Learned control over spinal nociception in patients with chronic back pain

Krafft, Stefanie; Göhmann, H.-D.; Sommer, Jens; Straube, Andreas; Ruscheweyh, Ruth

doi:10.1002/ejp.1055

Cited by 11 publications

(23 citation statements)

References 31 publications

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“…Averaged SEP traces consistently showed 4 components: (1) a positive peak around 45 ms (=P45), 40 (2) a negativity around 75-100 ms, likely corresponding to N100; (3) a negativity around 120 ms (=N120); (4) a broad positive wave around 260 ms (=P260). 21,22 In accordance with our previous procedure, 25,41 we defined analysis windows from 35-50 ms after stimulation to pick up the P45 peak, 70-100 ms for the N100, 100-150 ms for the N120, and from 280-350 ms for the P260 and measured mean amplitudes within those windows.…”

Section: Quantification Of Riii and Pain Thresholds-riiimentioning

confidence: 99%

A Randomized Sham‐Controlled Cross‐Over Study on the Short‐Term Effect of Non‐Invasive Cervical Vagus Nerve Stimulation on Spinal and Supraspinal Nociception in Healthy Subjects

Alt¹,

Wach²,

Liebler

et al. 2020

Headache

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Objective The aim of the present study was to test the effects of vagus nerve stimulation (VNS) on the descending pain inhibition, quantified by the nociceptive flexor (RIII) reflex and the conditioned pain modulation (CPM) paradigm, and on supraspinal nociceptive responses, assessed by pain intensity and unpleasantness ratings and late somatosensory evoked potentials (SEPs), in healthy subjects. Background Non‐invasive vagus nerve stimulation (nVNS) showed promising effects on headache and pain treatment. Underlying mechanisms are only incompletely understood but may include the activation of the descending pain inhibitory system and/or the modification of emotional responses to pain. Methods Twenty‐seven adult, healthy, and pain‐free subjects participated in this double‐blind cross‐over study conducted at a university research center. They received 4 minutes of cervical nVNS or sham stimulation in randomized order. RIII reflexes, pain ratings, and SEPs were assessed before, during, and 5, 15, 30, and 60 minutes after nVNS/sham stimulation, followed by CPM testing. The primary outcome was the nVNS effect on the RIII reflex size. Three subjects were excluded after the preparatory session (before randomization), 1 subject was excluded after outlier analysis, leaving 23 for analysis. Results RIII reflex areas were 917.1 ± 563.8 µV × ms (mean ± SD) before, 952.4 ± 467.4 µV × ms during and 929.2 ± 484.0 µV × ms immediately after nVNS and 858.4 ± 489.2 µV × ms before, 913.9 ± 539.7 µV × ms during and 862.4 ± 476.0 µV × ms after sham stimulation, revealing no differences between the immediate effects of nVNS and sham stimulation (F [3,66] = 0.67, P = .574). There also were no effects of nVNS over sham on RIII reflex areas up to 60 minutes after nVNS (F [1.7,37.4] = 1.29, P = .283). Similarly, there was no statistically significant effect of nVNS on pain intensity ratings and thresholds, RIII reflex thresholds, late SEP amplitudes, and the CPM effect, compared to sham. Pain unpleasantness ratings statistically significantly decreased from 4.4 ± 2.4 (NRS 0‐10) to 4.1 ± 2.5 during nVNS compared to sham stimulation (F [1,22] = 8.74, P = .007), but there were no longer lasting effects (5‐60 minutes after stimulation). Conclusions The present study does not support an acute effect of nVNS on descending pain inhibition, pain intensity perception or supraspinal nociception in healthy adults. However, there was a small effect on pain unpleasantness during nVNS, suggesting that nVNS may preferentially act on affective, not somatosensory pain components.

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Section: Quantification Of Riii and Pain Thresholds-riiimentioning

confidence: 99%

A Randomized Sham‐Controlled Cross‐Over Study on the Short‐Term Effect of Non‐Invasive Cervical Vagus Nerve Stimulation on Spinal and Supraspinal Nociception in Healthy Subjects

Alt¹,

Wach²,

Liebler

et al. 2020

Headache

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“…30,31 Two studies did not report inter-pulse duration, 27,28 and in one case, it was not applicable as the stimulus was just one pulse. 24 Inter-stimulant intervals were 6–10 ms in one study, 24 8–12 ms in four studies, 25,27–29 4–8 ms in two studies, 26,31 5–10 ms in one study and not reported in one study. 30 The total duration of each stimulus was 0.5 ms in one study, 24 21 ms in one study, 25 17 ms in one study 29 and 25 ms in two studies, 30,31 while the remaining four studies did not report.…”

Section: Resultsmentioning

confidence: 89%

“…24 Inter-stimulant intervals were 6–10 ms in one study, 24 8–12 ms in four studies, 25,27–29 4–8 ms in two studies, 26,31 5–10 ms in one study and not reported in one study. 30 The total duration of each stimulus was 0.5 ms in one study, 24 21 ms in one study, 25 17 ms in one study 29 and 25 ms in two studies, 30,31 while the remaining four studies did not report. 26–28,32 Maximum stimulus intensity was 100 mA in one study, 24 50 mA in one study 28 and 40 mA in one study, 32 while all other studies did not report.…”

Section: Resultsmentioning

confidence: 89%

“…25–32 The number of pulses in each stimulant was five pulses in six studies, 25,27,29–32 ten pulses in one study, 26 one pulse in one study 24 and not reported in one study. 28 Inter-pulse duration was 2 ms in one study, 26 3 ms in two studies, 29,32 4 ms in one study 25 and 5 ms in two studies. 30,31 Two studies did not report inter-pulse duration, 27,28 and in one case, it was not applicable as the stimulus was just one pulse.…”

Section: Resultsmentioning

confidence: 99%

“…This left a total of nine articles from which we extracted information regarding NFR stimulation and recording procedures, along with NFR thresholds in clinical populations and healthy matched controls. 24–32 Of these studies, only one was excluded from meta-analysis, due to a lack of reported comparison of NFR thresholds between clinical condition and matched control. 25 Their findings remain in the narrative synthesis of our proposed methodology for the NFR threshold assessment.…”

Section: Resultsmentioning

confidence: 99%

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The nociceptive flexion reflex: a scoping review and proposed standardized methodology for acquisition in those affected by chronic pain

Linde

Duarte

Esmaeili

et al. 2020

British Journal of Pain

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The nociceptive flexion reflex (NFR) is used in neurophysiological research as an objective measure of nociception. NFR thresholds are reduced in numerous chronic pain pathologies, which are indicative of common central hyperexcitability within conditions. However, variation exists in both the NFR assessment and determinants of NFR threshold among research groups. Our purpose was to provide a review of the recent literature to (a) confirm the NFR threshold’s efficacy in identifying those with chronic pain compared to controls and (b) provide a narrative synthesis on the current methodology used to assess the NFR in clinical populations. We conducted a review of multiple databases (MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google Scholar and Cochrane Library), including articles that reported controlled clinical studies of humans, in English, comparing NFR thresholds within chronic pain conditions to matched control subjects, published since the last NFR review in 2010. Our search resulted in nine studies included in our narrative synthesis and eight studies included in a meta-analysis. There was a significant pooled standardized mean difference in NFR threshold between chronic pain conditions and controls (−0.94, 95% confidence interval (CI) −1.33 to −0.55, p < 0.0001), with substantial heterogeneity of pooled estimates ( I2 = 87%, τ2 = 0.41, Q = 76.13, the degrees of freedom (df) = 11, p < 0.0001). Significant variations in participant positioning, stimulation parameters and determinants of the NFR threshold were evident among included studies. We provided a narrative synthesis on the methodologies of included studies, as a recommendation for future studies in the assessment of the NFR in chronic pain.

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Mechanismen der endogenen Schmerzhemmung

Laube

2022

Schmerztherapie Ohne Medikamente

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Learned control over spinal nociception in patients with chronic back pain

Abstract: Subjects with chronic back pain can learn to control their spinal nociception, quantified by the RIII reflex, when they receive feedback about the RIII reflex.

Cited by 11 publications

References 31 publications

A Randomized Sham‐Controlled Cross‐Over Study on the Short‐Term Effect of Non‐Invasive Cervical Vagus Nerve Stimulation on Spinal and Supraspinal Nociception in Healthy Subjects

A Randomized Sham‐Controlled Cross‐Over Study on the Short‐Term Effect of Non‐Invasive Cervical Vagus Nerve Stimulation on Spinal and Supraspinal Nociception in Healthy Subjects

The nociceptive flexion reflex: a scoping review and proposed standardized methodology for acquisition in those affected by chronic pain

Mechanismen der endogenen Schmerzhemmung

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