 11/24/2022]
Abstract
The nature of disturbance in body experience in anorexia nervosa (AN) remains poorly operationalized despite its prognostic significance. We examined the relationship of subjective reports of sensitivity to and behavioral avoidance of sensory experience (e.g., to touch, motion) to body image disturbance and temperament in adult women currently diagnosed with AN (n = 20), women with a prior history of AN who were weight restored (n = 15), and healthy controls with no eating disorder history (n = 24). Levels of sensitivity to sensation and attempts to avoid sensory experience were significantly higher in both clinical groups relative to healthy controls. Sensory sensitivity was associated with body image disturbance (r(56) = .51, p < .0001), indicating that body image disturbance increased with increased global sensitivity to sensation. Sensory sensitivity was also negatively and significantly correlated with lowest BMI (r(2) = -.32, p < .001), but not current BMI (r(2) = .03, p = .18), and to the temperament feature of harm avoidance in both clinical groups. We discuss how intervention strategies that address sensitization and habituation to somatic experience via conditioning exercises may provide a new manner in which to address body image disturbance in AN.
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Opioid-independent mechanisms supporting offset analgesia and temporal sharpening of nociceptive information. Pain 2012; 153:1232-1243. [PMID: 22503222 DOI: 10.1016/j.pain.2012.02.035] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Revised: 02/24/2012] [Accepted: 02/24/2012] [Indexed: 11/22/2022]
Abstract
The mechanisms supporting temporal processing of pain remain poorly understood. To determine the involvement of opioid mechanisms in temporal processing of pain, responses to dynamic noxious thermal stimuli and offset analgesia were assessed after administration of naloxone, a μ-opioid antagonist, and on a separate day, during and after intravenous administration of remifentanil, a μ-opioid agonist, in 19 healthy human volunteers. Multiple end points were sampled from real-time computerized visual analog scale ratings (VAS, 1 to 10) to assess thermal sensitivity, magnitude and duration of offset analgesia, and painful after sensations. It was hypothesized that the magnitude of offset analgesia would be reduced by direct opioid antagonism and during states of acute opioid-induced hypersensitivity (OIH), as well as diminished by the presence of exogenous opioids. Surprisingly, the magnitude of offset analgesia was not altered after naloxone administration, during remifentanil infusion, or after the termination of remifentanil infusion. Because thermal hyperalgesia was observed after both drugs, 8 of the original 19 subjects returned for an additional session without drug administration. Thermal hyperalgesia and increased magnitude of offset analgesia were observed across conditions of remifentanil, naloxone, and no drug within this subset analysis, indicating that repeated heat testing induced thermal hyperalgesia, which potentiated the magnitude of offset analgesia. Thus, it is concluded that the mechanisms subserving temporal processing of nociceptive information are largely opioid-independent, but that offset analgesia may be potentiated by heat-induced thermal hyperalgesia in a proportion of individuals.
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