Central and peripheral pain sensitization during an ultra-marathon competition

2018 ◽  
Vol 18 (4) ◽  
pp. 703-709 ◽  
Author(s):  
James W. Agnew ◽  
Steven B. Hammer ◽  
Alexandre L. Roy ◽  
Amina Rahmoune
Keyword(s):  
Pain Threshold ◽  
Pressure Pain Threshold ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Central Pain ◽  
Dominant Hand ◽  
Pressure Pain ◽  
Peripheral Pain ◽  
Pain Sensitization ◽  
Ultra Endurance

Abstract Background and aims The participation in ultra-marathons and other ultra-endurance events has increased exponentially over the past decade. There is insufficient data on variation in pain mechanisms in exercise overall but especially in the ultra-endurance athlete population. To further understand peripheral and central pain sensitization we have investigated pressure pain threshold and conditioned pain modulation during three separate ultra-marathon competitions. Methods Each ultra-marathon investigated was held in the state of Florida, USA, over flat, sandy and paved surfaces under generally warm to hot, humid conditions. Pressure pain threshold was measured utilizing a Baseline © Dolorimeter. The blunt end of the dolorimeter stylus was placed onto the distal dominant arm, equidistant between the distal radius and ulna, three times in a blinded manner to insure that the testing technician did not influence the subject’s responses. Conditioned pain modulation was measured immediately after the PPT measures by placing the non-dominant hand in a cool water bath maintained at 15°C. The same dolorimeter measurement was repeated two more times on the dominant arm while the non-dominant hand remained in the water. Data was analyzed with a paired t-test. Results Pressure pain threshold was significantly decreased (p<0.05) at 25, 50 and 100 miles. Conditioned pain modulation was also significantly decreased (p<0.05) at 25, 50 and 100 miles of an ultra-marathon competition. Conclusions Together these data suggest an increased peripheral and/or central pain sensitization starting at 25 miles and continuing throughout an ultra-marathon competition run in these conditions. This is the first study that provides evidence of a decreased peripheral pain threshold and decreased central pain inhibition from ultra-marathon running. Decreases in both the peripheral pain threshold and central inhibition may result from nociceptor plasticity, central sensitization or a combination of both. Implications Based on previous research that has indicated a central sensitization resulting from inflammation and the well-documented inflammatory response to the rigors of ultra-marathon competition, we suggest the decreased peripheral pain threshold and decreased descending pain inhibition results from this inflammatory response of running an ultra-marathon.

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.

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.

Pain sensitivity increases more in younger runners during an ultra-marathon

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
James W. Agnew ◽  
Alexandre L. Roy ◽  
Steven B. Hammer ◽  
Frederick F. Strale
Keyword(s):  
Pain Sensitivity ◽  
Cold Water ◽  
Statistical Significance ◽  
Pressure Pain Threshold ◽  
Pain Modulation ◽  
Central Pain ◽  
Dominant Hand ◽  
Pressure Algometer ◽  
The Difference ◽  
Ultra Endurance

AbstractObjectivesUltra-endurance research interest has increased in parallel with an increased worldwide participation in these extreme activities. Pain-related data for the growing population of ultra-endurance athletes, however, is insufficient. More data is especially needed regarding the variation in the aging populations of these athletes. We have previously shown that peripheral and central pain sensitivity increases during an ultra-marathon. To further clarify these changes in pain sensitivity during ultra-endurance competition we investigated these variations in two age populations: Younger runners ≤ 39-year-old (younger) and an older group of runners being ≥ 40 years of age (older).MethodsSubjects were recruited from ultra-marathon competitions held over a three-year period in Florida, USA. All courses were flat with either hard macadam surface or soft sandy trails; run in hot, humid weather conditions. Pressure pain threshold (PPT) was measured with a pressure algometer on the distal, dominant arm before and immediately after an ultra-marathon. Conditioned pain modulation (CPM) was also measured pre and post, immediately after the PPT by placing the non-dominant hand in a cold-water bath maintained at 13.5 ± 1.5 °C. The difference between the pre and post measurements for both PPT and CPM were calculated and referred to as ΔPPT and ΔCPM, respectively for analysis. Data were analyzed with a Mixed 2 × 2 (Within X Between) MANOVA.ResultsBoth PPT and CPM decreased during the ultra-marathons (p<0.05) in the younger group of runners. In the older runners there was not a statistically significant decrease in PPT during the ultramarathons whereas CPM did significantly decrease statistically (p=0.031). The ΔPPT was less in the older group compared to the younger group (p=0.018). The difference between the younger and older groups ΔCPM approached statistical significance at p=0.093.ConclusionsThis statistical evidence suggests that the overall increase in peripheral and possibly central pain sensitivity was different between our age groups. Pain sensitivity during the ultra-marathon increased more in our younger group of runners than in our older group. This study suggests that there is an unidentified factor in an older population of ultra-marathon runners that results in an attenuated increase in pain sensitivity during an ultra-endurance activity. These factors may include a decreased innate immune response, lower fitness level, lower exertion during the ultra-marathon, variation in endorphin, enkephalin, endocannabinoid and psychological factors in the older age runners.

Reliability of the conditioned pain modulation paradigm across three anatomical sites

2020 ◽  
Vol 20 (2) ◽  
pp. 283-296
Author(s):  
Rania Nuwailati ◽  
Michele Curatolo ◽  
Linda LeResche ◽  
Douglas S. Ramsay ◽  
Charles Spiekerman ◽  
...  
Keyword(s):  
Cold Pressor Test ◽  
Pressure Pain Threshold ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Dominant Hand ◽  
Pain Mechanisms ◽  
Relative Reliability ◽  
Contralateral Hand ◽  
The Face ◽  
Absolute Reliability

AbstractBackground and aimsConditioned Pain Modulation (CPM) is a measure of pain inhibition-facilitation in humans that may elucidate pain mechanisms and potentially serve as a diagnostic test. In laboratory settings, the difference between two pain measures [painful test stimulus (TS) without and with the conditioning stimulus (CS) application] reflects the CPM magnitude. Before the CPM test can be used as a diagnostic tool, its reliability on the same day (intra-session) and across multiple days (inter-session) needs to be known. Furthermore, it is important to determine the most reliable anatomical sites for both the TS and the CS. This study aimed to measure the intra-session and inter-session reliability of the CPM test paradigm in healthy subjects with the TS (pressure pain threshold-PPT) applied to three test sites: the face, hand, and dorsum of the foot, and the CS (cold pressor test-CPT) applied to the contralateral hand.MethodsSixty healthy participants aged 18–65 were tested by the same examiner on 3 separate days, with an interval of 2–7 days. On each day, testing was comprised of two identical experimental sessions in which the PPT test was performed on each of the three dominant anatomical sites in randomized order followed by the CPM test (repeating the PPT with CPT on the non-dominant hand). CPM magnitude was calculated as the percent change in PPT. The Intraclass Correlation Coefficient (ICC), Coefficient of Variation (CV), and Bland-Altman analyses were used to assess reliability.ResultsPPT relative reliability ranged from good to excellent at all three sites; the hand showed an intra-session ICC of 0.90 (0.84, 0.94) before CPT and ICC of 0.89 (0.83, 0.92) during CPT. The PPT absolute reliability was also high, showing a low bias and small variability when performed on all three sites; for example, CV of the hand intra-session was 8.0 before CPT and 8.1 during CPT. The relative reliability of the CPM test, although only fair, was most reliable when performed during the intra-session visits on the hand; ICC of 0.57 (0.37, 0.71) vs. 0.20 (0.03, 0.39) for the face, and 0.22 (0.01, 0.46) for the foot. The inter-session reliability was lower in all three anatomical sites, with the best reliability on the hand with an ICC of 0.40 (0.23, 0.55). The pattern of absolute reliability of CPM was similar to the relative reliability findings, with the reliability best on the hand, showing lower intra-session and inter-session variability (CV% = 43.5 and 51.5, vs. 70.1 and 73.1 for the face, and 75.9 and 78.9 for the foot). The CPM test was more reliable in women than in men, and in older vs. younger participants.DiscussionThe CPM test was most reliable when the TS was applied to the dominant hand and CS performed on the contralateral hand. These data indicate that using the CS and TS in the same but contralateral dermatome in CPM testing may create the most reliable results.

scholarly journals Conditioned Pain Modulation Is Not Impaired in Individuals with Frozen Shoulder: A Case-Control Study

2021 ◽  
Vol 18 (23) ◽  
pp. 12330
Author(s):  
Marta Aguilar-Rodríguez ◽  
Lirios Dueñas ◽  
Mercè Balasch i Bernat ◽  
Mira Meeus ◽  
Filip Struyf ◽  
...  
Keyword(s):  
Frozen Shoulder ◽  
Pressure Pain Threshold ◽  
Conditioning Stimulus ◽  
Cross Sectional Study ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Central Pain ◽  
Cross Sectional ◽  
Pain Mechanisms ◽  
The Absolute

Frozen shoulder (FS) is a poorly understood condition resulting in substantial shoulder pain and mobility deficits. The mechanisms behind FS are not yet fully understood, but, similar to other persistent pain states, central pain mechanisms may contribute to ongoing symptoms in this population. The objective of this research was to investigate conditioned pain modulation (CPM) in people with FS compared with pain-free individuals. A total of 64 individuals with FS and 64 healthy volunteers participated in this cross-sectional study. CPM was assessed by using the pressure pain threshold (PPT) and an occlusion cuff (tourniquet test) as the test and conditioning stimulus, respectively. The absolute and percentage of change in PPT (CPM effect) as well as pain profiles (pro-nociceptive vs. anti-nociceptive) of individuals with FS and healthy controls were calculated. No significant differences in the absolute change in the PPT or CPM effect were found in people with FS compared to pain-free controls. Moreover, no between-group differences in the percentage of subjects with pro-nociceptive and anti-nociceptive pain profiles were observed. These results suggest that endogenous pain inhibition is normally functioning in people with FS. Altered central pain-processing mechanisms may thus not be a characteristic of this population.

scholarly journals Conditioned pain modulation assessment using contact heat as conditioning stimulus and two different test stimuli

2019 ◽  
Vol 72 (3-4) ◽  
pp. 66-71
Author(s):  
Aleksandar Knezevic ◽  
Milena Kovacevic ◽  
Ljiljana Klicov ◽  
Magdalena Pantic ◽  
Jana Vasin ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Pain Threshold ◽  
Pressure Pain Threshold ◽  
Conditioning Stimulus ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Heat Pain ◽  
Contact Heat ◽  
Pain Thresholds ◽  
Heat Pain Threshold

Introduction. The objective of the study was to determine the potentials and reliability of conditioned pain modulation effect in healthy population by application of a conditioning contact heat stimulus, and heat and pressure applied to the low back region as a test stimulus. Material and Methods. The study included 33 healthy subjects (average age 25.73 ? 5.35 years). Pressure and heat pain thresholds were examined on the paravertebral musculature of the lower back as test stimuli. Contact heat was used on the contralateral forearm as a conditioning stimulus. Conditioned pain modulation was calculated as the difference between pain thresholds after and before conditioning stimulus application. To assess the reliability, identical testing was performed 14 ? 2 days later. Results. The pressure and heat pain thresholds, after the conditioning stimulus, were significantly higher compared to pain thresholds obtained before the conditioning stimulus (101,63 N/cm2 ? 45,21N/cm2 vs 82,15 N/cm2 ? 36,15 N/cm2, t = -7,528, p < 0,001 and 47,08?C ? 2,19o C vs 45,00 ? 3,05?C, t = -6,644, p < 0,001, respectively). The reli?ability of the same protocol, measured 14 ? 2 days after the previous testing, showed good reliability of the pressure pain threshold (intraclass correlation coefficient = 0,636, 95% confidence interval 0,240 - 0,825), and fair of the heat pain threshold (intraclass cor?relation coefficient = 0,435, 95% confidence interval - 0,070 - 0,713). Conclusion. Conditioned pain modulation was successfully induced by contact heat applied via a thermode, a conditioning stimulus. The reliability of this method of testing proved to be fair when it comes to the heat pain threshold and good when it comes to the pressure pain threshold.

scholarly journals Pain Sensitisation in Women with Active Rheumatoid Arthritis: A Comparative Cross-Sectional Study

Arthritis ◽  
2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Nora Vladimirova ◽  
Anders Jespersen ◽  
Else Marie Bartels ◽  
Anton W. Christensen ◽  
Henning Bliddal ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Temporal Summation ◽  
Pain Threshold ◽  
Cuff Pressure ◽  
Pressure Pain Threshold ◽  
Pain Tolerance ◽  
Leg Pain ◽  
Central Pain ◽  
Pressure Pain ◽  
Pain Sensitisation

Objectives. In some rheumatoid arthritis (RA) patients, joint pain persists without signs of inflammation. This indicates that central pain sensitisation may play a role in the generation of chronic pain in a subgroup of RA. Our aim was to assess the degree of peripheral and central pain sensitisation in women with active RA compared to healthy controls (HC). Methods. 38 women with active RA (DAS28>2.6) and 38 female HC were included in, and completed, the study. Exclusion criteria were polyneuropathy, pregnancy, and no Danish language. Cuff Pressure Algometry measurements were carried out on the dominant lower leg. Pain threshold, pain tolerance, and pain sensitivity during tonic painful stimulation were recorded. Results. Women with active RA had significantly lower pain threshold (p<0.01) and pain tolerance (p<0.01) than HC. The mean temporal summation- (TS-) index in RA patients was 0.98 (SEM: 0.09) and 0.71 (SEM: 0.04) in HC (p<0.01). Conclusion. Patients with active RA showed decreased pressure-pain threshold compared to HC. In addition, temporal summation of pressure-pain was increased, indicating central pain sensitization, at least in some patients. Defining this subgroup of patients may be of importance when considering treatment strategies.

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 &lt; 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.

scholarly journals Slowly repeated evoked pain (SREP) as a central sensitization marker in episodic migraine patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Pablo de la Coba ◽  
Stephen Bruehl ◽  
Gustavo A. Reyes del Paso
Keyword(s):  
Central Sensitization ◽  
Temporal Summation ◽  
Pain Threshold ◽  
Episodic Migraine ◽  
Pain Modulation ◽  
Pain Tolerance ◽  
Central Pain ◽  
Healthy Individuals ◽  
Discriminative Ability ◽  
Pain Sensitization

AbstractMigraine headache is a pain condition characterized by severe and recurrent unilateral head pain. Among other mechanisms, central pain sensitization processes seem to be involved in the disorder. An experimental protocol based on slowly repeated evoked pain (SREP) has been shown to indicate pain sensitization in fibromyalgia patients and differentiate these patients from healthy individuals and rheumatoid arthritis patients. This study examined SREP sensitization in migraine patients and explored its potential usefulness as a central sensitization marker. The SREP protocol was administered to 40 episodic migraine (EM) patients not currently experiencing a headache and 40 healthy controls. SREP consisted of a series of 9 suprathreshold painful pressure stimuli of 5 s duration and a 30 s interstimulus interval. SREP sensitization was indexed by the increase in pain ratings across the stimuli. Pain threshold, pain tolerance and temporal summation of pain were also assessed. SREP sensitization was observed in EM, but not in healthy individuals (p < .001). SREP differentiated between EM and healthy individuals with up to 75% diagnostic accuracy. Pain threshold, pain tolerance and temporal summation of pain did not show significant discriminative ability. An SREP index value of 0.5 was the most sensitive cut-off for detecting central pain sensitization when prioritizing diagnostic sensitivity (0.88). Results provide evidence for SREP as a possible central sensitization marker with potential clinical utility in migraine patients. Inclusion of SREP in Quantitative Sensory Testing protocols may enhance the assessment of altered pain modulation in different pain conditions.

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