Lack of pressure pain modulation by heterotopic noxious conditioning stimulation in patients with painful osteoarthritis before, but not following, surgical pain relief

Abstract

To investigate the influence of chronic nociceptive pain on endogenous pain modulation, the effect of heterotopic noxious conditioning stimulation (HNCS) on perception of various somatosensory modalities was assessed in 15 patients with painful osteoarthritis of the hip. Thirteen patients were re-assessed when pain-free 6-14 months following surgery. Sex- and age matched healthy subjects assessed at similar time intervals served as controls. The effects of HNCS were tested using the upper extremity submaximal effort tourniquet test. Subjects rated tourniquet-induced pain intensity on a visual analogue scale (VAS). Quantitative sensory testing (QST) was performed contralaterally to the maximally painful area in 13 patients and contralaterally to the second most painful area in two patients (i.e. lateral thigh n = 12, frontal thigh n = 1, lateral calf n = 2). Sensibility was assessed before, during and 45 min following the tourniquet test. Perception thresholds to light touch were assessed using von Frey filaments and pressure pain thresholds by pressure algometry. Perception thresholds to non-painful and painful warmth and cold were determined using a Thermotest. In both sessions, patients rated the tourniquet-induced pain higher than controls at the start (P < 0.003 and P < 0.006, respectively), but not at the end of the tourniquet test. Decreased sensitivity to light touch (P < 0.001) and innocuous cold (P < 0.002) was seen during the tourniquet in patients and controls alike, on both occasions, while perception thresholds to innocuous warmth and heat pain remained unaffected. In the first session, pressure pain thresholds increased during the tourniquet test in controls (P < 0.002), but not in patients. In the second session, pressure pain thresholds increased during the tourniquet test in controls (P < 0.001) and in patients (P < 0.02). In conclusion, no pressure pain modulation was induced by HNCS in patients before surgery, as opposed to controls, suggesting a dysfunction in systems subserving 'diffuse noxious inhibitory controls' (DNIC). Normal pressure pain modulation induced by HNCS was seen when patients were re-assessed in a pain-free state following surgery, indicating that the dysfunction of DNIC had been maintained by chronic nociceptive pain.

Impact of nervous system hyperalgesia on pain, disability, and quality of life in patients with knee osteoarthritis: A controlled analysis

“…A few other studies have directly assessed central sensitization in OA (1,(13)(14)(15)(16). Cutaneous and deep hyperalgesia have been demonstrated in the forearm of patients with thumb-base OA (15), and deep hyperalgesia has been shown in the tibialis anterior muscle of patients with knee OA (13).…”

(236) Impaired conditioned pain modulation in youth with functional abdominal pain

“…Patients with osteoarthritis exhibit impaired CPM but show a normalization of pressure pain modulation following surgical pain relief [20]. CPM efficiency may influence treatment outcome: patients with painful diabetic neuropathy and impaired CPM report greater efficacy of duloxetine than patients with intact CPM and also show stronger CPM effects following treatment [56].…”

Evidence of descending inhibition deficits in atypical but not classical trigeminal neuralgia

“…However, it is also possible that long-lasting noxious insults deplete endogenous inhibitory resources. As a result, DNIC deficits may evolve from prolonged pain [22]. Clearly, future research is essential to better understand the link that exists between chronic pain conditions and the functional integrity of pain modulating systems.…”