scholarly journals A pilot study investigating whether quantitative sensory testing alters after treatment in patients with fibromyalgia

2018 ◽  
Vol 12 (4) ◽  
pp. 250-256 ◽  
Author(s):  
Theresa Wodehouse ◽  
Kavita Poply ◽  
Shankar Ramaswamy ◽  
Saowarat Snidvongs ◽  
Julius Bourke ◽  
...  
Keyword(s):  
Pilot Study ◽  
Quantitative Sensory Testing ◽  
Fibromyalgia Impact Questionnaire ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Sensory Testing ◽  
Central Sensitisation ◽  
Pain Thresholds ◽  
Pressure Pain ◽  
Pressure Pain Thresholds

Background: Fibromyalgia is a chronic musculoskeletal pain condition that is often associated with sleep disturbances and fatigue. The pathophysiology of fibromyalgia is not understood, but indirect evidence suggests a central dysfunction of the nociceptive modulating system. The aim of this study was to evaluate whether quantitative sensory testing detects a change in pain thresholds in fibromyalgia patient receiving pregabalin treatment. Methods: A total of 25 patients were recruited for the study and received routine pregabalin, but only 14 patients completed the treatment. Assessment of pressure pain thresholds and changes in conditioned pain modulation using ischaemic pain as a conditioning stimulus were measured at baseline and every 4 weeks for 12 weeks. Fibromyalgia impact questionnaire, PainDETECT and SF-12 were also completed. Results: Patients with fibromyalgia demonstrated a less-efficient conditioned pain modulation at baseline. An efficient conditioned pain modulation was observed at 1 month and this was maintained until the final visit. Pressure pain thresholds (PPTs) showed a significant improvement from baseline. Patients also reported a similar magnitude of improvements in PainDETECT, fibromyalgia impact questionnaire (FIQ) and its impact on daily life and change in outcome for SF-12. Conclusion: This pilot study reports an increase in PPTs and improved conditioned pain modulation response after commencing pregabalin, which was maintained at 12 weeks, and this was supported by positive pain scores. Pregabalin is a licenced treatment for fibromyalgia in Europe, and its response to central sensitisation, particularly ‘dynamic responses’, has not been reported. We conclude that pregabalin has the potential to reduce peripheral and central sensitisation in patients with fibromyalgia, as measured using quantitative sensory testing.

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

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.

(177) Quantitative sensory testing of pressure pain thresholds in adolescents with Juvenile Fibromyalgia

2014 ◽  
Vol 15 (4) ◽  
pp. S20
Author(s):  
K. Barnett ◽  
D. Strotman ◽  
M. Bromberg ◽  
S. Sil ◽  
T. Ting ◽  
...  
Keyword(s):  
Quantitative Sensory Testing ◽  
Sensory Testing ◽  
Pain Thresholds ◽  
Pressure Pain ◽  
Juvenile Fibromyalgia ◽  
Pressure Pain Thresholds

scholarly journals Exploring the pain in patellofemoral pain: A systematic review and meta-analysis examining signs of central sensitization

2020 ◽  
Author(s):  
Kemery J. Sigmund ◽  
Marie K. Hoeger Bement ◽  
Jennifer E. Earl-Boehm
Keyword(s):  
Systematic Review ◽  
Central Sensitization ◽  
Temporal Summation ◽  
Meta Analysis ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Pain Thresholds ◽  
Pressure Pain ◽  
Pressure Pain Thresholds ◽  
Pain Mapping

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:

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

Pain Medicine ◽  
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.

scholarly journals An Exploratory Study of Endogenous Pain Modulatory Function in Patients Following Mild Traumatic Brain Injury

Pain Medicine ◽  
2019 ◽  
Vol 20 (11) ◽  
pp. 2198-2207 ◽  
Author(s):  
Christopher Carey ◽  
Jonathan Saxe ◽  
Fletcher A White ◽  
Kelly M Naugle
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Exploratory Study ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Pain Thresholds ◽  
Pressure Pain Thresholds ◽  
Post Traumatic ◽  
Headache Pain ◽  
Pain Inhibition

AbstractBackground. Recent animal research suggests that mild traumatic brain injury (mTBI) facilitates abnormal endogenous modulation of pain, potentially underlying the increased risk for persistent headaches following injury. However, no human studies have directly assessed the functioning of endogenous facilitory and inhibitory systems in the early stages after an mTBI. Objective. The purpose of this exploratory study was to examine trigeminal sensitization and endogenous pain inhibitory capacity in mTBI patients in the acute stage of injury compared with matched controls. We also examined whether post-traumatic headache pain intensity within the mTBI sample was related to sensitization and pain inhibitory capacity. Methods. Twenty-four mTBI patients recruited from emergency departments and 21 age-, race-, and sex-matched controls completed one experimental session. During this session, participants completed quantitative sensory tests measuring trigeminal sensitization (pressure pain thresholds and temporal summation of pain in the head) and endogenous pain inhibition (conditioned pain modulation). Participants also completed validated questionnaires measuring headache pain, depression, anxiety, and pain catastrophizing. Results. The results revealed that the mTBI group exhibited significantly decreased pressure pain thresholds of the head and decreased pain inhibition on the conditioned pain modulation test compared with the control group. Furthermore, correlational analysis showed that the measures of trigeminal sensitization and depression were significantly associated with headache pain intensity within the mTBI group. Conclusions. In conclusion, mTBI patients may be at risk for maladaptive changes to the functioning of endogenous pain modulatory systems following head injury that could increase risk for post-traumatic headaches.

Effect of conditioned pain modulation on trigeminal somatosensory function evaluated by quantitative sensory testing

Pain ◽  
2013 ◽  
Vol 154 (12) ◽  
pp. 2684-2690 ◽  
Author(s):  
Yuka Oono ◽  
Lene Baad-Hansen ◽  
Kelun Wang ◽  
Lars Arendt-Nielsen ◽  
Peter Svensson
Keyword(s):  
Quantitative Sensory Testing ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Sensory Testing ◽  
Somatosensory Function

Local hyperalgesia, normal endogenous modulation with pain report beyond its origin: a pilot study prompting further exploration into plantar fasciopathy

2020 ◽  
Vol 20 (2) ◽  
pp. 375-385
Author(s):  
Henrik Riel ◽  
Melanie L. Plinsinga ◽  
Rebecca Mellor ◽  
Shellie A. Boudreau ◽  
Viana Vuvan ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Pain Threshold ◽  
Pressure Pain Threshold ◽  
Plantar Fascia ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Pain Processing ◽  
Pain Thresholds ◽  
Pressure Pain ◽  
Plantar Fasciopathy

AbstractBackground and aimsPersistent tendinopathies were previously considered solely as peripheral conditions affecting the local tendinous tissue until quantitative sensory testing identified involvement of altered pain processing. In similar fashion, pain in patients with persistent plantar fasciopathy may also involve more than local tissue. The aim of this pilot study was to investigate potential differences in conditioned pain modulation and pressure and thermal pain thresholds, between individuals with PF and healthy pain-free controls, as a precursor to a larger-scale study.MethodsWe assessed 16 individuals with plantar fasciopathy and 11 pain-free controls. Plantar fasciopathy diagnosis was: palpation pain of the medial calcaneal tubercle or the proximal plantar fascia, duration ≥3 months, pain intensity ≥2/10, and ultrasound-measured plantar fascia thickness ≥4 mm. Quantitative sensory tests were performed locally at the plantar heel and remotely on the ipsilateral elbow. Assessments included pain thresholds for pressure, heat and cold, and conditioned pain modulation measured as change in local resting pressure pain threshold with cold water hand immersion. Participants rated pain intensity at pain threshold. Additionally, the area and distribution of plantar fasciopathy pain was drawn on a digital body chart of the lower limbs. Descriptive analyses were performed and between-group differences/effects expressed as standardised mean differences (d).ResultsThere was no conditioned pain modulation difference between participants with plantar fasciopathy and controls (d = 0.1). Largest effects were on local pressure pain threshold and reported pain intensity on pressure pain threshold (d > 1.8) followed by pain intensity for heat and cold pain thresholds (d = 0.3–1.5). According to the digital body chart, pain area extended beyond the plantar heel.ConclusionsThe unlikelihood of a difference in conditioned pain modulation yet a pain area extending beyond the plantar heel provide a basis for exploring altered pain processing in a larger-scale study.ImplicationsThis was the first study to investigate the presence of altered pain processing in individuals with plantar fasciopathy using a conditioned pain modulation paradigm and thermal pain thresholds. We found no indication of an altered pain processing based on these measures, however, patients rated pain higher on thresholds compared to controls which may be important to clinical practice and warrants further exploration in the future.

The inter- and intra-individual variance in descending pain modulation evoked by different conditioning stimuli in healthy men

2011 ◽  
Vol 2 (4) ◽  
pp. 162-169 ◽  
Author(s):  
Yuka Oono ◽  
Hongling Nie ◽  
Renata Lima Matos ◽  
Kelun Wang ◽  
Lars Arendt-Nielsen
Keyword(s):  
Coefficient Of Variation ◽  
Conditioning Stimulus ◽  
Pain Modulation ◽  
Noxious Stimulation ◽  
Pain Thresholds ◽  
Pressure Pain ◽  
Healthy Men ◽  
Individual Variations ◽  
Pressure Pain Thresholds ◽  
Conditioning Stimuli

AbstractBackground and purposeConditioned pain modulation (CPM) is a phenomenon in which pain is inhibited by heterotopic noxious stimulation. It is not known how the experimental condition affects the magnitude of the CPM response and the inter-and intra-individual variations. It is important to get the information of the test–retest reliability and inter–individual variations of CPM to apply CPM as a diagnostic tool or for screening analgesic compounds. This study evaluated (1) the magnitude of CPM, (2) the inter-individual coefficient of variation (inter-CV) and (3) the intra-individual coefficient of variation (intra-CV) to (A) different stimulus modalities to evoke CPM and (B) different assessment sites.MethodsTwelve healthy men (age 19–38 years) participated in this study. Cold pressor pain (CPP) (immersing the hand into cold water), tourniquet pain (cuff around the upper arm) and mechanical pressure pain (craniofacial region) were used in randomized order as conditioning stimuli (CS). The test stimulus (TS) was pressure pain applied to the right masseter muscle, left forearm and leg (bilateral tibialis anterior: TA). The responses were pressure pain thresholds (PPT), pressure pain tolerance (PPTol) thresholds and the pain intensity which was assessed on a visual analogue scale (VAS, 0–10 cm) following 1.4 and 1.6 × PPT applied to TA. The TS was applied before, during and 10 min after the CS. The intra-individual CV was estimated between different days.ResultsCPP induced the most powerful CPM on PPT (66.3 ± 10.0% increase), VAS ratings (41.5 ± 5.3% reduction) and PPTol (32.6±4.6% increase), especially at TA, and resulted in the smallest inter-CV (41.4–60.1%). Independently of the CS, the inter-CV in general showed that the recordings from the orofacial region and the forearm had smaller values than from the leg. The smallest intra-CV value was obtained in pain ratings with CPP (27.0%).ConclusionsThis study suggests that (1) the CPP evokes the largest CPM, (2) the leg as the assessment site results in the largest CPM responses and (3) the CPP causes the smallest inter- and intra-CV.ImplicationThe present investigation implicates that the CPP is the most efficient conditioning stimulus to induce CPM when assessed by pressure pain thresholds.

The Effect of Conditioned Pain Modulation on Tonic Heat Pain Assessed Using Participant-Controlled Temperature

Pain Medicine ◽  
2020 ◽  
Vol 21 (11) ◽  
pp. 2839-2849
Author(s):  
Laura Sirucek ◽  
Catherine Ruth Jutzeler ◽  
Jan Rosner ◽  
Petra Schweinhardt ◽  
Armin Curt ◽  
...  
Keyword(s):  
Test Stimulus ◽  
Temporal Summation ◽  
Pressure Pain Threshold ◽  
Conditioning Stimulus ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Heat Pain ◽  
Pressure Pain ◽  
Withdrawal Reflex ◽  
Pressure Pain Thresholds

Abstract Objective Descending pain modulation can be experimentally assessed by way of testing conditioned pain modulation. The application of tonic heat as a test stimulus in such paradigms offers the possibility of observing dynamic pain responses, such as adaptation and temporal summation of pain. Here we investigated conditioned pain modulation effects on tonic heat employing participant-controlled temperature, an alternative tonic heat pain assessment. Changes in pain perception are thereby represented by temperature adjustments performed by the participant, uncoupling this approach from direct pain ratings. Participant-controlled temperature has emerged as a reliable and sex-independent measure of tonic heat. Methods Thirty healthy subjects underwent a sequential conditioned pain modulation paradigm, in which a cold water bath was applied as the conditioning stimulus and tonic heat as a test stimulus. Subjects were instructed to change the temperature of the thermode in response to variations in perception to tonic heat in order to maintain their initial rating over a two-minute period. Two additional test stimuli (i.e., lower limb noxious withdrawal reflex and pressure pain threshold) were included as positive controls for conditioned pain modulation effects. Results Participant-controlled temperature revealed conditioned pain modulation effects on temporal summation of pain (P = 0.01). Increased noxious withdrawal reflex thresholds (P = 0.004) and pressure pain thresholds (P < 0.001) in response to conditioning also confirmed inhibitory conditioned pain modulation effects. Conclusions The measured interaction between conditioned pain modulation and temporal summation of pain supports the participant-controlled temperature approach as a promising method to explore dynamic inhibitory and facilitatory pain processes previously undetected by rating-based approaches.

Sign in / Sign up

Export Citation Format

Share Document