Defective Endogenous Pain Modulation in Fibromyalgia: A Meta-Analysis of Temporal Summation and Conditioned Pain Modulation Paradigms

O’Brien, Anthony Terrence; Deitos, Alícia; Pego, Yolanda Triñanes; Fregni, Felipe; Carrillo-de-la-Peña, M. T.

doi:10.1016/j.jpain.2018.01.010

Cited by 164 publications

(149 citation statements)

References 81 publications

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“…Another possibility is that EPM plays a smaller role in chronic pain pathophysiology than previously suggested, 59 as recent meta-analyses suggested that patients suffering from different chronic pain conditions such as fibromyalgia and TMD presented small to medium effect sizes when comparing TSP and CPM responses between patients and pain-free controls. 8,60 Increased psychosocial symptoms were found for TMD cases relative to controls in the present study, in agreement with the results from the OPPERA case-control study, 17 while both groups presented with similar BMI and handedness. No association of EPM responses with pain characteristics such as pain duration or pain intensity was found in the present study similarly to previous studies.…”

Section: Discussion and Con Clus I On Ssupporting

confidence: 91%

“…Reliability of EPM testing has been challenged recently, and there is a need for further studies to refine EPM testing methodology in order to improve its reliability. Another possibility is that EPM plays a smaller role in chronic pain pathophysiology than previously suggested, as recent meta‐analyses suggested that patients suffering from different chronic pain conditions such as fibromyalgia and TMD presented small to medium effect sizes when comparing TSP and CPM responses between patients and pain‐free controls …”

Section: Discussionmentioning

confidence: 97%

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Endogenous pain modulation in chronic temporomandibular disorders: Derivation of pain modulation profiles and assessment of its relationship with clinical characteristics

Moana-Filho

Babiloni

2018

J of Oral Rehabilitation

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Summary Background Endogenous pain modulation (EPM) reflects the brain's ability to modulate incoming nociceptive inputs, and deficient EPM was implicated as a chronic pain mechanism. EPM status has been investigated in temporomandibular disorders (TMD) patients with conflicting results, and its relationship with clinical characteristics in this population is not well known. Objectives (a) Determine EPM responses in chronic TMD cases and pain‐free controls; (b) Derive pain modulation profiles (PMP) based on individual EPM responses; and (c) Categorise clinical characteristics of TMD cases and pain‐free controls based on their individual PMP. Methods Twenty‐two chronic TMD cases and 17 age‐matched pain‐free controls, all females, were comprehensively characterised regarding clinical characteristics and underwent EPM testing using temporal summation of pain (TSP) and conditioned pain modulation (CPM) protocols over the face and hand. Individuals were categorised into PMPs (I‐IV) based on predetermined cut‐off points for TSP and CPM responses. Results Between‐group comparisons showed similar TSP and CPM responses (P > 0.23) in the face, while TMD cases showed significantly increased TSP (P = 0.04) but similar CPM responses (P > 0.17) in the hand relative to controls. Similar distribution across PMPs and clinical characteristics when categorised into PMPs was found for both groups. Body mass index was associated with increased TSP and reduced CPM in the face in TMD cases. Conclusion Endogenous pain modulation responses over the face were similar between groups. TMD cases showed increased hand TSP compared to controls while both groups showed no significant hand CPM. PMP classification showed similar results between groups, and further refinement of PMP determination is warranted.

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Section: Discussion and Con Clus I On Ssupporting

confidence: 91%

Section: Discussionmentioning

confidence: 97%

Endogenous pain modulation in chronic temporomandibular disorders: Derivation of pain modulation profiles and assessment of its relationship with clinical characteristics

Moana-Filho

Babiloni

2018

J of Oral Rehabilitation

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“…In a recent meta-analysis and numerous studies, a significant alteration of pain modulation mechanisms (CPM or temporal summation) is present in patients with fibromyalgia (FM) or chronic widespread pain (O’Brien, Deitos, Triñanes Pego, Fregni, & Carrillo-de-la-Peña, 2018). While major depressive disorder is not associated with CPM deficits (Normand et al, 2011), patients with FM and comorbid depression have more pronounced deficits in pain inhibition (de Souza, Potvin, Goffaux, Charest, & Marchand, 2009).…”

Section: Clinical Relevance Of Pain Modulationmentioning

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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“…Dazu zählen eine gesteigerte TS als Zeichen pronozizeptiver Sensibilisierungsmechanismen und eine reduzierte CPM als Zeichen für einen Verlust der endogenen Schmerzkontrolle. Beide Phänomene sind beispielsweise bei Fibromyalgie, dem klassischen Beispiel für ein "central sensitization syndrome", zu beobachten [36] und scheinen generell im Verlauf der Schmerzchronifizierung zuzunehmen. So wurde bei chronischen Schmerzerkrankungen (v. a. bei chronischen Kreuzschmerzen) beobachtet, dass eine gesteigerte TS und eine reduzierte CPM mit der Ausbildung multilokulärer Schmerzen und einer generalisierten Hyperalgesie einhergehen [44,12,38] Hypersensitivität Praxis zkm on der Stressantwort vor [9].…”

Section: Sensorische Zeichen Der Zentralen Sensibilisierung Bilden VIunclassified

Der sensibilisierte Patient in der Schmerztherapie

Bäumler¹

2020

Zeitschrift für Komplementärmedizin

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SummaryEine Gruppe von Patienten mit chronischen schmerzhaften Erkrankungen zeigen besonders viele unterschiedliche Symptome und ausgeprägte sensorische Sensibilisierungzeichen. Dieses Phänomen wird auch als Hypersensitivitätssyndrom beschrieben.Aus neurophysiologischer lässt sich dies durch komplexe Sensibilisierungsmechanismen auf Ebene des Rückenmarks und des Gehrins erklären. Gleichsam entscheidend ist die seelische Sensibilisierung – psychische Erkrankungen und negative Affekte, wie eine katastrophisierende Haltung, Ängste und eine depressive Stimmungslage.Intensive Forschungsarbeit hat gezeigt, dass neurophysiologische und psychologische Faktoren eng verwoben und nicht nur Folgen sondern auch Risikofaktoren für chronische schmerzhafte Erkrankungen sind.In der Therapie sensibilisierter Patienten haben sich Verfahren bewährt, die den zugrunde liegenden neurophysiologischen Veränderungen entgegenwirken und sich gleichzeitig regulierend auf dysfunktionale Kognitionen, Emotionen und Verhaltensmuster auswirken. Dabei kommt der Komplementärmedizin eine große Bedeutung zu.

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Defective Endogenous Pain Modulation in Fibromyalgia: A Meta-Analysis of Temporal Summation and Conditioned Pain Modulation Paradigms

Cited by 164 publications

References 81 publications

Endogenous pain modulation in chronic temporomandibular disorders: Derivation of pain modulation profiles and assessment of its relationship with clinical characteristics

Endogenous pain modulation in chronic temporomandibular disorders: Derivation of pain modulation profiles and assessment of its relationship with clinical characteristics

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

Der sensibilisierte Patient in der Schmerztherapie

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