Conditioned pain modulation using painful cutaneous electrical stimulation or simply habituation?

Eitner, Lynn; Özgül, Özüm Simal; Enax-Krumova, Elena; Vollert, Jan; Maier, Christoph; Höffken, Oliver

doi:10.1002/ejp.1215

Cited by 23 publications

(36 citation statements)

References 42 publications

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“…In accordance with our previous studies [ 20 , 36 ], the amplitudes of the PCES-induced evoked potentials were significantly reduced both during and after CS application, though, the reduction did not correlate with the changes in TS pain intensity. The latter is in contrast to our first study [ 20 ], but in line with following studies we performed using the same CPM testing paradigm [ 36 ]. This might be due to the less pronounced mean CPM-effect in the current study compared to the previous [ 20 ].…”

Section: Discussionsupporting

confidence: 92%

“…This might be due to the less pronounced mean CPM-effect in the current study compared to the previous [ 20 ]. Notably, the CPM-effect had a similar magnitude in both previous studies [ 20 , 36 ], but the correlation between pain intensity and the amplitudes of the PCES-induced evoked potentials was significant only in one of them.…”

Section: Discussionsupporting

confidence: 73%

“…Notably, the specificity for nociceptive fibers of PCES is still controversially debated [ 34 , 35 ]. The aim of the present study was to further elucidate the understanding of this recently introduced CPM model using PCES as TS with additionally recording of PCES evoked cortical potentials [ 20 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, the slight increase of PCES-induced pain intensity cannot be explained solely by peripheral mechanisms. In contrast, repeated PCES application with 2 min between the blocks led to a reduction of mean pain intensity, which was paralleled by a reduction of cortical evoked potentials [ 36 ], and central habituation processes were hypothesized. However, the slight increase in pain intensity in our study was observed after short-term repeated application.…”

Section: Discussionmentioning

confidence: 99%

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Painful Cutaneous Electrical Stimulation vs. Heat Pain as Test Stimuli in Conditioned Pain Modulation

et al. 2020

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Different paradigms can assess the effect of conditioned pain modulation (CPM). The aim of the present study was to compare heat pain, as an often used test stimulus (TS), to painful cutaneous electrical stimulation (PCES), having the advantage of the additional recording of PCES-related evoked potentials. In 28 healthy subjects we applied heat and PCES at the dominant hand as test stimulus (TS) to compare the CPM-effect elicited by hand immersion into cold water (10 °C) as conditioning stimulus (CS). Subjects rated the pain intensity of TS at baseline, during and 5 min after CS application and additionally of CS, on a numerical rating scale (NRS) (0–100). The ‘early’ (during CS–before CS) and ‘late’ (after CS–before CS) CPM-effects were analyzed. Parallel to the PCES, the related evoked potentials were recorded via Cz to evaluate any changes in PCES-amplitudes. CS reduced significantly the pain intensity of both PCES and heat pain as TS. On a group level, the CPM-effect did not differ significantly between both paradigms. Both early and late CPM-effect based on PCES correlated significantly with the CS pain intensity (r = −0.630 and −0.503, respectively), whereas using heat pain the correlation was not significant. We found a significant reduction of PCES-amplitudes during CS, but this did not correlate with the PCES-induced pain intensity. Correlation with the CS painfulness (r = −0.464) did not achieve the significance level after Bonferroni correction. The extent of the CPM effects was similar in both testing paradigms at group level, despite intraindividual differences. Future studies should further elicit the exact mechanisms explaining the modality of these specific differences.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Painful Cutaneous Electrical Stimulation vs. Heat Pain as Test Stimuli in Conditioned Pain Modulation

et al. 2020

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“…In summary, using the recently introduced novel CPM-paradigm we demonstrated that both PCES-induced pain and PCES-EP amplitudes can be reduced not only by CPM 20,39 but also during distraction by a cognitive task. While the amount of pain relief induced by CPM and distraction by a cognitive task did not differ signi cantly during both interventions, the decrease of PCES-EP amplitudes after distraction by a cognitive task was slightly more pronounce than during CPM.…”

Section: Discussionmentioning

confidence: 71%

Distraction by a cognitive task has a higher impact on electrophysiological measures compared with conditioned pain modulation

Lisa

Enax-Krumova

Özgül

et al. 2020

Preprint

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Background Conditioned pain modulation (CPM) evaluates the effect of a painful conditioning stimulus (CS) on a painful test stimulus (TS). Using painful cutaneous electrical stimulation (PCES) as TS and painful cold water as CS, the pain relief was paralleled by a decrease in evoked potentials (PCES-EPs). We now aimed to compare the effect of CPM with cognitive distraction on PCES-induced pain and PCES-EP amplitudes. Methods PCES was performed using surface electrodes inducing a painful sensation of 60 (NRS 0-100) on one hand. In a crossover design healthy subjects (included: n=38, analyzed: n=23) immersed the contralateral hand into 10°C cold water (CS) for CPM evaluation and performed the 1-back task for cognitive distraction. Before and during the CS and 1-back task, respectively, subjects rated the pain intensity of PCES and simultaneously cortical evoked potentials were recorded. Results Both CPM and cognitive distraction significantly reduced PCES-EP amplitudes (CPM: 27.6±12.0μV to 20.2±9.5μV, cognitive distraction: 30.3±14.2µV to 13.6±5.2μV, p<0.001) and PCES-induced pain (on a 0–100 numerical rating scale: CPM: 58±4 to 41.1±12.3, cognitive distraction: 58.3±4.4 to 38.0±13.0, p<0.001), though the changes in pain intensity and PCES-amplitude did not correlate. The changes of the PCES-EP amplitudes during cognitive distraction were more pronounced than during CPM (p=0.001). Conclusions CPM and cognitive distraction reduced the PCES-induced pain to a similar extent. The more pronounced decrease of PCES-EP amplitudes after distraction by a cognitive task implies that both conditions might not represent the general pain modulatory capacity of individuals, but may underlie different neuronal mechanisms with the final common pathway of perceived pain reduction.

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Divergent effects of conditioned pain modulation on subjective pain and nociceptive-related brain activity

Albu

Meagher

2019

Exp Brain Res

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Conditioned pain modulation using painful cutaneous electrical stimulation or simply habituation?

Abstract: Painful cutaneous electrical stimulation leads to moderate habituation of pain and evoked potential amplitudes, but the conditioned pain modulation effect using this method is significantly larger, which might indicate a different mechanism in central processing.

Cited by 23 publications

References 42 publications

Painful Cutaneous Electrical Stimulation vs. Heat Pain as Test Stimuli in Conditioned Pain Modulation

Painful Cutaneous Electrical Stimulation vs. Heat Pain as Test Stimuli in Conditioned Pain Modulation

Distraction by a cognitive task has a higher impact on electrophysiological measures compared with conditioned pain modulation

Divergent effects of conditioned pain modulation on subjective pain and nociceptive-related brain activity

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