Test-retest reliability of pressure pain threshold and heat pain threshold as test stimuli for evaluation of conditioned pain modulation

Kovacevic, Milena; Klicov, Ljiljana; Vukliš, Dragana; Neblett, Randy; Knežević, Aleksandar

doi:10.1016/j.neucli.2021.06.005

Cited by 14 publications

(16 citation statements)

References 63 publications

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“…This study revealed the highest CPM responder rate (inhibitors) using PPT as the test stimulus. Further, Kovacevic et al ( 2021 ) reported higher ICC for the CPM effect assessed with PPT compared with heat pain thresholds. These two studies endorse the usage of PPT as the test stimulus.…”

Section: Discussionmentioning

confidence: 98%

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Anti‐ and Pro‐Nociceptive mechanisms in neuropathic pain after human spinal cord injury

Lütolf

Schoenmacker

Rösner

et al. 2022

European Journal of Pain

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BACKGROUND Deficient endogenous pain modulation and increased nociceptive excitability are key features of central sensitization and can be assessed in humans by conditioned pain modulation (CPM, anti-nociceptive) and temporal summation of pain (TSP, pro-nociceptive), respectively. This study aimed to investigate these measures as proxies for central sensitization in subjects with chronic neuropathic pain (NP) after spinal cord injury (SCI). METHODS In paraplegic subjects with NP (SCI-NP; n = 17) and healthy controls (HC; n = 17), parallel and sequential sham-controlled CPM paradigms were performed using pressure pain threshold at the hand, that is, above lesion level, as test stimulus. The conditioning stimulus was a noxious cold (verum) or lukewarm water bath (sham) applied contralaterally. Regarding pro-nociceptive mechanisms, a TSP protocol with individually-adjusted pressure pain stimuli at the thenar eminence was used. CPM and TSP magnitudes were related to intensity and spatial extent of spontaneous NP. RESULTS Neither the parallel nor sequential sham-controlled CPM paradigm showed any significant inhibition of above-level pressure pain thresholds for SCI-NP or HC. Accordingly, no group difference in CPM capacity was found, however, subjects with more intense spontaneous NP showed lower inhibitory CPM capacity. TSP was observed for both groups but was not enhanced in SCI-NP. CONCLUSIONS Our results do not support altered above-level anti-or pro-nociceptive mechanisms in SCI-NP compared with HC; however, they also highlight the relevance of spontaneous NP intensity with regards to the capacity of endogenous pain modulation in SCI subjects. SIGNIFICANCE Central sensitization encompasses deficient endogenous pain modulation and increased nociceptive excitability. These two mechanisms can be assessed in humans by conditioned pain modulation and temporal summation of pain, respectively. Our data demonstrates a lack of descending pain inhibition only in subjects with severe neuropathic pain which may hint towards central sensitization at spinal and/or supra-spinal levels. Disentangling the mechanisms of endogenous pain modulation and neuronal hyperexcitability might improve mechanism-based treatment of neuropathic pain in subjects with spinal cord injury.

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Section: Discussionmentioning

confidence: 98%

“…Further, Kovacevic et al (2021) reported higher ICC for the CPM effect assessed with PPT compared with heat pain thresholds. These two studies endorse the usage of PPT as the test stimulus.…”

Section: Severe Neuropathic Pain Relates To Impaired Endogenous Pain ...mentioning

confidence: 95%

Anti‐ and Pro‐Nociceptive mechanisms in neuropathic pain after human spinal cord injury

Lütolf

Schoenmacker

Rösner

et al. 2022

European Journal of Pain

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“…Further, the assessments of pressure pain sensitivity may be more reliable than the assessment of heat pain sensitivity as the deeper tissues detected by PPT and PPTo may play an important role in many musculoskeletal pain conditions ( 33 ). One study reported a large variation in the statistical methods used when discussing the test-retest variability of the thermal threshold ( 43 , 44 ). Conversely, good reproducibility of the mechanical thresholds has been reported ( 45 ).…”

Section: Discussionmentioning

confidence: 99%

Caffeine Attenuates Electroacupuncture Effect on Pressure Pain Threshold and Tolerance in Healthy Individuals: A Randomized Controlled Trial

et al. 2022

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IntroductionThe effect of caffeine on acupuncture analgesia in humans is unclear. This study aimed to investigate whether caffeine-containing beverage intake influences the effect of electroacupuncture (EA) on static quantitative sensory testing (QST) and dynamic QST in healthy subjects.MethodsA total of 40 healthy subjects were enrolled and randomly assigned to receive coffee containing moderate doses of caffeine (coffee group) or non-caffeinated juice (juice group) for 4 weeks. The primary outcome measures were the pressure pain threshold (PPT), pressure pain tolerance (PPTo), and heat pain threshold (HPT) as static QST parameters. Numerical rating scales (NRS) of heat stimulus and nociceptive flexor reflex (RIII reflex), as parameters of dynamic QST, were also examined. EA stimulation with tolerance intensity was performed at ST36 (Zusanli)-GB34 (Yanglingquan) points at weeks 0, 2, and 4. PPT, PPTo, and HPT were detected pre- and post- EA. The NRS scores were examined pre-, during, and post-EA, and 1 min after EA was completed. The RIII reflex was examined pre- and 1–5 min post-EA.ResultsAt week 0, both groups showed increased PPT and PPTo and decreased NRS scores of heat stimuli and RIII reflex after EA, but HPT was not affected. After 4 weeks, the effects of EA on PPT and PPTo were attenuated in the coffee group compared to the juice group, whereas the effect of EA on the NRS scores and RIII reflex were not influenced. There was no significant difference found at week 2 for these indications. EA also did not affect the HPT in both groups at week 4.ConclusionModerate caffeine intake reduced the effects of EA on PPT and PPTo in healthy subjects.

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“…The PPT was evaluated using a quantitative sensory testing protocol [28] with a handheld pressure algometer (Baseline Dolorimeter, Fabrication Enterprises, USA) equipped with a 1 cm 2 metal probe. Pressure was applied at a rate of 0.5 kg/s over the right side of the two muscle groups: the extensor carpus radialis (PPT arm) and peroneus longus (PPT leg).…”

Section: Methodsmentioning

confidence: 99%

The magnitude of exercise-induced hypoalgesia in female can be improved and correlated with endogenous pain modulation following 4 weeks of treadmill running

Xu,

An,

et al. 2024

Preprint

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Objective: This study aimed to investigate the changes in pain perceptions, acute exercise-induced hypoalgesia (EIH), and endogenous pain modulation responses following 4-week treadmill running exercises with different intensities in females. Methods: Forty-two female individuals were randomly assigned to two groups (TRL and TRH) and performed 12 sessions of treadmill running within 4 weeks. Running intensities for each group is 55% of reserve heart rate (HRR) in TRL or 70% HRR in TRH. Before and after each running sessions, the pressure pain thresholds (PPT) and mechanical pain thresholds (MPT) were measured and the difference between pre- and post-running results were calculated as EIH responses. The conditioned pain modulation (CPM) and temporal summation (TS) were also measured at baseline and 24h after final running session. Results: Treadmill running only induced acute EIH responses with all pre-running PPT and MPT remained unaltered. However, the value EIH responses were significantly positively correlated with running sessions in TRL group, and negatively correlated with running sessions in TRH group. And running at low-intensity also showed greater EIH and CPM responses, and lower TS responses than running at high intensity. Besides, the EIH were positively correlated with CPM, and negatively correlated with TS after 12 running sessions. Conclusion: Four-week low-intensity treadmill running may improve acute EIH responses with the enhancement of endogenous pain modulation in healthy females. Meanwhile, CPM and TS may be correlated with EIH and be changed after exercise training, respectively. However, the individuals baseline pain thresholds may remain unaltered and not be affected by EIH or endogenous pain modulation.

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Test-retest reliability of pressure pain threshold and heat pain threshold as test stimuli for evaluation of conditioned pain modulation

Cited by 14 publications

References 63 publications

Anti‐ and Pro‐Nociceptive mechanisms in neuropathic pain after human spinal cord injury

Anti‐ and Pro‐Nociceptive mechanisms in neuropathic pain after human spinal cord injury

Caffeine Attenuates Electroacupuncture Effect on Pressure Pain Threshold and Tolerance in Healthy Individuals: A Randomized Controlled Trial

The magnitude of exercise-induced hypoalgesia in female can be improved and correlated with endogenous pain modulation following 4 weeks of treadmill running

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