Enhanced facilitation and diminished inhibition characterizes the pronociceptive endogenous pain modulatory balance of persons living with HIV and chronic pain

Owens, Michael A.; Parker, Romy; Rainey, R.; Gonzalez, Cesar E.; White, Dyan M.; Ata, Anooshah E.; Okunbor, Jennifer I.; Heath, Sonya L.; Merlin, Jessica S.; Goodin, Burel R.

doi:10.1007/s13365-018-0686-5

Cited by 17 publications

(10 citation statements)

References 71 publications

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“…Experimental protocols for the assessment of endogenous pain modulatory balance included TS of mechanical pain and CPM, each assessed at the lumbar spine. TS & CPM protocols were carried out in accordance with commonly recommended methods [ 19 , 30 , 37 , 38 ]. Our findings suggest that a pro-nociceptive pain modulatory balance, characterized by a high degree of endogenous pain facilitation (i.e., TS of mechanical pain), may be an important contributor to future episodes of movement-evoked cLBP severity and poorer physical function when assessed with the SPPB.…”

Section: Discussionmentioning

confidence: 99%

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Temporal summation of mechanical pain prospectively predicts movement-evoked pain severity in adults with chronic low back pain

Overstreet

Michl

Penn

et al. 2021

BMC Musculoskelet Disord

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Background Biopsychosocial factors above and beyond pathoanatomical changes likely contribute to the severity of chronic low back pain. A pro-nociceptive endogenous pain modulatory balance (↓inhibition and ↑facilitation) may be an important contributor to chronic low back pain severity and physical function; however, additional research is needed to address this possibility. The objective of this study was to determine whether quantitative sensory tests of endogenous pain inhibition and facilitation prospectively predict movement-evoked pain and cLBP severity self-reported on a validated questionnaire. Methods One hundred thirty-four individuals with chronic low back pain were enrolled in this two-session study. During the first study session, temporal summation of mechanical pain and conditioned pain modulation were assessed at the lumbar spine to determine endogenous pain facilitation and inhibition, respectively. One week later, participants returned for a second study session whereby they reported their pain severity and pain interference using the Brief Pain Inventory-Short Form. Movement-evoked pain and physical function capacity were assessed upon completion of the balance, walking, and transition from sit to stand tests of the Short Physical Performance Battery. Results Temporal summation of mechanical pain, but not conditioned pain modulation, significantly and prospectively predicted greater movement-evoked pain and poorer physical function on the Short Physical Performance Battery. Neither temporal summation nor conditioned pain modulation were significantly related to self-reported pain severity or pain interference on the Brief Pain Inventory-Short Form. Conclusions Findings suggest that a pro-nociceptive pain modulatory balance characterized by enhanced pain facilitation may be an important driver of movement-evoked pain severity and poor physical function in individuals with chronic low back pain.

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Section: Discussionmentioning

confidence: 99%

“…For this study, TS of mechanical pain was examined exclusively as a measure of endogenous pain facilitation. Previous research has demonstrated that TS of mechanical pain is more clinically relevant than TS of thermal pain for predicting musculoskeletal clinical pain severity [ 15 , 29 , 30 ].…”

Section: Methodsmentioning

confidence: 99%

Temporal summation of mechanical pain prospectively predicts movement-evoked pain severity in adults with chronic low back pain

Overstreet

Michl

Penn

et al. 2021

BMC Musculoskelet Disord

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“…As such, a complete methodology can be found elsewhere. 25 All participants provided written informed consent and study procedures were approved by the University of Alabama at Birmingham Institutional Review Board and conducted in compliance with the Declaration of Helsinki.…”

Section: Methodsmentioning

confidence: 99%

“…Our QST methodology has been described elsewhere. 25 In short, heat pain threshold (HPTh), heat pain tolerance (HPTo), and temporal summation (TS) of heat pain were assessed prior to TS of mechanical pain. Following TS procedure, conditioned pain modulation (CPM) was assessed.…”

Section: Quantitative Sensory Testing (Qst)mentioning

confidence: 99%

<p>Sex and Gender are Not the Same: Why Identity Is Important for People Living with HIV and Chronic Pain</p>

Strath

Sorge

Owens

et al. 2020

JPR

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Background: Sex differences in pain sensitivity have been well documented, such that women often report greater sensitivity than men. However, clinical reports highlighting sex differences often equate gender and sex. This is a particularly critical oversight for those whose gender identity is different than their genetic sex. Methods: This preliminary study sets to analyze differences in pain responses between cisgender and transgender individuals living with HIV and chronic pain. A total of 51 African-American participants (24 cisgender men, 20 cisgender women, 7 transgender women) with similar socioeconomic status were recruited. Genetic sex, gender identity, depression and anxiety, pain severity, pain interference and pain-related stigma were recorded. Participants also completed a quantitative sensory testing battery to assess pain in response to noxious heat and mechanical stimuli. Results: Transgender women and cisgender women demonstrated a greater magnitude of temporal summation for heat pain stimuli or mechanical stimuli compared to cisgender men. Specifically, transgender women reported greater mechanical summation than either cisgender women or cisgender men. Transgender women and cisgender women similarly reported greater chronic pain severity compared to cisgender men. Conclusion: These data support the notion that gender identity may play a more significant role in pain sensation than genetic sex. These results further maintain that not only gender identity and genetic sex are distinct variables but that treatment should be based on identity as opposed to genetic sex.

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“…In chronic pain cohorts, psychophysical pain assessments, such as quantitative sensory testing (QST) and conditioned pain modulation (CPM), can be used to demonstrate patterns of sensory change hypothesised to be linked to underlying pain mechanisms, with the potential to guide individualised analgesic treatment (Arendt-Nielsen et al, 2017;Baron et al, 2017;Campbell et al, 2012;Demant et al, 2014;Höper et al, 2014;Nahman-Averbuch et al, 2011;Owens et al, 2019;Simpson et al, 2010;Westermann et al, 2012;Yarnitsky et al, 2012). QST is a method of assessing somatosensory function, providing a semi-objective quantification of sensory large and small nerve fibre function (Gracely, 1999;Greenspan, 2001;Haanpaa et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

Chronic pain and cognitive impairment: a cross-sectional study in people living with HIV

et al. 2021

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Cognitive impairment and chronic pain are amongst the most prevalent neurological sequelae of HIV infection, yet little is understood about the potential bidirectional relationship between the two conditions. Cognitive dysfunction can occur in chronic pain populations whilst those with cognitive impairment can display modified responses to experimentally induced painful stimuli. To date, this has not been explored in HIV cohorts.This study aimed to identify any contribution of chronic pain to cognitive impairment in HIV and to determine differences in pain characteristics between those with and without cognitive dysfunction.This was an observational cohort study involving people living with HIV (n = 148) in the United Kingdom. Participants underwent validated questionnaire-based measurement of pain severity, interference and symptom quality as well as conditioned pain modulation and quantitative sensory testing. All participants completed a computer-based cognitive function assessment.Fifty-seven participants met the criteria for cognitive impairment and 73 for chronic pain. The cognitive impairment group had a higher prevalence of chronic pain (p = 0.004) and reported more neuropathic symptoms (p = 0.001). Those with chronic pain performed less well in emotional recognition and verbal learning domains. The interaction identified between chronic pain and cognitive dysfunction warrants further exploration to identify causal links or shared pathology.

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Enhanced facilitation and diminished inhibition characterizes the pronociceptive endogenous pain modulatory balance of persons living with HIV and chronic pain

Cited by 17 publications

References 71 publications

Temporal summation of mechanical pain prospectively predicts movement-evoked pain severity in adults with chronic low back pain

Temporal summation of mechanical pain prospectively predicts movement-evoked pain severity in adults with chronic low back pain

<p>Sex and Gender are Not the Same: Why Identity Is Important for People Living with HIV and Chronic Pain</p>

Chronic pain and cognitive impairment: a cross-sectional study in people living with HIV

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