Pain modulation as a function of hypnotizability: Diffuse noxious inhibitory control induced by cold pressor test vs explicit suggestions of analgesia

2017 ◽  
Vol 171 ◽  
pp. 135-141 ◽  
Author(s):  
Fabrizia Fidanza ◽  
Maurizio Varanini ◽  
Antonella Ciaramella ◽  
Giancarlo Carli ◽  
Enrica L. Santarcangelo
Keyword(s):  
Inhibitory Control ◽  
Cold Pressor Test ◽  
Cold Pressor ◽  
Pain Modulation ◽  
Diffuse Noxious Inhibitory Control ◽  
Pressor Test

Differential pain modulation in patients with peripheral neuropathic pain and fibromyalgia

2012 ◽  
Vol 3 (3) ◽  
pp. 116-123 ◽  
Author(s):  
Lise Gormsen ◽  
Flemming W. Bach ◽  
Raben Rosenberg ◽  
Troels S. Jensen
Keyword(s):  
Neuropathic Pain ◽  
Cold Water ◽  
Cold Pressor Test ◽  
Cold Pressor ◽  
Pain Modulation ◽  
Pain Tolerance ◽  
Spontaneous Pain ◽  
Peripheral Neuropathic Pain ◽  
Pressor Test ◽  
Pain Patients

AbstractBackgroundThe definition of neuropathic pain has recently been changed by the International Association for the Study of Pain. This means that conditions such as fibromyalgia cannot, as sometimes discussed, be included in the neuropathic pain conditions. However, fibromyalgia and peripheral neuropathic pain share common clinical features such as spontaneous pain and hypersensitivity to external stimuli. Therefore, it is of interest to directly compare the conditions.Material and methodsIn this study we directly compared the pain modulation in neuropathic pain versus fibromyalgia by recording responses to a cold pressor test in 30 patients with peripheral neuropathic pain, 28 patients with fibromyalgia, and 26 pain-free age-and gender-matched healthy controls. Patients were asked to rate their spontaneous pain on a visual analog scale (VAS (0–100 mm) immediately before and immediately after the cold pressor test. Furthermore the duration (s) of extremity immersion in cold water was used as a measure of the pain tolerance threshold, and the perceived pain intensity at pain tolerance on the VAS was recorded on the extremity in the water after the cold pressor test. In addition, thermal (thermo tester) and mechanical stimuli (pressure algometer) were used to determine sensory detection, pain detection, and pain tolerance thresholds in different body parts. All sensory tests were done by the same examiner, in the same room, and with each subject in a supine position. The sequence of examinations was the following: (1) reaction time, (2) pressure thresholds, (3) thermal thresholds, and (4) cold pressor test. Reaction time was measured to ensure that psychomotoric inhibitions did not influence pain thresholds.ResultsPain modulation induced by a cold pressor test reduced spontaneous pain by 40% on average in neuropathic pain patients, but increased spontaneous pain by 2.6% in fibromyalgia patients. This difference between fibromyalgia and neuropathic pain patients was significant (P < 0.002). Fibromyalgia patients withdrew their extremity from the cold water significantly earlier than neuropathic pain patients and healthy controls; however, they had a higher perceived pain intensity on the VAS than neuropathic pain patients and control subjects. Furthermore, neuropathic pain patients had a localized hypersensitivity to mechanical and thermal stimuli in the affected area of the body. In contrast, fibromyalgia patients displayed a general hypersensitivity to mechanical and thermal stimuli when the stimuli were rated by the VAS, and hypersensitivity to some of the sensory stimuli.ConclusionsThese findings are the first to suggest that a conditioning stimulus evoked by a cold pressor test reduced spontaneous ongoing pain in patients with peripheral neuropathic pain, but not in fibromyalgia patients when directly compared. The current study supports the notion that fibromyalgia and neuropathic pain are distinct pain conditions with separate sensory patterns and dysfunctions in pain-modulating networks. Fibromyalgia should therefore not, as sometimes discussed, be included in NP conditions.ImplicationsOn the basis of the findings, it is of interest to speculate on the underlying mechanisms. The results are consistent with the idea that peripheral neuropathic pain is primarily driven from damaged nerve endings in the periphery, while chronic fibromyalgia pain may be a central disorder with increased activity in pain-facilitating systems.

scholarly journals Impaired Modulation of Pain in Patients with Postherpetic Neuralgia

2014 ◽  
Vol 19 (1) ◽  
pp. e19-e23 ◽  
Author(s):  
Gisèle Pickering ◽  
Bruno Pereira ◽  
Elodie Dufour ◽  
Sylvie Soule ◽  
Claude Dubray
Keyword(s):  
Postherpetic Neuralgia ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Cold Pressor Test ◽  
Cold Pressor ◽  
Pain Modulation ◽  
Cognitive Test ◽  
Control Group ◽  
Pressor Test ◽  
Clinical Pain

BACKGROUND: The efficiency of inhibitory pain descending pathways (evaluated using conditioned pain modulation [CPM]) has not been studied in postherpetic neuralgia (PHN).OBJECTIVE: To compare CPM in PHN patients with healthy controls.METHODS: Nine PHN patients and nine control individuals were matched according to age and sex. Amplitudes of cortical thermal-evoked potentials were recorded on the surface of the scalp; clinical pain and thermal pain were evaluated on a 0 to 10 numerical rating scale, at baseline and at intervals during the 6 min after CPM (elicited by a cold pressor test, 8°C). A battery of cognitive tests was performed. Amplitude differences, percentages and related areas under the curve (AUCCPM) were calculated and all data were compared between both groups; P<0.05 was considered to be statistically significant.RESULTS: AUCCPM0–6 minwas significantly lower in PHN patients compared with controls (−39±51 μV/min versus −144±66 μV/min; P=0.0012) and correlated (P=0.04) with clinical pain intensity. Pain ratings before CPM were similar in both groups but were significantly lower in the control group 3 min after the cold pressor test. Cognitive test results were not significantly different.CONCLUSION: Psychophysical and electrophysiological approaches have shown that patients with PHN exhibit a deficiency of pain inhibition modulation, which could signal a predisposing factor to developing chronic pain. This deficiency was not linked to the cognitive performance but rather to subtle in situ cognitivoemotional adaptations, which remain to be investigated.

scholarly journals Reliability of the Conditioned Pain Modulation Paradigm to Assess Endogenous Inhibitory Pain Pathways

2012 ◽  
Vol 17 (2) ◽  
pp. 98-102 ◽  
Author(s):  
Gwyn N Lewis ◽  
Heales Luke ◽  
David A Rice ◽  
Keith Rome ◽  
Peter J McNair
Keyword(s):  
Pain Threshold ◽  
Intraclass Correlation ◽  
Cold Pressor Test ◽  
Pressure Pain Threshold ◽  
Cold Pressor ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Pressure Pain ◽  
Pressor Test ◽  
Conditioning Stimuli

BACKGROUND: Conditioned pain modulation paradigms are often used to assess the diffuse noxious inhibitory control (DNIC) system. DNICs provide one of the main supraspinal pain inhibitory pathways and are impaired in several chronic pain populations. Only one previous study has examined the psychometric properties of the conditioned pain modulation technique and this study did not evaluate intersession reliability.OBJECTIVES: To evaluate and compare the intra- and intersession reliability of two conditioned pain modulation paradigms using different conditioning stimuli, and to determine the time course of conditioned pain inhibition following stimulus removal.METHODS: An electronic pressure transducer was used to determine the pressure-pain threshold at the knee during painful conditioning of the opposite hand using the ischemic arm test and the cold pressor test. Assessments were completed twice on one day and repeated once approximately three days later.RESULTS: The two conditioning stimuli resulted in a similar increase in the pressure-pain threshold at the knee, reflecting presumed activation of the DNIC system. Intrasession intraclass correlation coefficients for the cold pressor (0.85) and ischemic arm tests (0.75) were excellent. The intersession intraclass correlation coefficient for the cold pressor test was good (0.66) but was poor for the ischemic arm test (−0.4). Inhibition of the pressure-pain threshold remained significant at 10 min following conditioning, but returned to baseline by 15 min.CONCLUSIONS: Within-session reliability of DNIC assessment using conditioned pain modulation paradigms was excellent, but the applicability of assessing pain modulation over multiple sessions was influenced by the conditioning stimulus. The cold pressor test was the superior technique.

scholarly journals Offset analgesia is not affected by cold pressor induced analgesia

2018 ◽  
Vol 18 (4) ◽  
pp. 695-701 ◽  
Author(s):  
Thomas Dahl Nissen ◽  
Carsten Dahl Mørch ◽  
Lars Arendt-Nielsen ◽  
Asbjørn Mohr Drewes ◽  
Anne Estrup Olesen
Keyword(s):  
Pain Intensity ◽  
Assessment Tool ◽  
Cold Pressor Test ◽  
Cold Pressor ◽  
Pain Modulation ◽  
Descending Inhibition ◽  
Cold Pain ◽  
Pressor Test ◽  
Endogenous Pain Modulation ◽  
Healthy Participants

Abstract Background and aims Offset analgesia (OA) is a pain modulating mechanism described as a disproportionately large decrease in pain intensity evoked by a minor decrease in stimulus intensity. Precise mechanisms of OA are still not elucidated and studies are needed to evaluate factors modulating OA. The aim of this study was to investigate OA before and during tonic cold pain (thought to induce descending inhibition), in a group of healthy volunteers. Methods A randomized, crossover study was performed in 17 healthy participants (8 males and 9 females). The OA paradigm lasted 35 s and was induced by the traditional method using thermal stimulation applied to the forearm. A constant control heat stimulus (CTL) paradigm was used as control to assess adaptation. Pain intensity was assessed continuously. For induction of tonic cold pain, the participants immersed their hand into 2°C water for 2 min. After 1 min and 25 s, the heat stimulation (OA or CTL paradigm) was repeated to assess the modulatory effect of the cold pressor test. Results It was possible to induce OA both before and during the cold pressor test. Tonic cold pain modulated the peak pain reported during both the OA (p=0.015) and CTL paradigms (p=0.001) reflecting endogenous pain modulation. However, the magnitude of OA was not modulated by tonic cold pain (p>0.05). Conclusions The offset analgesia magnitude was not modulated by simultaneously tonic cold pain, thought to reflect another endogenous pain modulation mechanism. Implications Neither offset analgesia magnitude nor adaptation were modulated by cold pressor induced endogenous analgesia. This could be explained by the fact, that offset analgesia was already at maximum in healthy participants. Hence, offset analgesia may not be a suitable assessment tool to investigate modulation induced by experimental methods or pharmacology in healthy participants.

scholarly journals Painful stimulation increases spontaneous blink rate in healthy subjects

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Giulia Paparella ◽  
Giulia Di Stefano ◽  
Alessandra Fasolino ◽  
Giuseppe Di Pietro ◽  
Donato Colella ◽  
...  
Keyword(s):  
Healthy Subjects ◽  
Pain Perception ◽  
Cold Pressor Test ◽  
Cold Pressor ◽  
Pain Modulation ◽  
Blink Rate ◽  
Dopaminergic Activity ◽  
Laser Stimulation ◽  
Stimulation Intensity ◽  
Pressor Test

AbstractSpontaneous blink rate is considered a biomarker of central dopaminergic activity. Recent evidence suggests that the central dopaminergic system plays a role in nociception. In the present study, we aimed to investigate whether pain modulates spontaneous blink rate in healthy subjects. We enrolled 15 participants. Spontaneous blink rate was quantified with an optoelectronic system before and after: (1) a painful laser stimulation, and (2) an acoustic startling stimulation. In control experiments, we investigated whether laser stimulation effects depended on stimulation intensity and whether laser stimulation induced any changes in the blink reflex recovery cycle. Finally, we investigated any relationship between spontaneous blink rate modification and pain modulation effect during the cold pressor test. Laser, but not acoustic, stimulation increased spontaneous blink rate. This effect was independent of stimulation intensity and negatively correlated with pain perception. No changes in trigeminal-facial reflex circuit excitability were elicited by laser stimulation. The cold pressor test also induced an increased spontaneous blink rate. Our study provides evidence on the role of dopamine in nociception and suggests that dopaminergic activity may be involved in pain modulation. These findings lay the groundwork for further investigations in patients with pathological conditions characterized by dopaminergic deficit and pain.

Repercussões pressóricas do frio local: a crioterapia deve ser administrada com precaução em pacientes hipertensos?

2016 ◽  
Vol 14 (4) ◽  
Author(s):  
Marcelo Coertjens
Keyword(s):  
Cold Pressor Test ◽  
Cold Pressor ◽  
Pressor Test

Introdução: A crioterapia é um recurso que diminui a temperatura corporal local com finalidades terapêuticas. Uma importante repercussão é a vasoconstrição local, que seria o desencadeador de um possível aumento na pressão arterial (PA). Entretanto, não existem trabalhos que comprovem essa suposição. Nossa hipótese é que os resultados das pesquisas de Cold Pressor Test (CPT) avaliando PA acabaram historicamente fundamentando as precauções da crioterapia em relação a pacientes hipertensos. Objetivo: Realizar uma revisão de literatura a respeito das pesquisas que sustentam a precaução da crioterapia em indivíduos hipertensos e verificar sua relação com estudos que utilizaram o CPT. Material e métodos: Trata-se de uma revisão de literatura que utilizou as bases de dados online Medline, Scielo, Lilacs e Google Acadêmico para a realização da pesquisa. Resultado: Apesar de não serem unânimes, diversas pesquisas que utilizaram o CPT encontraram significativos aumentos da atividade nervosa simpática muscular e da PA em normotensos e hipertensos, entretanto não encontramos estudos que tenham comprovado respostas significativas de PA com o uso da crioterapia, principalmente, em hipertensos. Conclusão: Não existem evidências científicas que comprovem a precaução da crioterapia em indivíduos hipertensos. Além disso, os estudos com CPT não são unânimes em relação aos aumentos pressóricos em indivíduos normotensos e hipertensos.Palavras-chave: crioterapia, hemodinâmica, hipertensão, pressão arterial. 

Correlation of Anxiety& Cold Pressor Test in Young Adults

2012 ◽  
Vol 3 (2) ◽  
pp. 210-211
Author(s):  
Anuradha Iyer Rajan ◽  
Keyword(s):  
Young Adults ◽  
Cold Pressor Test ◽  
Cold Pressor ◽  
Pressor Test
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