The influence of stimulus duration on the reliability of pain ratings after nociceptive stimulation of the nasal mucosa with CO2

Delta-9-tetrahydrocannabinol reduces the performance in sensory delayed discrimination tasks. A pharmacological-fMRI study in healthy volunteers

BACKGROUND

Cannabis proofed to be effective in pain relief, but one major side effect is its influence on memory in humans. Therefore, the role of memory on central processing of nociceptive information was investigated in healthy volunteers.

METHODS

In a placebo-controlled cross-over study including 22 healthy subjects, the effect of 20 mg oral Δ9-tetrahydrocannabinol (THC) on memory involving nociceptive sensations was studied, using a delayed stimulus discrimination task (DSDT). To control for nociceptive specificity, a similar DSDT-based study was performed in a subgroup of thirteen subjects, using visual stimuli.

RESULTS

For each nociceptive stimulus pair, the second stimulus was associated with stronger and more extended brain activations than the first stimulus. These differences disappeared after THC administration. The THC effects were mainly located in two clusters comprising the insula and inferior frontal cortex in the right hemisphere, and the caudate nucleus and putamen bilaterally. These cerebral effects were accompanied in the DSDT by a significant reduction of correct ratings from 41.61% to 37.05% after THC administration (rm-ANOVA interaction "drug" by "measurement": F (1,21) = 4.685, p = 0.042). Rating performance was also reduced for the visual DSDT (69.87% to 54.35%; rm-ANOVA interaction of "drug" by "measurement": F (1,12) = 13.478, p = 0.003) and reflected in a reduction of stimulus-related brain deactivations in the bilateral angular gyrus.

CONCLUSIONS

Results suggest that part of the effect of THC on pain may be related to memory effects. THC reduced the performance in DSDT of nociceptive and visual stimuli, which was accompanied by significant effects on brain activations. However, a pain specificity of these effects cannot be deduced from the data presented.

The intranasal trigeminal system

Many odors activate the intranasal chemosensory trigeminal system where they produce cooling and other somatic sensations such as tingling, burning, or stinging. Specific trigeminal receptors are involved in the mediation of these sensations. Importantly, the trigeminal system also mediates sensitivity to airflow. The intranasal trigeminal and the olfactory system are closely connected. With regard to central nervous processing, it is most interesting that trigeminal stimuli can activate the piriform cortex, which is typically viewed as the primary olfactory cortex. This suggests that interactions between the two systems may form at a relatively early stage of processing. For example, there is evidence showing that acquired olfactory loss leads to reduced trigeminal sensitivity, probably on account of the lack of interaction in the central nervous system. Decreased trigeminal sensitivity may also be responsible for changes in airflow perception, leading to the impression of congested nasal airways.

Chemo-somatosensory evoked potentials: a sensitive tool to assess conditioned pain modulation?

Abstract Background: Chemo-somatosensory evoked potentials (CSSEPs) elicited by chemical stimulation (CO₂ gas) of the nasal mucosa have been shown to be sensitive enough to pick up even weak analgesic effects. With the present study we wanted to investigate whether CSSEPs are also a sensitive tool to capture endogenous pain inhibitory mechanisms elicited by conditioned pain modulation (CPM; where a first conditioning stimulus reduces the sensitivity for a second test stimulus) with a conditioning stimulus of rather low noxious load.

METHODS

Seventeen healthy participants were tested for CPM effects (conditioning stimulus: tonic heat pain with intensities around the pain threshold induced via a thermode; test stimulus: chemonasal stimulation (73% and 78% CO₂)) on CSSEPs and on self-report ratings.

RESULTS

We found significant CPM effects in the CSSEPS, with reduced amplitudes and prolonged latencies at several electroencephalogram (EEG) recording positions when using the lower CO₂ concentration (73% CO₂). In contrast to the visible inhibitory effects on the CSSEPs, subjective ratings of the test stimulus did not reflect CPM action.

DISCUSSION

The experimental pain model using CO₂ stimuli to elicit CSSEPs proved to be sensitive enough to capture weak CPM effects elicited by a conditioning stimulus of rather low noxious load. The usage of such mild noxious conditioning stimuli-in contrast to stimuli of higher noxious load (e.g., cold pressor test)-has the advantage that the activation of other types of pain inhibitory mechanisms in parallel (like attentional distraction, stress-induced analgesia) can be avoided.

Separating brain processing of pain from that of stimulus intensity

Regions of the brain network activated by painful stimuli are also activated by nonpainful and even nonsomatosensory stimuli. We therefore analyzed where the qualitative change from nonpainful to painful perception at the pain thresholds is coded. Noxious stimuli of gaseous carbon dioxide (n = 50) were applied to the nasal mucosa of 24 healthy volunteers at various concentrations from 10% below to 10% above the individual pain threshold. Functional magnetic resonance images showed that these trigeminal stimuli activated brain regions regarded as the "pain matrix." However, most of these activations, including the posterior insula, the primary and secondary somatosensory cortex, the amygdala, and the middle cingulate cortex, were associated with quantitative changes in stimulus intensity and did not exclusively reflect the qualitative change from nonpainful to pain. After subtracting brain activations associated with quantitative changes in the stimuli, the qualitative change, reflecting pain-exclusive activations, could be localized mainly in the posterior insular cortex. This shows that cerebral processing of noxious stimuli focuses predominately on the quantitative properties of stimulus intensity in both their sensory and affective dimensions, whereas the integration of this information into the perception of pain is restricted to a small part of the pain matrix.

The influence of stimulus duration on odor perception

Although different parameters are known to alter the shape of olfactory event related potentials (ERP), ERP parameters are generally thought to be independent from stimulus duration. Evidence from recent studies investigating trigeminal ERP indicates that this may not be true. Aim of the present study was to investigate the relationship of stimulus duration and ERP. A total of 20 young healthy subjects participated. Subjects were investigated on 5 occasions on 5 different days. ERP were recorded to olfactory stimuli of two different concentrations and 3 different durations (100 ms, 200 ms, 300 ms). In two sessions olfactory ERP to PEA were recorded, in another two sessions H2S was applied. During the same sessions, intensity ratings were recorded. In the fifth session, subjects were asked to rate the duration of H2S stimuli and PEA stimuli. Whereas at weak stimulus concentrations no effect of stimulus duration could be observed, there was a clear effect of "duration" in ERP amplitudes following stimuli with higher concentrations: the longer the stimulus duration the larger the ERP amplitudes. No effect was found on ERP latencies. With regard to intensity ratings, strong stimuli and longer lasting stimuli lead to higher ratings. Similarly, ratings of stimulus duration were dependent from stimulus concentration and stimulus duration. Results of the present study showed that similar to trigeminal ERP, information about stimulus duration is encoded in olfactory ERP, mainly in amplitudes.

Event-related potentials to intranasal trigeminal stimuli change in relation to stimulus concentration and stimulus duration

Few data are available on the relation of EEG-derived trigeminal event-related potentials (ERPs) to stimulus duration or stimulus concentration. Thus, the aim of this study was to analyze the relation between ERP components and both stimulus duration and stimulus concentration. Twenty healthy young subjects participated. Trigeminal ERPs were recorded after stimulation with CO(2). Five concentrations (45 to 65% volume per volume CO(2)) and five stimulus durations (100 to 300 msec) were used. Trigeminal ERPs were quantified in terms of amplitudes and latencies of its major peaks N(410) (termed N1) and P(622) (termed P3). The relation between stimulus duration, concentration, and amplitudes or latencies of trigeminal ERP components could be described as a model of power, following the formula p = b + k.I g1.D(g2). A linear relationship was found between stimulus concentration, amplitude N1, and amplitude P3, and between stimulus duration and amplitude P3 respectively. Furthermore, a linear relationship was seen between intensity ratings, and stimulus duration and concentration. These data confirm that the different ERP components encode different stimulus characteristics. Specifically, later components of the trigeminal ERP encode not only stimulus concentration but, other than earlier ERP components, also encode stimulus duration. Thus, they reflect the integration of stimuli over relatively long periods of time.

Pain in the trigeminal system: irritation of the nasal mucosa using short- and long-lasting stimuli

The paper describes methods which allow intranasal irritation using short- and long-lasting painful stimuli in humans. Short-lasting pain is induced by gaseous CO(2), while long-lasting pain is induced by a stream of dry air. Both models have been explored regarding their major determinants, e.g. stimulus duration, stimulus intensity, or repeated stimulation. Short-lasting, non-inflammatory pain stimuli seem to provide specific indicators of A(delta)-fiber function, while responses to long-lasting, inflammatory pain appear to be indicative of C-fiber function. Responses to both types of painful stimuli are modulated by analgesic drugs. As these well-investigated models allow the detailed and precise analysis of modulatory effects on intranasal nociception, they appear to be suited for the investigation of subtle changes of intranasal irritation, e.g. induced by environmental agents.