The Decline of Endogenous Pain Modulation With Aging: A Meta-Analysis of Temporal Summation and Conditioned Pain Modulation

Objective: Patellofemoral pain has high recurrence rates and minimal long-term treatment success. Central sensitization refers to dysfunctional pain modulation that occurs when nociceptive neurons become hyper responsive. Research in this area in PFP has been increasingly productive in the past decade. The aim of this review is to determine whether evidence supports manifestations of central sensitization in individuals with PFP. Data sources: MeSH terms for quantitative sensory testing (QST) pressure pain thresholds, conditioned pain modulation, temporal summation, sensitization, hyperalgesia, and anterior knee pain or PFP were searched in PubMed, SportDiscus, CINAHL, Academic Search Complete, and Ebscohost. Study Selection: Peer reviewed studies written in English, published between 2005–2020 which investigated QST and/or pain mapping in a sample with PFP were included in this review. Data Extraction: The initial search yielded 140 articles. After duplicates were removed, 78 article abstracts were reviewed. Full-text review of 21 studies occurred, with 11 studies included in the meta-analysis and eight studies included in the systematic review. Data Synthesis: A random-effects meta-analysis was conducted for four QST variables (local pressure pain thresholds, remote pressure pain thresholds, conditioned pain modulation, temporal summation). Strong evidence supports lower local and remote pressure pain thresholds, impaired conditioned pain modulation, and facilitated temporal summation in individuals with PFP compared to pain-free individuals. Conflicting evidence is presented for heat and cold pain thresholds. Pain mapping demonstrated expanding pain patterns associated with long PFP symptom duration. Conclusions: Signs of central sensitization are present in individuals with PFP, indicating altered pain modulation. PFP etiological and treatment models should reflect the current body of evidence regarding central sensitization. Signs of central sensitization should be monitored clinically and treatments with central effects should be considered as part of a multi-modal plan of care. Registration Number: This review is registered with Prospero (CRD42019127548) Registration URL: https://www.crd.york.ac.uk/PROSPERO Key Points:

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Efficacy of Physical Therapy on Nociceptive Pain Processing Alterations in Patients with Chronic Musculoskeletal Pain: A Systematic Review and Meta-analysis

Pain Medicine ◽

10.1093/pm/pnz366 ◽

2020 ◽

Vol 21 (10) ◽

pp. 2502-2517 ◽

Cited By ~ 4

Author(s):

Alberto Arribas-Romano ◽

Josué Fernández-Carnero ◽

Francisco Molina-Rueda ◽

Santiago Angulo-Diaz-Parreño ◽

Marcos José Navarro-Santana

Keyword(s):

Systematic Review ◽

Physical Therapy ◽

Musculoskeletal Pain ◽

Manual Therapy ◽

Temporal Summation ◽

Meta Analysis ◽

Pain Modulation ◽

Chronic Musculoskeletal Pain ◽

Conditioned Pain Modulation ◽

Slight Improvement

Abstract Introduction Chronic musculoskeletal pain is a major health, social, and economic problem. Most of the subjects who suffer from chronic musculoskeletal pain present processes of central sensitization. Temporal summation and conditioned pain modulation are the two most commonly used clinical measures of this. The objective of this review is to evaluate the effects of physical therapy on temporal summation (TS) and conditioned pain modulation (CPM) in patients with chronic musculoskeletal pain. Methods This is a systematic review and meta-analysis. We searched the MEDLINE, EMBASE, CINAHL, EBSCO, PubMed, PEDro, Cochrane Collaboration Trials Register, Cochrane Database of Systematic Reviews, and SCOPUS databases. Different mesh terms and key words were combined for the search strategy, with the aim of encompassing all studies that have used any type of physical therapy treatment in patients with chronic musculoskeletal pain and have measured both TS and CPM. Results Eighteen studies remained for qualitative analysis and 16 for quantitative analysis. Statistically significant differences with a 95% confidence interval (CI) were obtained for TS (–0.21, 95% CI = –0.39 to –0.03, Z = 2.50, P = 0.02, N = 721) and CPM (0.34, 95% CI = 0.12 to 0.56, Z = 2.99, P = 0.003, N = 680) in favor of physical therapy as compared with control. Manual therapy produces a slight improvement in TS, and physical therapy modalities in general improve CPM. No significant differences between the subgroups of the meta-analysis were found. The methodological quality of the studies was high. Conclusions Physical therapy produces a slight improvement in central sensitization (CS)–related variables, with TS decreased and CPM increased when compared with a control group in patients with CMP. Only significant differences in TS were identified in the manual therapy subgroup.

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Development of a novel brief quantitative sensory testing protocol that integrates static and dynamic pain assessments: Test-retest performance in healthy adults

Pain Medicine ◽

10.1093/pm/pnab290 ◽

2021 ◽

Author(s):

Martin J De Vita ◽

Katherine Buckheit ◽

Christina E Gilmour ◽

Dezarie Moskal ◽

Stephen A Maisto

Keyword(s):

Quantitative Sensory Testing ◽

Temporal Summation ◽

Pain Threshold ◽

Pain Modulation ◽

Healthy Adults ◽

Dynamic Responses ◽

Conditioned Pain Modulation ◽

Sensory Testing ◽

Contact Heat ◽

Intraclass Correlations

Abstract Objective Quantitative sensory testing is an expanding pain research domain with numerous clinical and research applications. There is a recognized need for brief reliable quantitative sensory testing protocols that enhance assessment feasibility. This study aimed to integrate static (pain threshold, tolerance, suprathreshold) and dynamic (conditioned pain modulation, offset analgesia, temporal summation) pain reactivity measures into a brief 20-minute protocol that uses a single portable device. The test-retest performance of this optimized protocol was evaluated. Design Using a test-retest design, the brief quantitative sensory testing assessment was administered to participants on two occasions separated by exactly 7 days. Setting A clinical psychology research laboratory at Syracuse University. Subjects Participants were 33 healthy adults recruited from Syracuse University’s online research participation pool. Methods A portable computerized quantitative sensory testing device delivered contact-heat pain to assess static and dynamic pain measures in participants. Dynamic responses were continuously recorded using a computerized visual analog scale. Results Pain threshold, tolerance, and suprathreshold exhibited excellent reliability (intraclass correlations ranged from 0.80 to 0.83). Conditioned pain modulation, offset analgesia, temporal summation yielded reliability in the good to excellent range (intraclass correlations ranged from 0.66 to 0.71). Conclusions Findings suggested that this brief integrated QST protocol may reliably monitor human pain reactivity over brief periods. This protocol may enhance quantitative sensory testing feasibility in clinical and research settings.

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Acute alcohol effects on conditioned pain modulation, but not temporal summation of pain

Pain ◽

10.1097/j.pain.0000000000001597 ◽

2019 ◽

Vol 160 (9) ◽

pp. 2063-2071 ◽

Cited By ~ 2

Author(s):

Claudia Horn-Hofmann ◽

Eva Susanne Capito ◽

Jörg Wolstein ◽

Stefan Lautenbacher

Keyword(s):

Temporal Summation ◽

Pain Modulation ◽

Conditioned Pain Modulation ◽

Alcohol Effects

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Oxycodone alters temporal summation but not conditioned pain modulation: Preclinical findings and possible relations to mechanisms of opioid analgesia

Pain ◽

10.1016/j.pain.2013.04.036 ◽

2013 ◽

Vol 154 (8) ◽

pp. 1413-1418 ◽

Cited By ~ 20

Author(s):

Erica Suzan ◽

Ayelet Midbari ◽

Roi Treister ◽

May Haddad ◽

Dorit Pud ◽

...

Keyword(s):

Temporal Summation ◽

Pain Modulation ◽

Opioid Analgesia ◽

Conditioned Pain Modulation

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Central inhibition of pain is augmented in women with self-injurious behavior

10.1101/2021.05.12.21257091 ◽

2021 ◽

Author(s):

Maria Lalouni ◽

Jens Fust ◽

Johan Bjureberg ◽

Granit Kastrati ◽

Robin Fondberg ◽

...

Keyword(s):

Temporal Summation ◽

Pain Modulation ◽

Pain Tolerance ◽

Conditioned Pain Modulation ◽

Heat Pain ◽

Healthy Controls ◽

Down Regulation ◽

Pain Thresholds ◽

Pressure Pain ◽

Pressure Pain Thresholds

Individuals who engage in nonsuicidal self-injury (NSSI) have demonstrated higher pain thresholds and tolerance compared with individuals without NSSI. The objective of the study was to assess which aspects of the pain regulatory system that account for this augmented pain perception. In a cross-sectional design, 81 women, aged 18-35 (mean [SD] age, 23.4 [3.9]), were included (41 with NSSI and 40 healthy controls). A quantitative sensory testing protocol, including heat pain thresholds, heat pain tolerance, pressure pain thresholds, conditioned pain modulation (assessing central down-regulation of pain), and temporal summation (assessing facilitation of pain signals) was used. Thermal pain stimuli were assessed during fMRI scanning and NSSI behaviors and clinical symptoms were self-assessed. NSSI participants demonstrated higher pain thresholds during heat and pressure pain compared to controls. During conditioned pain modulation, NSSI participants showed a more effective central down-regulation of pain for NSSI participants. Temporal summation did not differ between the groups. There were no correlations between pain outcomes and NSSI behaviors or clinical characteristics. The fMRI analyses revealed increased activity in the primary and secondary somatosensory cortex in NSSI participants, compared to healthy controls, which are brain regions implicated in sensory aspects of pain processing. The findings suggest segregated inhibitory mechanisms for pain and emotion in NSSI, as pain insensitivity was linked to enhanced inhibitory control of pain in spite of significant impairments in emotion regulation. This may represent an endophenotype associated with a greater risk for developing self-injurious behavior.

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