Combined Evaluation of Nociceptive Detection Thresholds and Evoked Potentials during Conditioned Pain Modulation: A Feasibility Study

Abstract Background Conditioned pain modulation (CPM) evaluates the effect of a painful conditioning stimulus (CS) on a painful test stimulus (TS). Using painful cutaneous electrical stimulation (PCES) as TS and painful cold water as CS, the pain relief was paralleled by a decrease in evoked potentials (PCES-EPs). We now aimed to compare the effect of CPM with cognitive distraction on PCES-induced pain and PCES-EP amplitudes. Methods PCES was performed using surface electrodes inducing a painful sensation of 60 (NRS 0–100) on one hand. In a crossover design healthy subjects (included: n = 38, analyzed: n = 23) immersed the contralateral hand into 10 °C cold water (CS) for CPM evaluation and performed the 1-back task for cognitive distraction. Before and during the CS and 1-back task, respectively, subjects rated the pain intensity of PCES and simultaneously cortical evoked potentials were recorded. Results Both CPM and cognitive distraction significantly reduced PCES-EP amplitudes (CPM: 27.6 ± 12.0 μV to 20.2 ± 9.5 μV, cognitive distraction: 30.3 ± 14.2 µV to 13.6 ± 5.2 μV, p < 0.001) and PCES-induced pain (on a 0–100 numerical rating scale: CPM: 58 ± 4 to 41.1 ± 12.3, cognitive distraction: 58.3 ± 4.4 to 38.0 ± 13.0, p < 0.001), though the changes in pain intensity and PCES-amplitude did not correlate. The changes of the PCES-EP amplitudes during cognitive distraction were more pronounced than during CPM (p = 0.001). Conclusions CPM and cognitive distraction reduced the PCES-induced pain to a similar extent. The more pronounced decrease of PCES-EP amplitudes after distraction by a cognitive task implies that both conditions might not represent the general pain modulatory capacity of individuals, but may underlie different neuronal mechanisms with the final common pathway of perceived pain reduction.

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Distraction by a cognitive task has a higher impact on electrophysiological measures compared with conditioned pain modulation

10.21203/rs.3.rs-26882/v4 ◽

2020 ◽

Author(s):

A. T. Lisa Do ◽

Elena Enax-Krumova ◽

Özüm Özgül ◽

Lynn B. Eitner ◽

Stefanie Heba ◽

...

Keyword(s):

Evoked Potentials ◽

Pain Intensity ◽

Rating Scale ◽

Cold Water ◽

Cognitive Task ◽

Pain Modulation ◽

Conditioned Pain Modulation ◽

Cognitive Distraction ◽

Painful Sensation ◽

Back Task

Abstract BackgroundConditioned pain modulation (CPM) evaluates the effect of a painful conditioning stimulus (CS) on a painful test stimulus (TS). Using painful cutaneous electrical stimulation (PCES) as TS and painful cold water as CS, the pain relief was paralleled by a decrease in evoked potentials (PCES-EPs). We now aimed to compare the effect of CPM with cognitive distraction on PCES-induced pain and PCES-EP amplitudes. MethodsPCES was performed using surface electrodes inducing a painful sensation of 60 (NRS 0-100) on one hand. In a crossover design healthy subjects (included: n=38, analyzed: n=23) immersed the contralateral hand into 10°C cold water (CS) for CPM evaluation and performed the 1-back task for cognitive distraction. Before and during the CS and 1-back task, respectively, subjects rated the pain intensity of PCES and simultaneously cortical evoked potentials were recorded. ResultsBoth CPM and cognitive distraction significantly reduced PCES-EP amplitudes (CPM: 27.6±12.0μV to 20.2±9.5μV, cognitive distraction: 30.3±14.2µV to 13.6±5.2μV, p<0.001) and PCES-induced pain (on a 0–100 numerical rating scale: CPM: 58±4 to 41.1±12.3, cognitive distraction: 58.3±4.4 to 38.0±13.0, p<0.001), though the changes in pain intensity and PCES-amplitude did not correlate. The changes of the PCES-EP amplitudes during cognitive distraction were more pronounced than during CPM (p=0.001).ConclusionsCPM and cognitive distraction reduced the PCES-induced pain to a similar extent. The more pronounced decrease of PCES-EP amplitudes after distraction by a cognitive task implies that both conditions might not represent the general pain modulatory capacity of individuals, but may underlie different neuronal mechanisms with the final common pathway of perceived pain reduction.

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Conditioned pain modulation affects the N2/P2 complex but not the N1 wave: A pilot study with laser‐evoked potentials

European Journal of Pain ◽

10.1002/ejp.1693 ◽

2020 ◽

Author(s):

Giovanna Squintani ◽

Andrea Rasera ◽

Alessia Segatti ◽

Elisa Concon ◽

Bruno Bonetti ◽

...

Keyword(s):

Pilot Study ◽

Evoked Potentials ◽

Pain Modulation ◽

Conditioned Pain Modulation ◽

Laser Evoked Potentials ◽

N1 Wave

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Distraction by a cognitive task has a higher impact on electrophysiological measures compared with conditioned pain modulation

10.21203/rs.3.rs-26882/v1 ◽

2020 ◽

Author(s):

A. T. Lisa Do ◽

Elena Enax-Krumova ◽

Özüm Özgül ◽

Lynn B. Eitner ◽

Stefanie Heba ◽

...

Keyword(s):

Pain Relief ◽

Evoked Potentials ◽

Pain Intensity ◽

Cold Water ◽

Cognitive Task ◽

Pain Modulation ◽

Conditioned Pain Modulation ◽

Cognitive Distraction ◽

Painful Sensation ◽

Back Task

Abstract Background Conditioned pain modulation (CPM) evaluates the effect of a painful conditioning stimulus (CS) on a painful test stimulus (TS). Using painful cutaneous electrical stimulation (PCES) as TS and painful cold water as CS, the pain relief was paralleled by a decrease in evoked potentials (PCES-EPs). We now aimed to compare the effect of CPM with cognitive distraction on PCES-induced pain and PCES-EP amplitudes. Methods PCES was performed in 38 healthy subjects using surface electrodes inducing a painful sensation of 60 (NRS 0-100) on one hand. In a crossover design subjects immersed the contralateral hand into painful cold water (10 °C, CS) for CPM evaluation and performed the 1-back task for cognitive distraction. Before and during the CS and 1-back task, respectively, subjects rated the pain intensity of PCES and simultaneously cortical evoked potentials were recorded. Results Both CPM and cognitive distraction significantly reduced PCES-EP amplitudes (CPM: from 30.9 ± 9.9 µV to 24.35 ± 8.41 µV, cognitive distraction: from 33.0 ± 8.8 µV to 19.5 ± 6.5 µV, p < 0.05) and PCES-induced pain (CPM: from 58 ± 4 to 39 ± 12, cognitive distraction: from 58 ± 4 to 36 ± 14, p < 0.05), though the changes in pain intensity and PCES-amplitude did not correlate. The changes of the PCES-EP amplitudes during cognitive distraction were significantly more pronounced than during CPM. Conclusions The amount of pain relief induced by CPM and cognitive distraction seems to be similar. However, the even more pronounced decrease of PCES-EP amplitudes after distraction by a cognitive task implies that both conditions do not represent the general pain modulatory capacity of individuals, but may underlie different neuronal mechanisms with the final common pathway of perceived pain reduction.

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Painful Cutaneous Electrical Stimulation vs. Heat Pain as Test Stimuli in Conditioned Pain Modulation

Brain Sciences ◽

10.3390/brainsci10100684 ◽

2020 ◽

Vol 10 (10) ◽

pp. 684

Author(s):

Elena Enax-Krumova ◽

Ann-Christin Plaga ◽

Kimberly Schmidt ◽

Özüm S. Özgül ◽

Lynn B. Eitner ◽

...

Keyword(s):

Electrical Stimulation ◽

Test Stimulus ◽

Evoked Potentials ◽

Pain Intensity ◽

Rating Scale ◽

Pain Modulation ◽

Conditioned Pain Modulation ◽

Heat Pain ◽

Dominant Hand ◽

Group Level

Different paradigms can assess the effect of conditioned pain modulation (CPM). The aim of the present study was to compare heat pain, as an often used test stimulus (TS), to painful cutaneous electrical stimulation (PCES), having the advantage of the additional recording of PCES-related evoked potentials. In 28 healthy subjects we applied heat and PCES at the dominant hand as test stimulus (TS) to compare the CPM-effect elicited by hand immersion into cold water (10 °C) as conditioning stimulus (CS). Subjects rated the pain intensity of TS at baseline, during and 5 min after CS application and additionally of CS, on a numerical rating scale (NRS) (0–100). The ‘early’ (during CS–before CS) and ‘late’ (after CS–before CS) CPM-effects were analyzed. Parallel to the PCES, the related evoked potentials were recorded via Cz to evaluate any changes in PCES-amplitudes. CS reduced significantly the pain intensity of both PCES and heat pain as TS. On a group level, the CPM-effect did not differ significantly between both paradigms. Both early and late CPM-effect based on PCES correlated significantly with the CS pain intensity (r = −0.630 and −0.503, respectively), whereas using heat pain the correlation was not significant. We found a significant reduction of PCES-amplitudes during CS, but this did not correlate with the PCES-induced pain intensity. Correlation with the CS painfulness (r = −0.464) did not achieve the significance level after Bonferroni correction. The extent of the CPM effects was similar in both testing paradigms at group level, despite intraindividual differences. Future studies should further elicit the exact mechanisms explaining the modality of these specific differences.

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

Somatosensory & Motor Research ◽

10.3109/08990220.2014.887562 ◽

2014 ◽

Vol 31 (2) ◽

pp. 100-110 ◽

Cited By ~ 3

Author(s):

Miriam Kunz ◽

Parvaneh Mohammadian ◽

Bertold Renner ◽

Stephan Roscher ◽

Gerd Kobal ◽

...

Keyword(s):

Evoked Potentials ◽

Somatosensory Evoked Potentials ◽

Pain Modulation ◽

Conditioned Pain Modulation ◽

Sensitive Tool

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EPV 13. Pain-related evoked potentials depict the effect of conditioned pain modulation in healthy subjects

Clinical Neurophysiology ◽

10.1016/j.clinph.2016.05.033 ◽

2016 ◽

Vol 127 (9) ◽

pp. e218-e219

Author(s):

O. Höffken ◽

Î. Özgül ◽

E. Enax-Krumova ◽

M. Tegenthoff ◽

C. Maier

Keyword(s):

Evoked Potentials ◽

Healthy Subjects ◽

Pain Modulation ◽

Conditioned Pain Modulation

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Distraction by a cognitive task has a higher impact on electrophysiological measures compared with conditioned pain modulation

10.21203/rs.3.rs-26882/v2 ◽

2020 ◽

Author(s):

A. T. Lisa Do ◽

Elena Enax-Krumova ◽

Özüm Özgül ◽

Lynn B. Eitner ◽

Stefanie Heba ◽

...

Keyword(s):

Evoked Potentials ◽

Pain Intensity ◽

Rating Scale ◽

Cold Water ◽

Cognitive Task ◽

Pain Modulation ◽

Conditioned Pain Modulation ◽

Cognitive Distraction ◽

Painful Sensation ◽

Back Task

Abstract Background Conditioned pain modulation (CPM) evaluates the effect of a painful conditioning stimulus (CS) on a painful test stimulus (TS). Using painful cutaneous electrical stimulation (PCES) as TS and painful cold water as CS, the pain relief was paralleled by a decrease in evoked potentials (PCES-EPs). We now aimed to compare the effect of CPM with cognitive distraction on PCES-induced pain and PCES-EP amplitudes. Methods PCES was performed using surface electrodes inducing a painful sensation of 60 (NRS 0-100) on one hand. In a crossover design healthy subjects (included: n=38, analyzed: n=23) immersed the contralateral hand into 10°C cold water (CS) for CPM evaluation and performed the 1-back task for cognitive distraction. Before and during the CS and 1-back task, respectively, subjects rated the pain intensity of PCES and simultaneously cortical evoked potentials were recorded. Results Both CPM and cognitive distraction significantly reduced PCES-EP amplitudes (CPM: 27.6±12.0μV to 20.2±9.5μV, cognitive distraction: 30.3±14.2µV to 13.6±5.2μV, p<0.001) and PCES-induced pain (on a 0–100 numerical rating scale: CPM: 58±4 to 41.1±12.3, cognitive distraction: 58.3±4.4 to 38.0±13.0, p<0.001), though the changes in pain intensity and PCES-amplitude did not correlate. The changes of the PCES-EP amplitudes during cognitive distraction were more pronounced than during CPM (p=0.001). Conclusions CPM and cognitive distraction reduced the PCES-induced pain to a similar extent. The more pronounced decrease of PCES-EP amplitudes after distraction by a cognitive task implies that both conditions might not represent the general pain modulatory capacity of individuals, but may underlie different neuronal mechanisms with the final common pathway of perceived pain reduction.

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Distraction by a cognitive task has a higher impact on electrophysiological measures compared with conditioned pain modulation

10.21203/rs.3.rs-26882/v3 ◽

2020 ◽

Author(s):

A. T. Lisa Do ◽

Elena Enax-Krumova ◽

Özüm Özgül ◽

Lynn B. Eitner ◽

Stefanie Heba ◽

...

Keyword(s):

Evoked Potentials ◽

Pain Intensity ◽

Rating Scale ◽

Cold Water ◽

Cognitive Task ◽

Pain Modulation ◽

Conditioned Pain Modulation ◽

Cognitive Distraction ◽

Painful Sensation ◽

Back Task

Abstract Background Conditioned pain modulation (CPM) evaluates the effect of a painful conditioning stimulus (CS) on a painful test stimulus (TS). Using painful cutaneous electrical stimulation (PCES) as TS and painful cold water as CS, the pain relief was paralleled by a decrease in evoked potentials (PCES-EPs). We now aimed to compare the effect of CPM with cognitive distraction on PCES-induced pain and PCES-EP amplitudes. Methods PCES was performed using surface electrodes inducing a painful sensation of 60 (NRS 0-100) on one hand. In a crossover design healthy subjects (included: n=38, analyzed: n=23) immersed the contralateral hand into 10°C cold water (CS) for CPM evaluation and performed the 1-back task for cognitive distraction. Before and during the CS and 1-back task, respectively, subjects rated the pain intensity of PCES and simultaneously cortical evoked potentials were recorded. Results Both CPM and cognitive distraction significantly reduced PCES-EP amplitudes (CPM: 27.6±12.0μV to 20.2±9.5μV, cognitive distraction: 30.3±14.2µV to 13.6±5.2μV, p<0.001) and PCES-induced pain (on a 0–100 numerical rating scale: CPM: 58±4 to 41.1±12.3, cognitive distraction: 58.3±4.4 to 38.0±13.0, p<0.001), though the changes in pain intensity and PCES-amplitude did not correlate. The changes of the PCES-EP amplitudes during cognitive distraction were more pronounced than during CPM (p=0.001).Conclusions CPM and cognitive distraction reduced the PCES-induced pain to a similar extent. The more pronounced decrease of PCES-EP amplitudes after distraction by a cognitive task implies that both conditions might not represent the general pain modulatory capacity of individuals, but may underlie different neuronal mechanisms with the final common pathway of perceived pain reduction.

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