Conditioned pain modulation is not decreased after partial sleep restriction

Matre, Dagfinn; Andersen, M.R.; Knardahl, Stein; Nilsen, Kristian Bernhard

doi:10.1002/ejp.741

Cited by 27 publications

(20 citation statements)

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“…The experimental pain stimuli were delivered in this sequence: pressure pain, 60 electrical pain stimuli, heat pain and finally heat pain in parallel with cold pain. For more details on the experimental pain protocols, see (18,32). Sleep, sleepiness and vigilance measurements At inclusion, habitual daytime sleepiness was measured with the Epworth Sleepiness Scale (ESS) (33) and a composite measure of sleep disturbance was obtained with the Pittsburg Sleep Quality Index (PSQI) (34).…”

Section: Methodsmentioning

confidence: 99%

“…Due to technical difficulties in some of the procedures, the number of subjects was not the same across outcome measures. A priori power analysis based on a previous study from our laboratory (32) showed that 25 subjects were needed to detect a difference of 1 cm in pain inhibition on a 10 cm visual analog scale (VAS) between the two protocols with a standard deviation of 1.5, assuming a two-sided significance level of 5% and a power of 90%.…”

Section: Subjectsmentioning

confidence: 99%

“…High-density electrical stimulation was delivered by a constant current stimulator (DS7A and DG2A, Digitimer, Hertfordshire, England) through a platinum pin electrode (cathode, length: 0.2 mm Ø: 0.2 mm) attached to the skin by double-adhesive tape at the volar forearm 10 mm medial to half the distance between the insertion point of the biceps brachii tendon and the distal end of ulna (32). The anode was a conductive Velcro-strap (Alpine Biomed ApS, Skovlunde, Denmark) soaked in an isotonic NaCl solution at the ipsilateral upper arm.…”

Section: Electrical Stimulationmentioning

confidence: 99%

“…In the conditioned pain modulation paradigm, the change in pain response to a painful test stimulus (TS) induced by another painful conditioning stimulus (CS) is an indicator of endogenous pain inhibition (32,37,38). The 2-minute heat stimulation served as TS and the contralateral 2-minute cold stimulation served as CS.…”

Section: Pain Inhibitionmentioning

confidence: 99%

“…Prospective studies indicate that sleep problems are associated with an increased risk for longlasting musculoskeletal pain (9)(10)(11)(12)(13)(14)(15) and experimental studies suggest that even a relatively modest restriction or disturbance of sleep increases pain sensitivity. This is manifested as larger responses to experimentally induced pain (16)(17)(18)(19)(20)(21), as increased spontaneous pain (22)(23)(24), or as altered pain modulation (23,(25)(26)(27)(28)(29). A recent meta-analysis confirm that sleep restriction increases sensitivity for several types of pain (30).…”

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confidence: 99%

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Night-shift work is associated with increased pain perception

Matre

Knardahl²,

Nilsen³

2017

Scand J Work Environ Health

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Night-shift work is associated with increased pain perception by Matre D, Knardahl S, Nilsen KB To the authors' knowledge, pain sensitivity after night shifts has never been investigated. The present findings indicate that pain sensitivity does increase for some types of pain stimuli. Furthermore, the results indicate that experimental sleep restriction studies are relevant in assessments of health complaints among shift workers. Original article Scand J Work Environ Health. 2017;43(3):260-268. doi:10.5271/sjweh.3627 Night-shift work is associated with increased pain perception Objectives The aim of the present study was to determine whether shift workers exhibit increased perception of experimentally induced pain after working night shifts. Affiliation MethodsThe study was a paired cross-over design with two sleep conditions, after at least two nights of habitual sleep and after two consecutive night shifts at work. Fifty-three nurses in rotating shift work participated. The sensitivity to electrically induced pain, heat pain, cold pain, pressure pain and pain inhibition was determined experimentally in each sleep condition. Sleepiness and vigilance were also assessed.Results Night-shift work (NSW) increased the sensitivity to electrically induced pain and heat pain (P≤0.001).Relative to habitual sleep, electrically induced pain increased by 22.3% and heat pain increased by 26.5%. The sensitivity to cold and pressure pain did not change, changes relative to habitual sleep was <5% (P>0.5). Pain inhibition was 66.9% stronger after NSW versus after habitual sleep (P<0.001). Sleepiness (measured with the Karolinska Sleepiness Scale) increased from 4.1 after habitual sleep to 6.9 after NSW (P<0.001). Vigilance decreased after NSW, measured as a 0.03-second decrease in reaction time (P<0.005).Conclusions Changes in pain sensitivity after NSW is measurable with clinically relevant effect sizes and may be an important marker for studies comparing the physiological effects of different shift work schedules. Explanations for the differential effect on different pain modalities should be a focus for future studies.

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Section: Methodsmentioning

confidence: 99%

Section: Subjectsmentioning

confidence: 99%

Section: Electrical Stimulationmentioning

confidence: 99%

Section: Pain Inhibitionmentioning

confidence: 99%

mentioning

confidence: 99%

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Night-shift work is associated with increased pain perception

Matre

Knardahl²,

Nilsen³

2017

Scand J Work Environ Health

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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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Sleep restriction does not potentiate nocebo‐induced changes in pain and cortical potentials

Ree

Nilsen

Knardahl

et al. 2019

European Journal of Pain

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Background The increased pain sensitivity following reduced sleep may be related to changes in cortical processing of nociceptive stimuli. Expectations shape pain perception and can inhibit (placebo) or enhance (nocebo) pain. Sleep restriction appears to enhance placebo responses; however, whether sleep restriction also affects nocebo responses remains unknown. The aim of the present study was to determine whether sleep restriction facilitates nocebo‐induced changes in pain and pain‐evoked cortical potentials. Methods In an experimental study with a crossover design, the sensitivity to electrically induced pain was determined in 53 nurses under two sleep conditions, after habitual sleep and after two consecutive nights at work. Nocebo was induced by conditioning one‐third of the pain stimuli. Pain‐elicited cortical event‐related potentials were recorded by electroencephalography (EEG). Data were analysed both in the time domain (N2P2 amplitude) and in the time–frequency domain (ERP magnitude). Sleepiness and vigilance were also assessed. Results Both nocebo alone and sleep restriction alone increased the sensitivity to electrically induced pain. However, no interaction effect was found. Moreover, the magnitude of the pain‐elicited responses increased after sleep restriction and decreased after nocebo expectation, suggesting that nocebo is probably not an underlying mechanism for the commonly observed hyperalgesia induced by sleep restriction. Conclusions The present work addresses whether sleep restriction, known to increase the sensitivity of the pain system, facilitates nocebo‐induced hyperalgesia. Our findings suggest that this is not the case, indicating that the increased sensitivity of the pain system following nocebo and sleep restriction are mediated by different cortical mechanisms.

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Conditioned pain modulation is not decreased after partial sleep restriction

Abstract: The results indicate that SR leads to increased heat pain perception, but not reduced inhibitory CPM. This contradicts general assumptions on the relation between SR and the CPM effect.

Cited by 27 publications

References 59 publications

Night-shift work is associated with increased pain perception

Night-shift work is associated with increased pain perception

Psychophysical or spinal reflex measures when assessing conditioned pain modulation?

Sleep restriction does not potentiate nocebo‐induced changes in pain and cortical potentials

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