Current methodological approaches in conditioned pain modulation assessment in pediatrics

Hwang, Philippe; Ma, My-Linh; Spiegelberg, Nora; Ferland, Catherine

doi:10.2147/jpr.s150857

Cited by 16 publications

(18 citation statements)

References 23 publications

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“…The present study also compared inhibitory pain modulation capabilities, using the CPM paradigm, between adolescents with migraine and healthy adolescents. Previous studies on CPM responses found reduced inhibitory efficacy in youth with chronic pain such as irritable bowel syndrome, functional abdominal pain, and musculoskeletal pain, compared to healthy controls 45 . For migraine patients, our group has published the only study to date comparing CPM responses between adolescents with migraine and healthy adolescents.…”

Section: Discussionmentioning

confidence: 97%

“…Previous studies on CPM responses found reduced inhibitory efficacy in youth with chronic pain such as irritable bowel syndrome, functional abdominal pain, and musculoskeletal pain, compared to healthy controls. 45 For migraine patients, our group has published the only study to date comparing CPM responses between adolescents with migraine and healthy adolescents. No differences between the groups were found in CPM responses, which were evoked using 2 paradigms (heat and pressure as the test stimuli).…”

Section: Discussionmentioning

confidence: 99%

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Spatial aspects of pain modulation are not disrupted in adolescents with migraine

et al. 2020

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Objective: To compare spatial pain modulation capabilities between adolescents with and without migraine. Background: Conditioned pain modulation (CPM) responses at the leg are similar in adolescents with versus without migraine. However, the anatomical region of testing may affect spatial pain modulation capabilities as differences in nociceptive processing between patients with migraine and healthy controls are found in local areas that are near the site of clinical pain but not in nonlocal areas. This study aimed to examine spatial pain modulation capabilities tested by the CPM paradigm using test stimulus applied to a local body area. Methods: Nineteen adolescents with migraine (age 14.9 ± 2.3, mean ± SD; 16 female) and 20 healthy adolescents (age 13.8 ± 2.5, mean ± SD; 16 female) completed this case-control study at Cincinnati Children's Hospital Medical Center. Pressure pain thresholds (PPT) were assessed at the trapezius before and during immersion of the foot in a cold water bath (8°C). Results: In the migraine group (146.0 ± 79.1, mean ± SD), compared to healthy controls (248.0 ± 145.5, mean ± SD), significantly lower PPT (kilopascal) values were found (estimate = 124.28, 95% CI: 58.98, 189.59, p < 0.001; effect size: d = 1.40). No differences between the groups were found for pain intensity and unpleasantness ratings of cold-water immersion nor the CPM response. Conclusions: This study found altered ascending nociceptive processing of mechanical stimuli at the neck in adolescents with migraine. However, endogenous pain modulatory mechanisms were functional and not altered. In light of other studies, impairments in inhibitory control may not be involved in migraine pathophysiology in pediatric patients regardless of stimulus location.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Spatial aspects of pain modulation are not disrupted in adolescents with migraine

et al. 2020

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“…Conditioning reduces pain sensitivity (i.e. evokes descending inhibition) but impaired CPM (reduced degree of inhibition and/or facilitation) is common in patients with chronic pain [41] . CPM was impaired in adolescents with scoliosis, many of whom also reported neuropathic pain descriptors [42] and in adolescents with peripheral neuropathic pain [8] .…”

Section: Assessmentmentioning

confidence: 99%

Neuropathic pain in children: Steps towards improved recognition and management

Walker

2020

eBioMedicine

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Neuropathic pain in children can be severe and persistent, difficult to recognise and manage, and associated with significant pain-related disability. Recognition based on clinical history and sensory descriptors is challenging in young children, and screening tools require further validation at older ages. Confirmatory tests can identify the disease or lesion of the somatosensory nervous system resulting in neuropathic pain, but feasibility and interpretation may be influenced by age-and sex-dependent changes throughout development. Quantitative sensory testing identifies specific mechanism-related sensory profiles; brain imaging is a potential biomarker of alterations in central processing and modulation of both sensory and affective components of pain; and genetic analysis can reveal known and new causes of neuropathic pain. Alongside existing patient-and parent-reported outcome measures, somatosensory system research methodologies and validation of mechanism-based standardised end-points may inform individualised therapy and stratification for clinical trials that will improve evidence-based management of neuropathic pain in children.

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“… 21 , 24–28 Studies in the pediatric population using dynamic QST (ie, focusing on the evaluation of pain modulation) have shown that chronic pain conditions are associated with altered excitatory and inhibitory endogenous pain modulation systems. 10 , 15 , 29–36 The endogenous inhibitory pathways of pain modulation can be indirectly assessed using the CPM paradigm. 29 , 37 Assessing CPM in a clinical setting may be a valuable tool to assess any deficits in the descending inhibitory pain response found in some chronic pain conditions such as abdominal pain and chronic musculoskeletal pain in youth when compared to healthy controls.…”

Section: Introductionmentioning

confidence: 99%

“… 10 , 15 , 29–36 The endogenous inhibitory pathways of pain modulation can be indirectly assessed using the CPM paradigm. 29 , 37 Assessing CPM in a clinical setting may be a valuable tool to assess any deficits in the descending inhibitory pain response found in some chronic pain conditions such as abdominal pain and chronic musculoskeletal pain in youth when compared to healthy controls. 10 , 30 , 33 , 38 , 39 The endogenous facilitatory phenomenon of pain modulation such as temporal summation has been shown to be involved in the development of some chronic pain conditions such as sickle cell disease, fibromyalgia, migraines, and functional abdominal pain.…”

Section: Introductionmentioning

confidence: 99%

Phenotyping Chronic Musculoskeletal Pain in Male and Female Adolescents: Psychosocial Profiles, Somatosensory Profiles and Pain Modulatory Profiles

Ocay¹,

Larche²,

Betinjane³

et al. 2022

JPR

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Purpose A major limitation in treatment outcomes for chronic pain is the heterogeneity of the population. Therefore, a personalized approach to the assessment and treatment of children and adolescents with chronic pain conditions is needed. The objective of the study was to subgroup pediatric patients with chronic MSK pain that will be phenotypically different from each other based on their psychosocial profile, somatosensory function, and pain modulation. Patients and Methods This observational cohort study recruited 302 adolescents (10–18 years) with chronic musculoskeletal pain and 80 age-matched controls. After validated self-report questionnaires on psychosocial factors were completed, quantitative sensory tests (QST) and conditioned pain modulation (CPM) were performed. Results Three psychosocial subgroups were identified: adaptive pain (n=125), high pain dysfunctional (n=115), high somatic symptoms (n=62). Based on QST, four somatosensory profiles were observed: normal QST (n=155), thermal hyperalgesia (n=98), mechanical hyperalgesia (n=34) and sensory loss (n=15). Based on CPM and temporal summation of pain (TSP), four distinct groups were formed, dysfunctional central processing group (n=27) had suboptimal CPM and present TSP, dysfunctional inhibition group (n=136) had suboptimal CPM and absent TSP, facilitation group (n=18) had optimal CPM and present TSP, and functional central processing (n=112) had optimal CPM and absent TSP. A significant association between the psychosocial and somatosensory profiles. However, no association was observed between the psychosocial or somatosensory profiles and pain modulatory profiles. Conclusion Our results provide evidence that adolescents with chronic musculoskeletal pain are a heterogenous population comprising subgroups that may reflect distinct mechanisms and may benefit from different treatment approaches. The combination of screening self-reported questionnaires, QST, and CPM facilitate subgrouping of adolescents with chronic MSK pain in the clinical context and may ultimately contribute to personalized therapy.

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Current methodological approaches in conditioned pain modulation assessment in pediatrics

Cited by 16 publications

References 23 publications

Spatial aspects of pain modulation are not disrupted in adolescents with migraine

Spatial aspects of pain modulation are not disrupted in adolescents with migraine

Neuropathic pain in children: Steps towards improved recognition and management

Phenotyping Chronic Musculoskeletal Pain in Male and Female Adolescents: Psychosocial Profiles, Somatosensory Profiles and Pain Modulatory Profiles

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