scholarly journals The Potential Clinical Utility of Pressure-Based vs. Heat-Based Paradigms to Measure Conditioned Pain Modulation in Healthy Individuals and Those With Chronic Pain

2021 ◽  
Vol 2 ◽  
Author(s):  
Rima El-Sayed ◽  
Camille Fauchon ◽  
Junseok A. Kim ◽  
Shahrzad Firouzian ◽  
Natalie R. Osborne ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Pain Treatment ◽  
Detection Threshold ◽  
Conditioning Stimulus ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Healthy Individuals ◽  
Significant Difference ◽  
Clinical Adoption

Conditioned pain modulation (CPM) is a physiological measure thought to reflect an individual's endogenous pain modulation system. CPM varies across individuals and provides insight into chronic pain pathophysiology. There is growing evidence that CPM may help predict individual pain treatment outcome. However, paradigm variabilities and practical issues have impeded widespread clinical adoption of CPM assessment. This study aimed to compare two CPM paradigms in people with chronic pain and healthy individuals. A total of 30 individuals (12 chronic pain, 18 healthy) underwent two CPM paradigms. The heat CPM paradigm acquired pain intensity ratings evoked by a test stimulus (TS) applied before and during the conditioning stimulus (CS). The pressure CPM paradigm acquired continuous pain intensity ratings of a gradually increasing TS, before and during CS. Pain intensity was rated from 0 (no pain) to 100 (worst pain imaginable); Pain50 is the stimulus level for a response rated 50. Heat and pressure CPM were calculated as a change in TS pain intensity ratings at Pain50, where negative CPM scores indicate pain inhibition. We also determined CPM in the pressure paradigm as change in pressure pain detection threshold (PDT). We found that in healthy individuals the CPM effect was significantly more inhibitory using the pressure paradigm than the heat paradigm. The pressure CPM effect was also significantly more inhibitory when based on changes at Pain50 than at PDT. However, in individuals with chronic pain there was no significant difference in pressure CPM compared to heat or PDT CPM. There was no significant correlation between clinical pain measures (painDETECT and Brief Pain Inventory) and paradigm type (heat vs. pressure), although heat-based CPM and painDETECT scores showed a trend. Importantly, the pressure paradigm could be administered in less time than the heat paradigm. Thus, our study indicates that in healthy individuals, interpretation of CPM findings should consider potential modality-dependent effects. However, in individuals with chronic pain, either heat or pressure paradigms can similarly be used to assess CPM. Given the practical advantages of the pressure paradigm (e.g., short test time, ease of use), we propose this approach to be well-suited for clinical adoption.

Fixed or adapted conditioning intensity for repeated conditioned pain modulation

2017 ◽  
Vol 16 (1) ◽  
pp. 176-176
Author(s):  
M. Hoegh ◽  
K.K. Petersen ◽  
T. Graven-Nielsen
Keyword(s):  
Pain Intensity ◽  
Repeated Measures ◽  
Rating Scale ◽  
Cuff Pressure ◽  
Detection Threshold ◽  
Conditioning Stimulus ◽  
Pain Modulation ◽  
Pain Tolerance ◽  
Conditioned Pain Modulation ◽  
The Difference

Abstract Aims Conditioned pain modulation (CPM) is used to assess descending pain modulation through a test stimulation (TS) and a conditioning stimulation (CS). Due to potential carry-over effects, sequential CPM paradigms might alter the intensity of the CS, which potentially can alter the CPM-effect. This study aimed to investigate the difference between a fixed and adaptive CS intensity on CPM-effect. Methods On the dominant leg of 20 healthy subjects the cuff pressure detection threshold (PDT) was recorded as TS and the pain tolerance threshold (PTT) was assessed on the non-dominant leg for estimating the CS. The difference in PDT before and during CS defined the CPM-effect. The CPM-effect was assessed four times using a CS with intensities of 70% of baseline PTT (fixed) or 70% of PTT measured throughout the session (adaptive). Pain intensity of the conditioning stimulus was assessed on a numeric rating scale (NRS). Data were analyzed with repeated-measures ANOVA. Results No difference was found comparing the four PDTs assessed before CSs for the fixed and the adaptive paradigms. The CS pressure intensity for the adaptive paradigm was increasing during the four repeated assessments (P < 0.01). The pain intensity was similar during the fixed (NRS: 5.8±0.5) and the adjusted paradigm (NRS: 6.0±0.4). The CPM-effect was higher using the fixed condition compared with the adaptive condition (P < 0.05). Conclusions The current study found that sequential CPM paradigms using a fixed conditioning stimulus produced an increased CPM-effect compared with adaptive and increasing conditioning intensities.

scholarly journals Inter-Individual Differences Explain More Variance in Conditioned Pain Modulation Than Age, Sex and Conditioning Stimulus Intensity Combined

2021 ◽  
Vol 11 (9) ◽  
pp. 1186
Author(s):  
Philipp Graeff ◽  
Alina Itter ◽  
Katharina Wach ◽  
Ruth Ruscheweyh
Keyword(s):  
Individual Differences ◽  
Pain Intensity ◽  
Repeated Measures ◽  
Conditioning Stimulus ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Cross Sectional ◽  
Mixed Effect ◽  
Mixed Effect Models ◽  
Endogenous Pain Modulation

Conditioned pain modulation (CPM) describes the reduction in pain evoked by a test stimulus (TS) when presented together with a heterotopic painful conditioning stimulus (CS). CPM has been proposed to reflect inter-individual differences in endogenous pain modulation, which may predict susceptibility for acute and chronic pain. Here, we aimed to estimate the relative variance in CPM explained by inter-individual differences compared to age, sex, and CS physical and pain intensity. We constructed linear and mixed effect models on pooled data from 171 participants of several studies, of which 97 had repeated measures. Cross-sectional analyses showed no significant effect of age, sex or CS intensity. Repeated measures analyses revealed a significant effect of CS physical intensity (p = 0.002) but not CS pain intensity (p = 0.159). Variance decomposition showed that inter-individual differences accounted for 24% to 34% of the variance in CPM while age, sex, and CS intensity together explained <3% to 12%. In conclusion, the variance in CPM explained by inter-individual differences largely exceeds that of commonly considered factors such as age, sex and CS intensity. This may explain why predictive capability of these factors has had conflicting results and suggests that future models investigating them should account for inter-individual differences.

scholarly journals Telemedicine for chronic pain treatment during the COVID‐19 pandemic: Do pain intensity and anxiousness correlate with patient acceptance?

Pain Practice ◽  
2021 ◽  
Author(s):  
Michael Alexander Harnik ◽  
Larissa Blättler ◽  
Andreas Limacher ◽  
Florian Reisig ◽  
Martin Grosse Holtforth ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Pain Treatment ◽  
Patient Acceptance ◽  
Chronic Pain Treatment

scholarly journals Ejaculatory Pain

2007 ◽  
Vol 107 (2) ◽  
pp. 298-304 ◽  
Author(s):  
Eske K. Aasvang ◽  
Bo Møhl ◽  
Henrik Kehlet
Keyword(s):  
Chronic Pain ◽  
Sexual Dysfunction ◽  
Quantitative Sensory Testing ◽  
Groin Hernia ◽  
Pain Treatment ◽  
Detection Threshold ◽  
Control Group ◽  
Sensory Testing ◽  
Detection Thresholds ◽  
Pain Detection

Background Sexual dysfunction due to ejaculatory and genital pain after groin hernia surgery may occur in approximately 2.5% of patients. However, the specific psychosexological and neurophysiologic characteristics have not been described, thereby precluding assessment of pathogenic mechanisms and treatment strategies. Methods Ten patients with severe pain-related sexual dysfunction and ejaculatory pain were assessed in detail by quantitative sensory testing and interviewed by a psychologist specialized in evaluating sexual functional disorders and were compared with a control group of 20 patients with chronic pain after groin hernia repair but without sexual dysfunction, to identify sensory changes associated with ejaculatory pain. Results Quantitative sensory testing showed significantly higher thermal and mechanical detection thresholds and lowered mechanical pain detection thresholds in both groups compared with the nonpainful side. Pressure pain detection threshold and tolerance were significantly lower in the ejaculatory pain group compared with the control group. 'The maximum pain was specifically located at the external inguinal annulus in all ejaculatory pain patients, but not in controls. The psychosexual interview revealed no major psychosexual disturbances and concluded that the pain was of somatic origin. All patients with ejaculatory pain had experienced major negative life changes and deterioration in their overall quality of life and sexual function as a result of the hernia operation. Conclusions Postherniotomy ejaculatory pain and pain-related sexual dysfunction is a specific chronic pain state that may be caused by pathology involving the vas deferens and/or nerve damage. Therapeutic strategies should therefore include neuropathic pain treatment and/or surgical exploration.

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

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
A. T. L. Do ◽  
E. K. Enax-Krumova ◽  
Ö. Özgül ◽  
L. B. Eitner ◽  
S. 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 ± 12.0 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.

scholarly journals Assessment of conditioned pain modulation in healthy participants and patients with chronic pain

2019 ◽  
Vol 13 (2) ◽  
pp. 99-106 ◽  
Author(s):  
Kristian K. Petersen ◽  
Megan E. McPhee ◽  
Morten S. Hoegh ◽  
Thomas Graven-Nielsen
Keyword(s):  
Chronic Pain ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Healthy Participants

Not just a matter of pain intensity: Effects of three different conditioning stimuli on conditioned pain modulation effects

2018 ◽  
Vol 48 (5) ◽  
pp. 287-293 ◽  
Author(s):  
Valquíria Aparecida da Silva ◽  
Ricardo Galhardoni ◽  
Manoel Jacobsen Teixeira ◽  
Daniel Ciampi de Andrade
Keyword(s):  
Pain Intensity ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Conditioning Stimuli

Individual variability and sex differences in conditioned pain modulation and the impact of resilience, and conditioning stimulus pain unpleasantness and salience

Pain ◽  
2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Shahrzad Firouzian ◽  
Natalie R. Osborne ◽  
Joshua C. Cheng ◽  
Junseok A. Kim ◽  
Rachael L. Bosma ◽  
...  
Keyword(s):  
Sex Differences ◽  
Conditioning Stimulus ◽  
Individual Variability ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
The Impact ◽  
Pain Unpleasantness

scholarly journals Adaptations in Evoked Pain Sensitivity and Conditioned Pain Modulation after Development of Chronic Neck Pain

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Bahar Shahidi ◽  
Katrina S. Maluf
Keyword(s):  
Neck Pain ◽  
Pain Sensitivity ◽  
Time Course ◽  
Secondary Analysis ◽  
Chronic Neck Pain ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Healthy Individuals ◽  
Cold Pain

Numerous studies demonstrate elevated pain sensitivity and impaired conditioned pain modulation (CPM) in patients with chronic musculoskeletal pain compared to healthy individuals; however, the time course of changes in pain sensitivity and CPM after the development of a chronic pain condition is unclear. Secondary analysis of data from a prospective investigation examined changes in evoked pain sensitivity and CPM before and after development of chronic neck pain (CNP). 171 healthy office workers participated in a baseline assessment, followed by monthly online questionnaires to identify those who developed CNP over the subsequent year. These individuals (N=17) and a cohort of participants (N=10) who remained pain-free during the follow-up period returned for a 12-month follow-up assessment of mechanical and thermal pain sensitivity and CPM. Pain sensitivity measures did not differ between groups at baseline; however, cold pain threshold decreased in the CNP group at follow-up (p<0.05). CPM was lower at baseline in the CNP group compared to those who reported no neck pain (p<0.02) and remained unchanged one year later. These findings indicate that CPM is reduced in healthy individuals prior to the development of chronic neck pain and the subsequent reduction of thresholds for cold but not pressure pain.

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