Unimpaired endogenous pain inhibition in the early phase of complex regional pain syndrome

Kumowski, Nina; Hegelmaier, Tobias; Kolbenschlag, Jonas; Maier, Christoph; Mainka, Tina; Vollert, Jan; Enax-Krumova, Elena

doi:10.1002/ejp.988

Cited by 10 publications

(17 citation statements)

References 71 publications

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“…Most notably, a recent study in patients with complex regional pain syndrome for less than 1 year demonstrated greater CPM compared with healthy controls. 48 This could be explained by neuropathic pain symptoms initially and defensively boosting or engaging CPM, momentarily increasing antinociceptive functions (eg, descending control). Greater CPM associated with neuropathic pain at Admission cannot, however, be maintained in light of persistent symptoms (ie, at Discharge), eventually leading to reductions in CPM.…”

Section: Discussionmentioning

confidence: 99%

Conditioned Pain Modulation Decreases Over Time in Patients With Neuropathic Pain Following a Spinal Cord Injury

Gagné

Côté

Boulet

et al. 2020

Neurorehabil Neural Repair

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Background Neuropathic pain is a major problem following spinal cord injury (SCI). Central mechanisms involved in the modulation of nociceptive signals have been shown to be altered at the chronic stage, and it has been hypothesized that they might play a role in the development of chronic pain. Objective This prospective longitudinal study aimed to describe the evolution of pain modulation mechanisms over time after SCI, and to explore the relationships with the presence of clinical (neuropathic and musculoskeletal) pain. Methods Patients with an SCI were assessed on admission (n = 35; average of 38 days postinjury) and discharge (n = 25; average of 131 days postinjury) using the International Spinal Cord Injury Pain Basic Data Set. Conditioned pain modulation was assessed using the cold pressor test (10 °C; 120 s) as the conditioning stimulus and tonic heat pain, applied above the level of injury, as the test stimulus (120 s). Heat pain threshold was also assessed. Results A marked decrease in the efficacy of conditioned pain modulation was observed over time, with 30.2% of inhibition at admission and only 12.9% at discharge on average ( P = .010). This decrease was observed only in patients already suffering from neuropathic pain at admission and was not explained by a general increase in sensitivity to thermal nociceptive stimuli. Conclusion These results suggest that the presence of neuropathic pain leads to a decrease in conditioned pain modulation over time, rather than supporting the hypothesis that inefficient conditioned pain modulation mechanisms are leading to the development of neuropathic pain.

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Section: Discussionmentioning

confidence: 99%

Conditioned Pain Modulation Decreases Over Time in Patients With Neuropathic Pain Following a Spinal Cord Injury

Gagné

Côté

Boulet

et al. 2020

Neurorehabil Neural Repair

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“…Repeated, unconditioned painful stimulations are commonly used to study phenomena such as temporal summation of pain (Gehling et al., ; Kumowski et al., ), and one study used repeated test‐stimuli to test for after‐effects of a single conditioning epoch (Fujii et al., ). No studies have previously evaluated the effects of repeated, individual test‐stimuli and compared them to repeated CPM‐effects.…”

Section: Discussionmentioning

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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“…Ten studies were included in the qualitative analysis based on z-scores [ 14 , 39 , 40 , 53 , 61 , 66 , 68 , 71 – 73 ], and the frequencies of gain and loss of sensations in CRPS were mentioned in six studies (Table 5 ) [ 14 , 15 , 44 , 53 , 65 , 69 ]. Twenty-six studies were included in the quantitative analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Studies that investigated endogenous pain modulation could not be used in the meta-analysis because of different methodological approaches [ 45 , 53 ]. One study used repetitive electrical stimuli [ 45 ], while the other study used a restricted CPM paradigm [ 53 ].…”

Section: Resultsmentioning

confidence: 99%

Pain mechanisms in complex regional pain syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomes

et al. 2023

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Background Complex regional pain syndrome (CRPS) is a chronic condition following inciting events such as fractures or surgeries with sensorimotor and autonomic manifestations and poor prognosis. This review aimed to provide conclusive evidence about the sensory phenotype of CRPS based on quantitative sensory testing (QST) to understand the underlying pain mechanisms and guide treatment strategies. Databases Eight databases were searched based on a previously published protocol. Forty studies comparing QST outcomes (thermal, mechanical, vibration, and electric detection thresholds, thermal, mechanical, pressure, and electric pain thresholds, wind-up ratio, mechanical pain sensitivity, allodynia, flare area, area after pinprick hyperalgesia, pleasantness after C-tactile stimulation, and pain ratings) in chronic CRPS (adults and children) versus healthy controls were included. Results From 37 studies (14 of low quality, 22 of fair quality, and 1 of good quality), adults with CRPS showed: (i) significant loss of thermal, mechanical, and vibration sensations, significant gain of thermal and mechanical pain thresholds, significant elevation of pain ratings, and no difference in wind-up ratio; (ii) significant reduction of pleasantness levels and increased area of pinprick hyperalgesia, in the affected limb. From three fair-quality studies, adolescents and children with CRPS showed loss of cold detection with cold hyperalgesia in the affected limb. There was moderate to substantial overall heterogeneity. Conclusion Diffuse thermal and mechanical hypoesthesia with primary and secondary hyperalgesia, enhanced pain facilitation evidenced by increased area of pinprick hyperalgesia, and elevated pain ratings are dominant in adults with CRPS. Adolescents and children with CRPS showed less severe sensory abnormalities.

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Unimpaired endogenous pain inhibition in the early phase of complex regional pain syndrome

Abstract: Conditioned pain modulation (CPM) is not impaired in the early phase of complex regional pain syndrome (CRPS) and neuralgia. Only in CRPS higher CPM was associated with lower cold pain thresholds.

Cited by 10 publications

References 71 publications

Conditioned Pain Modulation Decreases Over Time in Patients With Neuropathic Pain Following a Spinal Cord Injury

Conditioned Pain Modulation Decreases Over Time in Patients With Neuropathic Pain Following a Spinal Cord Injury

Effects of repeated conditioning pain modulation in healthy volunteers

Pain mechanisms in complex regional pain syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomes

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