Chemo-somatosensory evoked potentials: A sensitive tool to assess conditioned pain modulation?

Kunz, Miriam; Mohammadian, Parvaneh; Renner, Bertold; Roscher, Stephan; Kobal, Gerd; Lautenbacher, Stefan

doi:10.3109/08990220.2014.887562

Cited by 7 publications

(9 citation statements)

References 28 publications

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“…Therefore, the CPM-induced reduction of PCES-EP-amplitudes in our study mainly refers to modulation of the sensory input. In contrast to our results, CPM-induced changes of CSSEP were not reflected by the subjects’ pain ratings [ 22 ].…”

Section: Discussioncontrasting

confidence: 99%

“…In our CPM-paradigm, the PCES-EP-amplitude significantly decreased during CS by 32 ± 11%, which was much more pronounced than CHEP-amplitudes [ 2 ] or SEP-amplitudes after chemonasal CO 2 -stimulation [ 22 ] as TS. Furthermore, the PCES-EP-amplitude is comparable to studies assessing SEP-amplitudes after CO 2 laser stimulation [ 17 ], and after electrical tooth stimulation [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 91%

“…Another study investigated CPM using chemo-somatosensory evoked potentials (CSSEPs) elicited by CO 2 -gas as TS and tonic heat pain as CS, and found significantly reduced CSSEP-amplitudes and prolonged latencies during CS [ 22 ]. The authors postulated that earlier CSSEP-components reflect the sensory input, while later components reflect the cerebral signal processing, and based on their findings they concluded the analgesic effects of CPM at a cerebral level.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous paradigms with different TS and CS (pressure, heat, cold, ischemia, electricity, laser) have been introduced, with high variability in the magnitude of the CPM-effect across subjects and studies [ 13 ]. Several studies have evaluated the CPM-effect using electrophysiological findings to objectively quantify the CPM effect, based on the spinal nociceptive flexion reflex (changes of amplitude [ 14 ] or threshold [ 15 ]), the R2-response of the blink reflex [ 16 ], as well as on sensory evoked potentials (SEP) after CO 2 -laser stimulation [ 17 – 19 ], electrical tooth stimulation [ 20 , 21 ], contact-heat stimulation [ 2 ] and chemonasal CO 2 -stimulation [ 22 ]. All of them showed significant effects across the study populations, however, they report of variable effects on individual subject level, and not all studies reported the number of subjects in whom the CPM-effect was detectable [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

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Evoked potentials after painful cutaneous electrical stimulation depict pain relief during a conditioned pain modulation

Höffken¹,

Özgül²,

Enax-Krumova³

et al. 2017

BMC Neurol

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BackgroundConditioned pain modulation (CPM) evaluates the pain modulating effect of a noxious conditioning stimulus (CS) on another noxious test stimulus (TS), mostly based solely on subjective pain ratings. We used painful cutaneous electrical stimulation (PCES) to induce TS in a novel CPM-model. Additionally, to evaluate a more objective parameter, we recorded the corresponding changes of cortical evoked potentials (PCES-EP).MethodsWe examined the CPM-effect in 17 healthy subjects in a randomized controlled cross-over design during immersion of the non-dominant hand into 10 °C or 24 °C cold water (CS). Using three custom-built concentric surface electrodes, electrical stimuli were applied on the dominant hand, inducing pain of 40–60 on NRS 0–100 (TS). At baseline, during and after CS we assessed the electrically induced pain intensity and electrically evoked potentials recorded over the central electrode (Cz).ResultsOnly in the 10 °C-condition, both pain (52.6 ± 4.4 (baseline) vs. 30.3 ± 12.5 (during CS)) and amplitudes of PCES-EP (42.1 ± 13.4 μV (baseline) vs. 28.7 ± 10.5 μV (during CS)) attenuated during CS and recovered there after (all p < 0.001). In the 10 °C-condition changes of subjective pain ratings during electrical stimulation and amplitudes of PCES-EP correlated significantly with each other (r = 0.5) and with CS pain intensity (r = 0.5).ConclusionsPCES-EPs are a quantitative measure of pain relief, as changes in the electrophysiological response are paralleled by a consistent decrease in subjective pain ratings. This novel CPM paradigm is a feasible method, which could help to evaluate the function of the endogenous pain modulation processes.Trial registrationGerman Clinical Trials Register DRKS-ID: DRKS00012779, retrospectively registered on 24 July 2017.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Evoked potentials after painful cutaneous electrical stimulation depict pain relief during a conditioned pain modulation

Höffken¹,

Özgül²,

Enax-Krumova³

et al. 2017

BMC Neurol

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“…The intensity of the CS has been shown to be unrelated or positively correlated to the magnitude of CPM (Yarnitsky, 2015). It is believed that once CPM is induced by a minimal noxious load, even mild pain elicited by tonic heat pain with intensities around the pain threshold (Kunz et al, 2014), CPM might not be further activated by increased conditioning pain levels, hence CPM is considered a saturable phenomenon (Nir, Granovsky, Yarnitsky, Sprecher, & Granot, 2011). …”

Section: Conditioning Stimulusmentioning

confidence: 99%

Pain Modulation: From Conditioned Pain Modulation to Placebo and Nocebo Effects in Experimental and Clinical Pain

Damien

Colloca

Belleï-Rodriguez

et al. 2018

International Review of Neurobiology

112

107

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Accumulating evidence reveal important applications of endogenous pain modulation assessment in healthy controls and in patients in clinical settings, as dysregulations in the balance of pain modulatory circuits may facilitate pain and promote chronification of pain. This article reviews data on pain modulation, focusing on the mechanisms and translational aspects of pain modulation from conditioned pain modulation (CPM) to placebo and nocebo effects in experimental and clinical pain. The specific roles of expectations, learning, neural and neurophysiological mechanisms of the central nervous system are briefly reviewed herein. The interaction between CPM and placebo systems in pain inhibitory pathways is highly relevant in the clinic and in randomized controlled trials yet remains to be clarified. Examples of clinical implications of CPM and its relationship to placebo and nocebo effects are provided. A greater understanding of the role of pain modulation in various pain states can help characterize the manifestation and development of chronic pain and assist in predicting the response to pain-relieving treatments. Placebo and nocebo effects, intrinsic to every treatment, can be used to develop personalized therapeutic approaches that improve clinical outcomes while limiting unwanted effects.

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Is conditioned pain modulation (CPM) affected by negative emotional state?

Horn‐Hofmann,

Jablonowski,

Madden

et al. 2023

European Journal of Pain

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BackgroundConditioned pain modulation (CPM) is an experimental paradigm, which describes the inhibition of responses to a noxious or strong‐innocuous stimulus, the test stimulus (TS), by the additional application of a second noxious or strong‐innocuous stimulus, the conditioning stimulus (CS). As inadequate CPM efficiency has been assumed to be predisposing for clinical pain, the search for moderating factors explaining inter‐individual variations in CPM is ongoing. Psychological factors have received credits in this context. However, research concerning associations between CPM and trait factors relating to negative emotions has yielded disappointing results. Yet, the influence of anxious or fearful states on CPM has not attracted much interest despite ample evidence that negative affective states enhance pain. Our study aimed at investigating the effect of fear induction by symbolic threat on CPM.MethodsThirty‐seven healthy participants completed two experimental blocks: one presenting aversive pictures showing burn wounds (high‐threat block) and one presenting neutral pictures (low‐threat block). Both blocks contained a CPM paradigm with contact heat as TS and hot water as CS; subjective numerical ratings as well as contact‐heat evoked potentials (CHEPs) were assessed.ResultsWe detected an overall inhibitory CPM effect for CHEPs amplitudes but not for pain ratings. However, we found no evidence for a modulation of CPM by threat despite threat ratings indicating that our manipulation was successful.DiscussionThese results suggest that heat/thermal CPM is resistant to this specific type of symbolic threat induction and further research is necessary to examine whether it is resistant to fearful states in general.SignificanceThe attempt of modulating heat conditioned pain modulation (CPM) by emotional threat (fear/anxiety state) failed. Thus, heat CPM inhibition again appeared resistant to emotional influences. Pain‐related brain potentials proved to be more sensitive for CPM effects than subjective ratings.

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Chemo-somatosensory evoked potentials: A sensitive tool to assess conditioned pain modulation?

Cited by 7 publications

References 28 publications

Evoked potentials after painful cutaneous electrical stimulation depict pain relief during a conditioned pain modulation

Evoked potentials after painful cutaneous electrical stimulation depict pain relief during a conditioned pain modulation

Pain Modulation: From Conditioned Pain Modulation to Placebo and Nocebo Effects in Experimental and Clinical Pain

Is conditioned pain modulation (CPM) affected by negative emotional state?

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