Psychophysic-psychological dichotomy in very early acute mTBI pain

Kuperman, Pora; Granovsky, Yelena; Granot, Michal; Bahouth, Hany; Fadel, Shiri; Hyams, Gila; Lulu, Hen Ben; Aspis, Osnat; Salame, Rabia; Begal, Julia; Hochstein, David; Grunner, Shahar; Honigman, Liat; Reshef, Maya; Sprecher, Elliot; Bosak, Noam; Sterling, Michele; Yarnitsky, David

doi:10.1212/wnl.0000000000006120

Cited by 18 publications

(30 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similarly, in a crosssectional human study, our lab revealed decreased pressure pain thresholds of the head and decreased pain inhibition on the conditioned pain modulation (CPM) test in mild TBI patients within 2 weeks of injury compared to a non-mild TBI control group [13]. These results are in line with another study showing less efficient CPM in mild TBI patients within 72 h of the injury [14]. Furthermore, a cross-sectional human study demonstrated that mild TBI patients with chronic PTH (> 1 year post injury) exhibit diminished pain inhibitory capacity compared to control groups [15], with the magnitude of headache pain intensity correlating negatively with magnitude of pain inhibition.…”

Section: Introductionsupporting

confidence: 84%

The role of deficient pain modulatory systems in the development of persistent post-traumatic headaches following mild traumatic brain injury: an exploratory longitudinal study

et al. 2020

View full text Add to dashboard Cite

Background Post-traumatic headache (PTH) is one of the most common and long-lasting symptoms following mild traumatic brain injury (TBI). However, the pathological mechanisms underlying the development of persistent PTH remain poorly understood. The primary purpose of this prospective pilot study was to evaluate whether early pain modulatory profiles (sensitization and endogenous pain inhibitory capacity) and psychological factors after mild TBI predict the development of persistent PTH in mild TBI patients. Methods Adult mild TBI patients recruited from Level I Emergency Department Trauma Centers completed study sessions at 1–2 weeks, 1-month, and 4-months post mild TBI. Participants completed the following outcome measures during each session: conditioned pain modulation to measure endogenous pain inhibitory capacity, temporal summation of pain and pressure pain thresholds of the head to measure sensitization of the head, Pain Catastrophizing Scale, Center for Epidemiological Studies – Depression Scale, and a standardized headache survey. Participants were classified into persistent PTH (PPTH) and no-PPTH groups based on the 4-month data. Results The results revealed that mild TBI patients developing persistent PTH exhibited significantly diminished pain inhibitory capacity, and greater depression and pain catastrophizing following injury compared to those who do not develop persistent PTH. Furthermore, logistic regression indicated that headache pain intensity at 1–2 weeks and pain inhibitory capacity on the conditioned pain modulation test at 1–2 weeks predicted persistent PTH classification at 4 months post injury. Conclusions Overall, the results suggested that persistent PTH is characterized by dysfunctional alterations in endogenous pain modulatory function and psychological processes in the early stages following mild TBI, which likely exacerbate risk for the maintenance of PTH.

show abstract

Section: Introductionsupporting

confidence: 84%

The role of deficient pain modulatory systems in the development of persistent post-traumatic headaches following mild traumatic brain injury: an exploratory longitudinal study

et al. 2020

View full text Add to dashboard Cite

show abstract

“…This is important as although oftentimes compared, post-traumatic and post-surgical pain represent 2 distinctive models for the study of acute pain, due in part to the cognitive attributions each may hold. We 19 have recently reported that these patients are psychologically similar to healthy controls in most pain-related psychological characteristics, which bolsters the likelihood that their results are generalizable. Given that most of the work regarding PSQ has been performed in the chronic stage, a preliminary goal was to examine the association between clinical and experimental pain and the PSQ in acute pain patients.…”

Section: Introductionsupporting

confidence: 55%

“…The chosen cohort of individuals with acute post-traumatic pain due to MVC offers a unique opportunity to explore pain variability in a setting in which there exists an interplay between clinical pain, contextual psychological factors, and the cognitive processes necessary to interpret and respond to the event. To that end, postinjury individuals with acute pain at the very early phase after injury, who were previously found to be psychologically similar to healthy controls, 19 were investigated.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Explaining very early acute mild traumatic brain injury after motor vehicle collision pain variability: additive value of pain sensitivity questionnaire

Kuperman

Granovsky

Bahouth

et al. 2020

PR9

Self Cite

View full text Add to dashboard Cite

Introduction and Objectives: Chronic pain is a common postcollision consequence. Wherein, a clearer understanding of acute pain can help stem the acute-to-chronic pain transition. However, the variability of acute pain is only partially explained by psychophysical pain characteristics as measured by quantitative sensory testing. The Pain Sensitivity Questionnaire (PSQ) may reflect inherent psychocognitive representations of patient's sensitivity and thus may reveal less-explored pain dimensions. In the vein of the biopsychosocial approach, this study aimed to explore whether PSQ holds additive value in explaining head and neck pain reports in very early acute-stage mild traumatic brain injury (mTBI) after collision, above the use of psychophysical assessment. Methods: Study cohort (n = 130) consisted of mTBI patients (age range 19–66, 57 F) after accident with area-of-injury pain of at least 20 on the day of testing (mean pain 58.4 ± 21.6, range 20–100 Numerical Pain Scale) who underwent clinical, psychophysical, and pain-related psychological assessment within 72-hour after injury. Results: Pain Sensitivity Questionnaire scores were significantly correlated with acute clinical, psychophysical, and pain-related psychological measures. Regression model ( R 2 = 0.241, P < 0.001) showed that, together, age, sex, high PSQ, enhanced temporal summation, and less-efficient conditioned pain modulation explained head and neck pain variance. This model demonstrated that the strongest contribution to degree of postinjury pain was independently explained by PSQ (ß = 0.32) and then pressure pain threshold-conditioned pain modulation (ß = −0.25). Conclusion: Appraisal of cognitive daily-pain representations, by way of memory and imagination, provides an additional important dispositional facet to explain the variability in the acute mTBI postcollision clinical pain experience, above assessing nociceptive responsiveness to experimentally induced pain.

show abstract

“…A considerable limitation of the study is that Pain-60 is not an established test for evaluation bias, and that we did not use other tests for evaluation biases. Nonetheless, we do think that the measure of pain-50 or pain-60 temperature can potentially serve as a test for higher pain responsiveness; a recent study of our collaborators (22) demonstrated a lower Pain-50 temperature in patients with mild traumatic brain injury pain as compared with healthy controls. Thus, we believe that our finding on Pain-60 temperature as differentiating between the pain sensory-perceptual profile of patients suffering from major depression and healthy controls is not surprising.…”

Section: Discussionmentioning

confidence: 99%

Initial Evaluation of Pain Intensity Among Depressed Patients as a Possible Mediator Between Depression and Pain Complaints

et al. 2019

Self Cite

View full text Add to dashboard Cite

Pain complaints are frequently described by depressed patients, and are mostly attributed to abnormal pain perception and modulation. The present study aimed to assess whether a unique pain processing profile differentiates depressed patients from healthy controls. Participants were 25 patients suffering from a moderate-severe unipolar depressive episode and 25 age and sex-matched healthy controls. Thermal stimuli were used to assess sensory threshold and pain threshold. Pain-60 temperature (temperature that induces pain ratings of 60 out of 100) was the first noxious stimuli to be administered during the experimental session. Central pain inhibition was assessed via conditioned pain modulation (CPM) and the degree of central nervous system excitability was assessed via mechanical temporal summation. Depressed patients reported higher levels of pain compared with healthy controls, and a significantly higher perceived pain during the last month. Additionally, they displayed significantly lower pain-60 temperature values compared with healthy controls ( p = 0.01). Otherwise, no significant group differences were found in measures of pain perception and modulation. Our results suggest that the initial evaluation of pain intensity among depressed patients, as validated by pain-60 temperature values, is increased compared with healthy controls, and might be the mediator between depression and pain complaints. Possibly, depressed patients' negative bias in the processing of pain is similar to their processing pattern of facial expression or future events. Further studies are necessary in order to establish the mechanisms underlying the excessive pain complaints reported by patients with unipolar depression.

show abstract

Psychophysic-psychological dichotomy in very early acute mTBI pain

Cited by 18 publications

References 17 publications

The role of deficient pain modulatory systems in the development of persistent post-traumatic headaches following mild traumatic brain injury: an exploratory longitudinal study

The role of deficient pain modulatory systems in the development of persistent post-traumatic headaches following mild traumatic brain injury: an exploratory longitudinal study

Explaining very early acute mild traumatic brain injury after motor vehicle collision pain variability: additive value of pain sensitivity questionnaire

Initial Evaluation of Pain Intensity Among Depressed Patients as a Possible Mediator Between Depression and Pain Complaints

Contact Info

Product

Resources

About