A tonic heat test stimulus yields a larger and more reliable conditioned pain modulation effect compared to a phasic heat test stimulus

Lie, Marie Udnesseter; Matre, Dagfinn; Hansson, Per; Stubhaug, Audun; Zwart, John‐Anker; Nilsen, Kristian Bernhard

doi:10.1097/pr9.0000000000000626

Cited by 16 publications

(19 citation statements)

References 37 publications

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“…The number of CPM non‐responders were higher in the phasic test‐stimuli paradigm compared to what would be expected (Klyne et al., ; Potvin & Marchand, ; Skovbjerg et al., ). However, the results in the current study are in line with two other studies using comparable paradigms (Lie et al., ; McPhee & Graven‐Nielsen, ). Compared to the classical paradigm with tonic conditioning, the phasic paradigm seem so show a higher number of CPM non‐responders, which may reflect inter‐individual differences in combination with relatively smaller effects.…”

Section: Discussionsupporting

confidence: 93%

“…It is unlikely that the difference between Pain‐I and Pain‐II VAS‐ scores are related to carry‐over effects because they were separated by a 5‐min break, which has previously been found to be sufficient to reduce the risk of carry‐over effects (Graven‐Nielsen et al., ; Hoegh et al., ; Imai, Petersen, Mørch, & Arendt‐Nielsen, ; McPhee & Graven‐Nielsen, ), was included between the two sessions. Two recent studies have used phasic test‐stimuli (Lie et al., ; McPhee & Graven‐Nielsen, ) of which one does not find CPM effects (McPhee & Graven‐Nielsen, ) while the other study does show a CPM effect (Lie et al., ). More studies indicate that the duration of a conditioning stimulus is less important for CPM effects than the intensity of the stimulus (Graven‐Nielsen et al., ; Smith & Pedler, ), however, Lie et al.…”

Section: Discussionmentioning

confidence: 99%

“…More studies indicate that the duration of a conditioning stimulus is less important for CPM effects than the intensity of the stimulus (Graven‐Nielsen et al., ; Smith & Pedler, ), however, Lie et al. () show that phasic heat stimuli can induce a CPM effect but that it is smaller compared to a tonic test stimulus. It may be possible that shorter stimulation time in the phasic paradigm is an essential factor in these findings and that longer, phasic test‐stimuli may be preferable to shorter phasic test‐stimuli.…”

Section: Discussionmentioning

confidence: 99%

“…Two recent studies have used phasic test-stimuli (Lie et al, 2017;McPhee & Graven-Nielsen, 2018) of which one does not find CPM effects (McPhee & Graven-Nielsen, 2018) while the other study does show a CPM effect (Lie et al, 2017). More studies indicate that the duration of a conditioning stimulus is less important for CPM effects than the intensity of the stimulus Smith & Pedler, 2017), however, Lie et al (2017) show that phasic heat stimuli can induce a CPM effect but that it is smaller compared to a tonic test stimulus. It may be possible that shorter stimulation time in the phasic paradigm is an essential factor in these findings and that longer, phasic test-stimuli may be preferable to shorter phasic test-stimuli.…”

Section: Conditioning Pain Modulationmentioning

confidence: 99%

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Delayed effects of attention on pain sensitivity and conditioned pain modulation

Hoegh

Seminowicz

Graven‐Nielsen

2019

European Journal of Pain

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Background Efficacy of pain modulation is assessed as the difference in pain sensitivity during a painful conditioning, compared to before (conditioning pain modulation, CPM). Attention can be assessed with the Stroop task, in which participants report the number of words on a screen; either congruent or incongruent with the value of the words. Attention away from painful stimuli during CPM enhances the CPM effect. However, it is unknown if attention influences CPM effects when the two are done in sequence. Methods Healthy men (n = 25) underwent cuff algometry CPM‐assessment where the pressure‐pain detection and tolerance thresholds (PTT) were recorded on one leg with and without contralateral conditioning. Two identical sessions of four test stimuli equal to PTT (5 s, 1‐min interval, scored on a visual analogue scale, VAS) with a painful conditioning from the second to the last test‐stimulus were performed. Stroop sessions were followed by test stimuli with or without painful conditioning. Results The VAS scores in the first two sessions showed excellent reliability (ICC = 0.92). VAS scores were lower in sessions with Stroop compared to sessions without Stroop (p = .05) indicating an analgesic effect of Stroop. Participants were subgrouped into CPM responders and CPM non‐responders according to CPM effects in the first two sessions. CPM non‐responders (n = 13) showed facilitation to repeated noxious stimuli in all sessions with no effect of conditioning or Stroop (p = .02). Conclusion Attention and CPM both modulate pain in healthy men. Attention‐induced analgesia works in CPM non‐responders. Results indicate that attention and CPM are not the same and that they do not demonstrate additive effects when applied in sequence. Significance Pain sensitivity is reduced after an attention task in healthy men. The delayed effects from attention only have minor effects on Conditioned Pain Modulation (CPM), and results support that attention‐driven analgesia works independently of CPM. Results indicate that individual strategies for pain inhibition exist and that an overlap between the mechanisms of CPM and selective attention is limited. Moreover, painful phasic stimuli may increase the number of healthy volunteers with negative CPM effects.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Conditioning Pain Modulationmentioning

confidence: 99%

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Delayed effects of attention on pain sensitivity and conditioned pain modulation

Hoegh

Seminowicz

Graven‐Nielsen

2019

European Journal of Pain

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“…This is somewhat consistent with previous studies. Studies using 120 s heat test‐stimulus report a CPM effect between −29 and −47% (Lie et al, ; Matre, Andersen, Knardahl, & Nilsen, ; Nilsen et al, ; Potvin et al, ; Tousignant‐Laflamme, Page, Goffaux, & Marchand, ), whereas studies using electrical test‐stimulus giving rise to a NWR, report a CPM effect between 11.5% and 40% (Biurrun Manresa et al, ; Bouhassira, Danziger, Attal, & Guirimand, ; Jurth et al, ; Sandrini et al, ). The somewhat higher CPM effect in other studies using an electrical test‐stimulus in comparison to the result of this study may be due to different testing sites.…”

Section: Discussionmentioning

confidence: 99%

Psychophysical or spinal reflex measures when assessing conditioned pain modulation?

Lie

Petriu

Matre

et al. 2019

European Journal of Pain

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Background Assessing conditioning pain modulation (CPM) with spinal reflex measures may produce more objective and stable CPM effects than using psychophysical measures. The aim of the study was to compare the CPM effect and test–retest reliability between a psychophysical protocol with thermal test‐stimulus and a spinal reflex protocol with electrical test‐stimulus. Methods Twenty‐five healthy volunteers participated in two identical experiments separated by minimum 1 week. The thermal test‐stimulus was a constant heat stimulation of 120 s on the subjects’ forearm with continuous ratings of pain intensity on a 10 cm visual analogue scale. The electrical test‐stimulus was repeated electrical stimulation on the arch of the foot for 120 s, which elicited a nociceptive withdrawal reflex recorded from the anterior tibial muscle. Conditioning stimulus was a 7°C water bath. Differences in the magnitude and test–retest reliability were investigated with repeated‐measures analysis of variance and by relative and absolute reliability indices. Results The CPM effect was −46% and 4.5% during the thermal and electrical test‐stimulus (p < 0.001) respectively. Intraclass correlation coefficient of 0.5 and 0.4 was found with the electrical and thermal test‐stimulus respectively. Wide limits of agreement were found for both the electrical (−3.4 to 3.8 mA) and the thermal test‐stimulus (−3.2 to 3.6 cm). Conclusions More pronounced CPM effect was demonstrated when using a psychophysical protocol with thermal test‐stimulus compared to a spinal reflex protocol with electrical test‐stimulus. Fair relative reliability and poor absolute reliability (due to high intraindividual variability) was found in both protocols. Significance The large difference in CPM effect between the two protocols suggests that the CPM effect relates to pain perception rather than nociception on the spinal level. Due to poor absolute intrarater reliability, we recommend caution and further research before using any of the investigated CPM protocols in clinical decision making on an individual level.

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Alterations in Temporal Summation of Pain and Conditioned Pain Modulation Across an Episode of Experimental Exercise-Induced Low Back Pain

McPhee

Graven‐Nielsen

2019

The Journal of Pain

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Persistent pain conditions, including low back pain (LBP), are often accompanied by alterations in pronociceptive and antinociceptive mechanisms, as quantified by temporal summation of pain (TSP) and conditioned pain modulation (CPM). It remains unclear whether altered pain sensitivity, CPM, and/or TSP are a consequence of pain presence or determine the degree of pain development. Pressure pain sensitivity, TSP, and CPM were assessed across an episode of exercise-induced LBP maintained for several days. Thirty healthy individuals participated in 3 experimental sessions: before (day 0), 2 days after fatiguing back muscle exercise with exercise-induced LBP present (day 2), and after pain resolution (day 7). Both handheld and cuff pressure-pain thresholds, along with TSP (10-cuff pain stimuli at .5 Hz) and CPM (cuff pain detection threshold prior versus during painful pressure conditioning) were assessed, alongside questionnaires pertaining to pain, disability, mood, sleep, menstruation, physical activity, and catastrophizing. The exercise-induced LBP model produced mild pain and disability, and reductions in pressure pain thresholds over both the lumbar and distant testing sites (p < .007). No pain-related changes were observed for TSP (p > .44) or CPM (p > .17). The baseline TSP was associated with the peak pain intensity of the exercise-induced LBP (p < .003). Perspective: Pressure-pain sensitivity was impacted by the presence of exercise-induced LBP, whereas TSP seemed to be more stable and was instead associated with the intensity of pain developed. No significant pain-related changes or associations were observed for CPM, suggesting this measure may have less usefulness in mild musculoskeletal pain conditions.

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A tonic heat test stimulus yields a larger and more reliable conditioned pain modulation effect compared to a phasic heat test stimulus

Abstract: Supplemental Digital Content is Available in the Text.Larger and more reliable conditioned pain modulation effect with tonic test-stimulus compared to phasic test-stimuli, but large intraindividual differences between sessions in both protocols.

Cited by 16 publications

References 37 publications

Delayed effects of attention on pain sensitivity and conditioned pain modulation

Delayed effects of attention on pain sensitivity and conditioned pain modulation

Psychophysical or spinal reflex measures when assessing conditioned pain modulation?

Alterations in Temporal Summation of Pain and Conditioned Pain Modulation Across an Episode of Experimental Exercise-Induced Low Back Pain

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