Mechanistic perspective on conditioned pain modulation

Piché, Mathieu

doi:10.1097/j.pain.0000000000002717

Cited by 6 publications

(8 citation statements)

References 31 publications

(37 reference statements)

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“…Attention is known to modulate pain [35,36]. While attention to the conditioning stimulus can increase CPM and also produce hypoalgesia in addition or independent of CPM [37][38][39][40], a limitation of our study is that we cannot separate conditioning stimulus effects due to painfulness and attention or salience since we applied the conditioning and test stimuli in parallel [33,41]. However, we included a non-painful control condition to somewhat counter this and to be able to claim that our effects are not due to pressure per se but due to painful pressure.…”

Section: Limitationsmentioning

confidence: 99%

Section: Pain Modulation In the Cortexmentioning

confidence: 99%

“…We used parallel stimulation that has been posited to be a requirement for any CPM effect to reflect a DNIC-like mechanism in humans [33]. However, our protocol included homotopic stimulation where spinal mechanisms may be at play via communication within or across proximal segments, and only protocols with heterotopic stimulation can confirm a supraspinal CPM mechanism [28,33]. In principle, a neural CPM effect would be expected to be stronger contralateral to the test stimulus when looking at the brain and ipsilateral to the test stimulus when looking at the spinal cord.…”

Section: Pain Modulation In the Cortexmentioning

confidence: 99%

“…Ischemic pressure pain applied with a cuff algometer has been shown to reliably induce CPM in humans [30][31][32]. The simultaneous application of tonic and phasic stimuli was motivated by the requirement for DNIC mechanism that noxious stimuli are applied in a concurrent and competing manner [33] and allowed us to acquire trial-wise pain ratings as well as BOLD responses over multiple stimulus repetitions. We investigated whether distinct neural correlates of test and conditioning stimuli as well as correlates of CPM could be observed in the brain, but also in the brainstem, medulla and spinal cord.…”

Section: Introductionmentioning

confidence: 99%

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Conditioned pain modulation of pressure pain is associated with reduced activation in the parietal operculum and posterior insula

Ojala,

Chu,

Finsterbusch

et al. 2023

Preprint

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Conditioned pain modulation (CPM) is the phenomenon of pain inhibiting further pain. CPM is impaired in patients suffering from various chronic pain conditions and may resemble a pro-nociceptive profile. A possible neural mechanism for CPM is descending control from cortical regions via brainstem that modulates neural activity at the level of the dorsal horn of the spinal cord where noxious input first arrives. We studied the involvement of the descending pain modulatory pathway by simultaneous functional imaging of the brain, brainstem, rostral medulla, and cervical spinal cord during CPM with pressure cuff algometry in 42 healthy human participants. Subjective CPM as measured by decreased pain ratings developed over the experiment with application of repeated short test stimuli for long conditioning pain compared with non-painful conditioning. Test stimuli paired with painful conditioning were associated with decreased BOLD fMRI activity in the parietal operculum (secondary somatosensory cortex) and posterior insula, as well as increased responses in bilateral primary somatosensory cortices. Subjective CPM reflected in pain ratings was associated with decreased test stimulus responses in somatosensory and pain-responsive brain regions such as the anterior and posterior insula and the parietal operculum. Conditioning pain and test pain were associated with increased neural activity in stimulus-ipsilateral spinal cord dorsal horn at segment C6 and C4, respectively. No evidence for neural correlates of CPM or associations with subjective CPM was observed in the spinal cord. Functional connectivity between the brain and spinal cord was altered during both conditioning and test pain but did not depend on conditioning intensity. Taken together, we observed neural activity associated with both negative (CPM) and positive modulation of pain in different somatosensory and pain-associated brain regions, and an association of these and other neural responses with subjective CPM. While we found that painful stimuli altered the connectivity along the descending pain modulatory pathway, we did not find evidence for a modulation by conditioning intensity nor neural correlates of CPM in the spinal cord.

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Section: Limitationsmentioning

confidence: 99%

Section: Pain Modulation In the Cortexmentioning

confidence: 99%

Section: Pain Modulation In the Cortexmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Conditioned pain modulation of pressure pain is associated with reduced activation in the parietal operculum and posterior insula

Ojala,

Chu,

Finsterbusch

et al. 2023

Preprint

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“…This paradigm assesses the "pain inhibits pain" effect by modulating the perceived pain intensity or by increasing the pain threshold to a noxious test stimulus by another noxious "conditioning" stimulus (COS) applied heterotopically. 11 It is not yet clear the underlying mechanisms that are produced in the CPM paradigm 11,12 and therefore the effect of the complex facilitatory and inhibitory mechanisms of pain processing is being recorded. 13 Several studies have investigated the efficacy of CPM in patients with chronic NSNP compared to a control group of pain-free participants.…”

Section: Introductionmentioning

confidence: 99%

Conditioned pain modulation and psychological factors in young adults with recurrent or chronic neck pain

Arribas‐Romano,

Fernández‐Carnero,

González‐Zamorano

et al. 2023

Pain Practice

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BackgroundControversy exists with the presence of alterations in descending pain inhibition mechanisms in patients with non‐specific neck pain (NSNP). The aim of the present study was to evaluate the status of conditioned pain modulation CPM, remote pressure pain thresholds (PPT), and psychological factors in a specific subgroup of patients with NSNP such as young adult students. In addition, possible associations between CPM, psychological factors, and pain characteristics were analyzed.MethodsThirty students with recurrent or chronic NSNP and 30 pain‐free students were included in this cross‐sectional study. The following measures were assessed: CPM, remote PPT, psychological factors (depression, anxiety, pain catastrophizing, and kinesiophobia), pain characteristics (duration, intensity, severity of chronic pain, interference with daily life), and central sensitization inventory (CSI).ResultsNo significant differences were found in the efficacy of CPM between students with chronic or recurrent NSNP and pain‐free students (β coefficient = −0.67; 95% CI = −1.54, 0.20). However, students with pain showed a significantly higher remote PPT (mean difference = −1.94; 95% CI = −2.71, −1.18). and a greater presence of anxious (mean difference = 6; 95% CI = 2, 9) and depressive symptoms (mean difference = 8.57; 95% CI = 3.97, 13.16). In addition, significant moderate or strong correlations were found between CPM and pain intensity (partial r = 0.41), pain catastrophizing and mean pain intensity (r = 0.37), grade (r = 0.50), and interference of pain (r = 0.57), kinesiophobia and disability (r = 0.38), and depression and CSI (r = 0.39).ConclusionsYoung adult students with chronic or recurrent NSNP present remote hyperalgesia and symptoms of depression and anxiety but not dysfunctional CPM.

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Expectation of analgesia increases the inhibitory response of conditioned pain modulation in healthy participants who at baseline have a non‐inhibitory profile

Nascimento,

Ardestani,

Novaes

et al. 2024

European Journal of Pain

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BackgroundThis study assessed the effect of expectation of analgesia on conditioned pain modulation (CPM) in healthy participants stratified into inhibitors and non‐inhibitors.MethodsA parallel CPM protocol was assessed on 21 women and 22 men across two sessions: baseline and expectation of analgesia, which was induced by a standardized audiovisual suggestion. The CPM assessment involved two different test stimuli (TS): mechanically controlled palpation and the pressure pain threshold, applied to two different regions: anterior temporalis and thenar eminence of the hand. The conditioning stimulus (CS) involved immersing the non‐dominant forearm in cold water. The order of the TS and regions was randomized for each participant. The CPM protocol was performed three times, with a 1‐min interval between TS/region sequences. After a 20‐min rest, the CPM assessment was repeated (two blocks in total). The standard error of measurement (SEM) was computed to identify inhibitors (inhibitory responses) and non‐inhibitors (including non‐inhibitors and facilitatory responses). Cochran's Q, ANOVA and ANCOVA were applied to the data (p < 0.05).ResultsThere was a significant decrease in the proportion of non‐inhibitors during the expectation of analgesia session (32.6%–44.2%) when compared with the baseline session (51.2%–72.1%). The non‐inhibitors exhibited a lower inhibitory CPM magnitude than the inhibitors only in block 1 of the baseline session. The expectation of analgesia resulted in an increased magnitude of the inhibitory CPM solely in non‐inhibitors.ConclusionExpectation of analgesia can increase the inhibitory response of the CPM beyond the measurement error in healthy participants with a baseline non‐inhibitory profile.SignificanceSeveral studies have investigated whether cognitive modulation can alter the magnitude of the inhibitory response of conditioned pain modulation (CPM), yet some gaps remain. This study accounted for measurement error to accurately determine changes in CPM influenced by expectation of analgesia.

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Mechanistic perspective on conditioned pain modulation

Cited by 6 publications

References 31 publications

Conditioned pain modulation of pressure pain is associated with reduced activation in the parietal operculum and posterior insula

Conditioned pain modulation of pressure pain is associated with reduced activation in the parietal operculum and posterior insula

Conditioned pain modulation and psychological factors in young adults with recurrent or chronic neck pain

Expectation of analgesia increases the inhibitory response of conditioned pain modulation in healthy participants who at baseline have a non‐inhibitory profile

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