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

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.

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Reliability of the conditioned pain modulation paradigm across three anatomical sites

Scandinavian Journal of Pain ◽

10.1515/sjpain-2019-0080 ◽

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.

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Impaired Conditioned Pain Modulation in Young Female Adults with Long-Standing Patellofemoral Pain: A Single Blinded Cross-Sectional Study

Pain Medicine ◽

10.1093/pm/pnv017 ◽

2015 ◽

pp. pnv017 ◽

Cited By ~ 4

Author(s):

Michael Skovdal Rathleff ◽

Kristian Kjær Petersen ◽

Lars Arendt-Nielsen ◽

Kristian Thorborg ◽

Thomas Graven-Nielsen

Keyword(s):

Cross Sectional Study ◽

Patellofemoral Pain ◽

Young Female ◽

Pain Modulation ◽

Conditioned Pain Modulation ◽

Sectional Study ◽

Cross Sectional

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Central and peripheral pain sensitization during an ultra-marathon competition

Scandinavian Journal of Pain ◽

10.1515/sjpain-2018-0079 ◽

2018 ◽

Vol 18 (4) ◽

pp. 703-709 ◽

Cited By ~ 3

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.

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

Medicinski pregled ◽

10.2298/mpns1904066k: ◽

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.

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Individuals with Persistent Greater Trochanteric Pain Syndrome Exhibit Impaired Pain Modulation, as well as Poorer Physical and Psychological Health, Compared with Pain-Free Individuals: A Cross-Sectional Study

Pain Medicine ◽

10.1093/pm/pnaa047 ◽

2020 ◽

Vol 21 (11) ◽

pp. 2964-2974 ◽

Cited By ~ 1

Author(s):

Melanie Louise Plinsinga ◽

Brooke Kaye Coombes ◽

Rebecca Mellor ◽

Bill Vicenzino

Keyword(s):

Quality Of Life ◽

Pain Threshold ◽

Pressure Pain Threshold ◽

Pain Syndrome ◽

Cross Sectional Study ◽

Pain Modulation ◽

Greater Trochanteric Pain Syndrome ◽

Cross Sectional ◽

Hip Abductor

Abstract Objectives To compare physical, sensory, and psychosocial factors between individuals with greater trochanteric pain syndrome and controls and to explore factors associated with pain and disability. Design Cross-sectional study. Setting General community. Subjects Patients with persistent, clinically diagnosed greater trochanteric pain syndrome and healthy controls. Methods Participants completed tests of thermal and pressure pain threshold, conditioned pain modulation, temporal summation, muscle strength, physical function, physical activity, psychological factors, and health-related quality of life. Standardized mean differences between groups were calculated, and multiple linear regression identified factors associated with pain and disability. Results Forty patients (95% female, average [SD] age = 51 [9] years) and 58 controls (95% female, average [SD] age = 53 [11] years) were included. Heat pain threshold, temporal summation, and pain catastrophizing were not different between groups. Compared with controls, patients displayed significantly poorer quality of life (standardized mean difference = –2.66), lower pressure pain threshold locally (–1.47, remotely = –0.57), poorer health status (–1.22), impaired physical function (range = 0.64–1.20), less conditioned pain modulation (–1.01), weaker hip abductor/extensor strength (–1.01 and –0.59), higher depression (0.72) and anxiety (0.61) levels, lower cold pain threshold locally (–0.47, remotely = –0.39), and less time spent in (vigorous) physical activity (range = –0.43 to –0.39). Twenty-six percent of pain and disability was explained by depression, hip abductor strength, and time to complete stairs. Conclusions Patients with greater trochanteric pain syndrome exhibited poorer health-related quality of life, physical impairments, widespread hyperalgesia, and greater psychological distress than healthy controls. Physical and psychological factors were associated with pain and disability.

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

Pain Medicine ◽

10.1093/pm/pnaa041 ◽

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.

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

Brain Sciences ◽

10.3390/brainsci11091186 ◽

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.

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Contralateral mechanical hyperalgesia and altered pain modulation in men who have unilateral insertional Achilles tendinopathy: A cross-sectional study

Musculoskeletal Science and Practice ◽

10.1016/j.msksp.2021.102353 ◽

2021 ◽

Vol 52 ◽

pp. 102353

Author(s):

Patrick Vallance ◽

Liam Crowley ◽

Bill Vicenzino ◽

Peter Malliaras

Keyword(s):

Cross Sectional Study ◽

Achilles Tendinopathy ◽

Pain Modulation ◽

Mechanical Hyperalgesia ◽

Sectional Study ◽

Cross Sectional ◽

Insertional Achilles Tendinopathy

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Pain-related beliefs are associated with arm function in persons with frozen shoulder

Shoulder & Elbow ◽

10.1177/1758573220921561 ◽

2020 ◽

Vol 12 (6) ◽

pp. 432-440

Author(s):

L De Baets ◽

T Matheve ◽

J Traxler ◽

JWS Vlaeyen ◽

A Timmermans

Keyword(s):

Pain Intensity ◽

Self Efficacy ◽

Glenohumeral Joint ◽

Pain Catastrophizing ◽

Frozen Shoulder ◽

Cross Sectional Study ◽

Cross Sectional ◽

Negative Effect ◽

Explained Variance ◽

Arm Function

Background Frozen shoulder is a painful glenohumeral joint condition. Pain-related beliefs are recognized drivers of function in musculoskeletal conditions. This cross-sectional study investigates associations between pain-related beliefs and arm function in frozen shoulder. Methods Pain intensity, arm function (Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH)), pain catastrophizing (Pain Catastrophizing Scale (PCS)), pain-related fear (Tampa Scale for Kinesiophobia (TSK-11)) and pain self-efficacy (Pain Self-Efficacy Questionnaire (PSEQ)) were administered in 85 persons with frozen shoulder. Correlation analyses assessed associations between pain-related beliefs and arm function. Regression analysis calculated the explained variance in arm function by pain-related beliefs. Results Pain-related fear, pain catastrophizing and pain self-efficacy were significantly associated with arm function (r = 0.51; r = 0.45 and r = −0.69, all p < .0001, respectively). Thirty-one percent of variance in arm function was explained by control variables, with pain intensity being the only significant one. After adding TSK-11, PCS and PSEQ scores to the model, 26% extra variance in arm function was explained, with significant contributions of pain intensity, pain-related fear and pain self-efficacy (R2 = 0.57). Conclusions Attention should be paid towards the negative effect of pain-related fear on outcomes in frozen shoulder and towards building one’s pain self-efficacy given its protective value in pain management.

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