The Decline of Endogenous Pain Modulation With Aging: A Meta-Analysis of Temporal Summation and Conditioned Pain Modulation

Hackett, Jason; Naugle, Kelly M.

doi:10.1016/j.jpain.2019.09.005

Cited by 56 publications

(43 citation statements)

References 45 publications

(119 reference statements)

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“…In the current study there were only six participants (four women) above 40 years, which explains the limited influence of age. This is in line with the literature (Grashorn et al., 2013; Hackett et al., 2020; Lariviere et al., 2007; Leone & Truini, 2019). Gender influenced only the CPM‐efficacy at the m. quadriceps with all the conditioning stimuli.…”

Section: Discussionsupporting

confidence: 92%

Comparison of five conditioned pain modulation paradigms and influencing personal factors in healthy adults

Mertens

Hermans

Crombez

et al. 2020

European Journal of Pain

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Background: Conditioned pain modulation (CPM) methods are experimental procedures to assess presumed descending nociceptive modulatory pathways. Various CPM-methods are currently used, making the comparison of results difficult. The aim of this study was to compare five conditioning stimuli and to evaluate the influencing effects of personal factors on CPM-efficacy. Methods: 101 healthy pain-free adults (50 males, 51 females) participated in this cross-sectional study with repeated measures design. The CPM-method consisted of hot water immersion (46°C, HWI), cold pressor test (12°C, CPT), cold pack application, and single and double ischemic occlusion as conditioning stimuli in randomized order. Pressure pain threshold was used as test stimulus at the mm. trapezius and quadriceps for all CPM-protocols. Results: All CPM-protocols resulted in effective CPM, although cold pack application revealed smaller CPM-magnitudes compared to all other methods at both muscles, except single ischemic occlusion at the m. quadriceps. A smaller CPM-effect at the m. trapezius was shown when CPM was provoked by single ischemic occlusion compared to the CPT. Chronic stress, gender, attentional focus, age, physical activity and perceived pain are all influencing factors, in various conditioning stimuli at the mm. trapezius and quadriceps. Conclusions: CPT and HWI seem to be the most appropriate conditioned pain modulation paradigms for research settings, while single and double ischemic occlusion seem to be more useful for clinical settings. Influencing factors to be considered are gender, age, stress, physical activity, perceived pain and attentional focus to the conditioning stimulus, but depend on the test site and exerted method. Significance: Hot water immersion, cold pressor test, and single and double ischemic occlusion result in comparable CPM-effects at the mm. trapezius and quadriceps. Anti-nociceptive effects of the cold pack are mainly a result of attention towards the cold pack. Chronic stress, attentional focus towards the conditioning stimulus and perceived pain of the conditioning stimulus influenced the anti-nociceptive effects at the m. trapezius. Gender and level of physical activity influenced the anti-nociceptive effects with the other methods at the m. quadriceps.

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Section: Discussionsupporting

confidence: 92%

Comparison of five conditioned pain modulation paradigms and influencing personal factors in healthy adults

Mertens

Hermans

Crombez

et al. 2020

European Journal of Pain

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“…In the present study the late CPM-effect, i.e., endogenous inhibition lasting for at least 5 min after CS termination, was smaller than the early CPM-effect during CS application, in line with previous studies. The magnitude of the early CPM-effect induced by heat as TS was similar to our previous reliability study [10], though the range in the existing literature is quite high and depends also on the subjects' age [41]. Interestingly, the pain reduction induced by PCES as TS in the current study was lower compared to our previous two studies, which was also paralleled by smaller changes of the N1-P1 amplitudes of the PCES-evoked potentials [20,36] A study demonstrated that the CPM-effect depends on the perceived level of the CS pain when it is altered by cognitive manipulation, rather than solely on its physical intensity [42].…”

Section: Extend and Duration Of The Cpm-effectsupporting

confidence: 85%

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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“…Our models were not able to find a relationship between intracortical excitability and quantitative sensory testing measurements (CPM and pain thresholds). This is one of the most powered studies to analyze this relationship in a multivariate model adjusting for clinical factors that influence both markers, such as age 20 , 51 , gender 52 , emotion 53 , and cognitive variables 54 . However, the relationship between the CPM and cortical excitability is not well understood.…”

Section: Discussionmentioning

confidence: 99%

Increased motor cortex inhibition as a marker of compensation to chronic pain in knee osteoarthritis

Simis

Imamura

Melo

et al. 2021

Sci Rep

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This study aims to investigate the associative and multivariate relationship between different sociodemographic and clinical variables with cortical excitability as indexed by transcranial magnetic stimulation (TMS) markers in subjects with chronic pain caused by knee osteoarthritis (OA). This was a cross-sectional study. Sociodemographic and clinical data were extracted from 107 knee OA subjects. To identify associated factors, we performed independent univariate and multivariate regression models per TMS markers: motor threshold (MT), motor evoked potential (MEP), short intracortical inhibition (SICI), intracortical facilitation (ICF), and cortical silent period (CSP). In our multivariate models, the two markers of intracortical inhibition, SICI and CSP, had a similar signature. SICI was associated with age (β: 0.01), WOMAC pain (β: 0.023), OA severity (as indexed by Kellgren–Lawrence Classification) (β: − 0.07), and anxiety (β: − 0.015). Similarly, CSP was associated with age (β: − 0.929), OA severity (β: 6.755), and cognition (as indexed by the Montreal Cognitive Assessment) (β: − 2.106). ICF and MT showed distinct signatures from SICI and CSP. ICF was associated with pain measured through the Visual Analogue Scale (β: − 0.094) and WOMAC (β: 0.062), and anxiety (β: − 0.039). Likewise, MT was associated with WOMAC (β: 1.029) and VAS (β: − 2.003) pain scales, anxiety (β: − 0.813), and age (β: − 0.306). These associations showed the fundamental role of intracortical inhibition as a marker of adaptation to chronic pain. Subjects with higher intracortical inhibition (likely subjects with more compensation) are younger, have greater cartilage degeneration (as seen by radiographic severity), and have less pain in WOMAC scale. While it does seem that ICF and MT may indicate a more acute marker of adaptation, such as that higher ICF and MT in the motor cortex is associated with lesser pain and anxiety.

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The Decline of Endogenous Pain Modulation With Aging: A Meta-Analysis of Temporal Summation and Conditioned Pain Modulation

Cited by 56 publications

References 45 publications

Comparison of five conditioned pain modulation paradigms and influencing personal factors in healthy adults

Comparison of five conditioned pain modulation paradigms and influencing personal factors in healthy adults

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

Increased motor cortex inhibition as a marker of compensation to chronic pain in knee osteoarthritis

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