scholarly journals Conditioned pain modulation is minimally influenced by cognitive evaluation or imagery of the conditioning stimulus

2014 ◽  
pp. 689 ◽  
Author(s):  
Jiang-Ti Kong ◽  
Mario Bernaba ◽  
Kevin Johnson ◽  
Sean Mackey
Keyword(s):  
Conditioning Stimulus ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Cognitive Evaluation

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 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 Development of a new bed-side-test assessing conditioned pain modulation: a test-retest reliability study

2019 ◽  
Vol 19 (3) ◽  
pp. 565-574 ◽  
Author(s):  
Jesper Bie Larsen ◽  
Pascal Madeleine ◽  
Lars Arendt-Nielsen
Keyword(s):  
Test Stimulus ◽  
Conditioning Stimulus ◽  
Pain Modulation ◽  
Clinical Settings ◽  
Conditioned Pain Modulation ◽  
Reliability Study ◽  
Test Protocol ◽  
Bedside Test ◽  
Pressure Algometer ◽  
Test Retest Reliability

Abstract Background and aims Conditioned pain modulation (CPM) is of considerable interest within pain research. Often CPM testing is conducted in experimental settings using complicated instrumentation, thus challenging the implementation in clinical settings. Being able to assess CPM in a fast and reliable way in clinical settings could lead to a new diagnostic tool allowing improved profiling of pain patients. Methods A test-retest reliability study and a methodological development study were conducted based on different populations. The reliability study included 22 healthy subjects, mean age 23.6 years (SD: 2.4) and the methodological study included 29 healthy subjects, mean age 21.5 years (SD: 1.6). As painful phasic test stimulus, a 6–10 kg handheld, spring-based pressure algometer was applied perpendicularly to the muscle belly of the tibialis anterior muscle for 10 s and as painful tonic conditioning stimulus, 1–2 standard clamps, inducing a force of 1.3 kg, were applied extra-segmentally at the ipsilateral earlobe for 60–120 s. Four different test protocols were evaluated, of which one protocol was investigated for reliability. Test protocol 1 used a 6 kg pressure algometer as painful phasic test stimulus and a single clamp applied for 60 s as painful tonic conditioning stimulus. Test protocol 2 used a 10 kg pressure algometer as painful phasic test stimulus, and two clamps applied for 60 s as painful tonic conditioning stimulus. Test protocol 3 used a 10 kg pressure algometer as painful phasic test stimulus and a single clamp applied for 120 s as painful tonic conditioning stimulus. Test protocol 4 used a 6 kg pressure algometer as painful phasic test stimulus and a single clamp applied for 120 s as painful tonic conditioning stimulus. Results None of the stimuli caused any adverse events, e.g. bruises. In the reliability study (test protocol (1), non-significant CPM effects of 0.3 (SD: 1.6) and 0.2 (SD: 1.0) were observed in session 1 and 2, respectively. The intra-class correlations were 0.67 and 0.72 (p = < 0.01) and limits of agreement (LoA) ranged from −2.76 to 3.31. Non-significant CPM effects of 0.2 (SD: 1.0), −0.1 (SD: 1.1), and 0.0 (SD: 1.2) were observed for test protocol 2, 3, and 4, respectively). Conclusions The bedside test developed for investigating CPM was feasible and easy to use in healthy volunteers. No significant CPM effects were measured and a large variation in CPM effect ranging from −0.14 to 0.32 was observed. Intra-class correlation (ICC) values for the pressure algometer were interpreted as “good relative reliability” (test protocol 1), and LoA revealed a somewhat low absolute reliability. Implications The pressure algometer provided reproducible measurements and was useful for inducing phasic test stimuli. Since no significant CPM effects were detected, no recommendations for the bedside test can yet be made. Further examinations will have to establish if the “one size fits all” application of both test and conditioning stimuli is useful. Future bedside studies involving patient populations are warranted to determine the usefulness of the method.

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 No relevant differences in conditioned pain modulation effects between parallel and sequential test design. A cross-sectional observational study

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e12330
Author(s):  
Roland R. Reezigt ◽  
Sjoerd C. Kielstra ◽  
Michel W. Coppieters ◽  
Gwendolyne G.M. Scholten-Peeters
Keyword(s):  
Test Stimulus ◽  
Stimulus Intensity ◽  
Mechanical Test ◽  
Conditioning Stimulus ◽  
Lower Leg ◽  
Pain Modulation ◽  
Sequential Design ◽  
Stimulus Selection ◽  
Conditioned Pain Modulation ◽  
Parallel Design

Background Conditioned pain modulation (CPM) is measured by comparing pain induced by a test stimulus with pain induced by the same test stimulus, either during (parallel design) or after (sequential design) the conditioning stimulus. Whether design, conditioning stimulus intensity and test stimulus selection affect CPM remains unclear. Methods CPM effects were evaluated in healthy participants (N = 89) at the neck, forearm and lower leg using the cold pressor test as the conditioning stimulus. In three separate experiments, we compared the impact of (1) design (sequential versus parallel), (2) conditioning stimulus intensity (VAS 40/100 versus VAS 60/100), and (3) test stimulus selection (single versus dual, i.e., mechanical and thermal). Statistical analyses of the main effect of design (adjusted for order) and experiment were conducted using linear mixed models with random intercepts. Results No significant differences were identified in absolute CPM data. In relative CPM data, a sequential design resulted in a slightly lower CPM effect compared to a parallel design, and only with a mechanical test stimulus at the neck (−6.1%; 95% CI [−10.1 to −2.1]) and lower leg (−5.9%; 95% CI [−11.7 to −0.1]) but not forearm (−4.5%; 95% CI [−9.0 to 0.1]). Conditioning stimulus intensity and test stimulus selection did not influence the CPM effect nor the difference in CPM effects derived from parallel versus sequential designs. Conclusions Differences in CPM effects between protocols were minimal or absent. A parallel design may lead to a minimally higher relative CPM effect when using a mechanical test stimulus. The conditioning stimulus intensities assessed in this study and performing two test stimuli did not substantially influence the differences between designs nor the magnitude of the CPM effect.

scholarly journals The effect of conditioning stimulus intensity on conditioned pain modulation (CPM) hypoalgesia

2020 ◽  
Author(s):  
Alexia Coulombe-Lévêque ◽  
Yannick Tousignant-Laflamme ◽  
Guillaume Léonard ◽  
Serge Marchand
Keyword(s):  
Stimulus Intensity ◽  
Conditioning Stimulus ◽  
Pain Modulation ◽  
Conditioned Pain Modulation

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 Comparison of Thermal and Electrical Modalities in the Assessment of Temporal Summation of Pain and Conditioned Pain Modulation

2021 ◽  
Vol 2 ◽  
Author(s):  
Monica Sean ◽  
Alexia Coulombe-Lévêque ◽  
Martine Bordeleau ◽  
Matthieu Vincenot ◽  
Louis Gendron ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Temporal Summation ◽  
Cold Pressor Test ◽  
Conditioning Stimulus ◽  
Cold Pressor ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Electrical Nerve Stimulation ◽  
Clinical Assessments ◽  
Healthy Participants

Temporal summation of pain (TSP) and conditioned pain modulation (CPM) can be measured using a thermode and a cold pressor test (CPT). Unfortunately, these tools are complex, expensive, and are ill-suited for routine clinical assessments. Building on the results from an exploratory study that attempted to use transcutaneous electrical nerve stimulation (TENS) to measure CPM and TSP, the present study assesses whether a “new” TENS protocol can be used instead of the thermode and CPT to measure CPM and TSP. The objective of this study was to compare the thermode/CPT protocol with the new TENS protocol, by (1) measuring the association between the TSP evoked by the two protocols; (2) measuring the association between the CPM evoked by the two protocols; and by (3) assessing whether the two protocols successfully trigger TSP and CPM in a similar number of participants. We assessed TSP and CPM in 50 healthy participants, using our new TENS protocol and a thermode/CPT protocol (repeated measures and randomized order). In the TENS protocol, both the test stimulus (TS) and the conditioning stimulus (CS) were delivered using TENS; in the thermode/CPT protocol, the TS was delivered using a thermode and the CS consisted of a CPT. There was no association between the response evoked by the two protocols, neither for TSP nor for CPM. The number of participants showing TSP [49 with TENS and 29 with thermode (p &lt; 0.001)] and CPM [16 with TENS and 30 with thermode (p = 0.01)] was different in both protocols. Our results suggest that response to one modality does not predict response to the other; as such, TENS cannot be used instead of a thermode/CPT protocol to assess TSP and CPM without significantly affecting the results. Moreover, while at first glance it appears that TENS is more effective than the thermode/CPT protocol to induce TSP, but less so to induce CPM, these results should be interpreted carefully. Indeed, TSP and CPM response appear to be modality-dependent as opposed to an absolute phenomenon, and the two protocols may tap into entirely different mechanisms, especially in the case of TSP.

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