Nonpainful wide-area compression inhibits experimental pain

Introduction: Increase in excitability of the primary motor cortex (M1) is associated with pain inhibition by analgesics, which is, in turn, associated with the psychophysical antinociceptive pain modulation profile. However, the relationship between neurophysiological M1 excitability and psychophysical pain modulation has not yet been explored. Objectives: We aim to study these relationships in healthy subjects. Methods: Forty-one young healthy subjects (22 women) underwent a wide battery of psychophysical testing that included conditioned pain modulation (CPM) and pain temporal summation, and a transcranial magnetic stimulation neurophysiological assessment of the motor corticospinal excitability, including resting motor threshold, motor-evoked potentials (MEPs), and cortical silent period. Results: Increased motor corticospinal excitability in 2 parameters was associated with more efficient CPM: (1) higher MEP amplitude ( r = −0.574; P _Bonferroni = 0.02) and (2) longer MEP duration ( r = −0.543; P _Bonferroni = 0.02). The latter also correlated with the lower temporal summation magnitude ( r = −0.421; P = 0.007); however, on multiplicity adjustment, significance was lost. Conclusions: Increased corticospinal excitability of the primary motor cortex is associated with more efficient inhibitory pain modulation as assessed by CPM, in healthy subjects. Motor-evoked potential amplitude and duration may be considered as an additional, objective and easy to measure parameter to allow for better individual assessment of pain modulation profile.

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“…1,23,79 Using this cutoff, we aimed to eliminate the possible floor effect on the test-stimulus pain scores. 29…”

Section: Resultsmentioning

confidence: 99%

Motor corticospinal excitability: a novel facet of pain modulation?

Granovsky

Sprecher

Sinai

2019

PR9

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“…The role of conditioning intensity on CPM-effect is not trivial but most studies agree that CPM requires a painful conditioning (Lautenbacher et al, 2002;Granot et al, 2008;Klyne et al, 2015) although inconsistency exists (Honigman et al, 2016). The majority of studies seem to indicate that pain intensity in itself is not an important constituent for the magnitude of CPM-effects (Granot et al, 2008;Nir et al, 2011;Valencia et al, 2013).…”

Section: Conditioning Pain Intensity and Stimulation Intensitymentioning

confidence: 99%

Effects of repeated conditioning pain modulation in healthy volunteers

Hoegh

Petersen

Graven‐Nielsen

2018

European Journal of Pain

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Conditioning pain modulation can be assessed in 5-min intervals by cuff algometry with a fixed conditioning stimulus. Without applying conditioning stimuli the pain sensitivity of test-stimuli habituated. As a consequence, it can be speculated that the conditioning stimulus may negate the temporal habituation effects during repeated sessions, whereas this may not be the case for unconditioned stimuli. Applying both conditioned and unconditioned repeated test-stimuli may be a way to assess different parts of the pain modulatory system, and a model for measuring a netCPM-effect, which could indicate a balance between habituation and sensitization, is proposed.

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“…[41][42][43][44][45] Noninvasive electrical stimulation of nociceptive fibers is possible, but substantial activation requires high intensity that may be technically challenging and will cause pain. 35,42,43,46 Interestingly, high-frequency Aβ-fiber stimulation may be perceived as uncomfortable or painful, 43 and robust Aβ-fiber input may trigger conditioned pain modulation (CPM), 47 which are both characteristics of AL-TENS. Moreover, electroacupuncture in animal models primarily activates Aαβ nerve fibers.…”

Section: Technical Characteristics Of Conventional Tensmentioning

confidence: 99%

“…[65][66][67] This analgesic mechanism decreases nociceptive signal transmission in the spinal cord through supraspinal-mediated descending inhibition. CPM can be triggered by remote noxious 65,68 and nonnoxious 24,47,[68][69][70] conditioning stimuli.…”

Section: Modulation Of Central Pain Processingmentioning

confidence: 99%

“…For example, as the distance from the pain site increases, stimulation intensity, duration of application, and regularity of use may be increased in a compensatory fashion. 16,47,173 The importance of maximizing stimulation intensity in conventional TENS, irrespective of the site of stimulation, must be emphasized. 15,109,174 Stimulation should always be delivered at the highest tolerable intensity.…”

Section: Perspectivesmentioning

confidence: 99%

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<p>Remote Analgesic Effects Of Conventional Transcutaneous Electrical Nerve Stimulation: A Scientific And Clinical Review With A Focus On Chronic Pain</p>

Gozani

2019

JPR

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Background: Transcutaneous electrical nerve stimulation (TENS) is a safe, noninvasive treatment for chronic pain that can be self-administered. Conventional TENS involves stimulation of peripheral sensory nerves at a strong, non-painful level. Following the original gate-control theory of pain, stimulation is typically near the target pain. As another option, remote stimulation may also be effective and offers potential advantages. Objective: This narrative review examines mechanisms underlying the remote analgesic effects of conventional TENS and appraises the clinical evidence. Methods: A literature search for English-language articles was performed on PubMed. Keywords included terms related to the location of TENS. Citations from primary references and textbooks were examined for additional articles. Results: Over 30 studies reported remote analgesic effects of conventional TENS. The evidence included studies using animal models of pain, experimental pain in humans, and clinical studies in subjects with chronic pain. Three types of remote analgesia were identified: at the contralateral homologous site, at sites distant from stimulation but innervated by overlapping spinal segments, and at unrelated extrasegmental sites. Conclusion: There is scientific and clinical evidence that conventional TENS has remote analgesic effects. This may occur through modulation of pain processing at the level of the dorsal horn, in brainstem centers mediating descending inhibition, and within the pain matrix. A broadening of perspectives on how conventional TENS produces analgesia may encourage researchers, clinicians, and medical-device manufacturers to develop novel ways of using this safe, cost-effective neuromodulation technique for chronic pain.

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Nonpainful wide-area compression inhibits experimental pain

Abstract: Supplemental Digital Content is Available in the Text.Upper limb experimental heat pain is attenuated by lower limb nonpainful compression pants in an area-dependent mode, and in correlation with conditioned pain modulation, in healthy controls.

Cited by 14 publications

References 74 publications

Motor corticospinal excitability: a novel facet of pain modulation?

Motor corticospinal excitability: a novel facet of pain modulation?

Effects of repeated conditioning pain modulation in healthy volunteers

<p>Remote Analgesic Effects Of Conventional Transcutaneous Electrical Nerve Stimulation: A Scientific And Clinical Review With A Focus On Chronic Pain</p>

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