Modality-specific Somatosensory Changes in a Human Surrogate Model of Postoperative Pain

Fißmer, Ina; Klein, Thomas; Magerl, Walter; Treede, Rolf‐Detlef; Zahn, Peter; Pogatzki-Zahn, Esther

doi:10.1097/aln.0b013e318219509e

Cited by 28 publications

(31 citation statements)

References 52 publications

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“…The same mediators also induce TRPV1-dependent primary hyperalgesia to heat, and heat pain sensitivity seems to exhibit the largest gender differences. 13,37,40 4.5. The contribution of A and C fibers to incisional pain Incisional pain is most likely evoked by excitation of A and C fiber nociceptors.…”

Section: Gender Differencesmentioning

confidence: 99%

“…This procedure has been established previously as a model for incisional pain after surgery. 13 The incision took place either at the beginning or the end of the whole session (balanced across participants).…”

Section: Reference Stimulus: Incisionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…25 The latter has been tackled by miniature incision models, [3][4][5]13,22,36,37,48 which have limited application. It has, however, been demonstrated that incision has similarities to needle-like punctate stimuli, 1,13 and that noncutting blades may bridge the gap between punctate stimuli and frank cutting injury. 14 This may also allow the study of this type of impact in subjects, where experimental cuts may be ethically problematic, when the stimulus needs to be applied repeatedly, eg, in functional imaging studies 38 or in patients, in whom cutting is a behavioral disorder of nonsuicidal self-injury regular with a lifetime prevalence of 14%, met in patients with borderline personality disorder (BPD) or eating disorder.…”

Section: Introductionmentioning

confidence: 99%

“…26 With respect to research of mechanisms of postoperative pain, incision pain models in rats display reduced mechanical response thresholds to punctate stimuli in Ad and C fibers after incision, especially in mechanically insensitive afferents, 18 higher response magnitude to suprathreshold stimuli and expansion of receptive fields. [3][4][5]13,22,36,37,48,49 Primary hyperalgesia based on peripheral sensitization of the wound strongly influences pain behavior. 48 Secondary hyperalgesia due to enhanced central processing may not necessarily directly affect postoperative spontaneous pain ratings, but may play a role in the development of chronic postsurgical pain.…”

Section: Introductionmentioning

confidence: 99%

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A novel human surrogate model of noninjurious sharp mechanical pain

Shabes

Schloss

Magerl

et al. 2016

Pain

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We propose a blade as a noninjurious nociceptive stimulus modeling sharp mechanical pain and yielding acute pain and hyperalgesia responses with closer proximity to incision-induced pain/hyperalgesia than punctate or blunt pressure mechanical pain models. Twenty-six healthy men and women were investigated to compare a small incision in the left forearm with noninvasive stimuli of different shapes and modalities to the right forearm. The magnitude and time course of incisional and blade-induced pain were assessed by numerical rating scales. Affective vs sensory components of pain experience were differentiated using a pain sensation questionnaire. The magnitude and time course of the axon reflex vasodilator response and of secondary hyperalgesia following a 7-second blade application were assessed. The maximum blade or incisional pain was similar (visual analogue scale [mean ± SD]: 32.9 ± 22.5 [blade] vs. 33.6 ± 29.8 [incision]), and both time courses matched closely in the first 10 seconds (paired t test; P = 0.5-1.0), whereas incision but not blade was followed by a second phase of pain, probably related to the tissue injury (decrease to half maximum pain 8 ± 2 vs. 33 ± 35 seconds; P < 0.01). Affective pain scores were significantly lower than sensory scores for all stimuli (P < 0.001). Comparing blade and incision, patterns of affective and sensory pain descriptors exhibited a remarkably similar pattern. Hence, we suggest the blade as novel model of sharp mechanical pain, which will be useful in investigating postoperative/mechanical pain and the role of self-injurious behavior in, eg, patients with borderline personality disorder.

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Section: Gender Differencesmentioning

confidence: 99%

Section: Reference Stimulus: Incisionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A novel human surrogate model of noninjurious sharp mechanical pain

Shabes

Schloss

Magerl

et al. 2016

Pain

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Differential perception of sharp pain in patients with borderline personality disorder

Schloss

Shabes

Kuniss

et al. 2019

European Journal of Pain

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Background Cutting is the most common method of non‐suicidal self‐injury (NSSI) to reduce inner tension in patients with Borderline Personality Disorder (BPD). Aim of this study was to compare pain perception induced by an incision and by application of a surrogate model for sharp mechanical pain (a non‐invasive “blade”) in BPD. Methods 22 female patients and 20 healthy controls (HC) received a small incision into the volar forearm, a 7s‐blade application on the same side, and non‐invasive phasic stimuli (pinprick, blade, laser, tactile). Pain intensity as well as affective versus sensory components were assessed. Results Incision was rated similarly by both groups (BPD: 28.6 ± 5.5 vs. HC: 33.9 ± 6.6; mean maximum pain ± SEM; p > 0.8), without significant difference for “7‐s‐blade” (BPD: 18.1 ± 3.8 vs. HC: 25.3 ± 3.6; mean maximum pain ± SEM; p > 0.17) or between “7‐s‐blade” and incision (BPD: p > 0.12; HC: p > 0.84). However, patients’ intensity ratings returned significantly faster to baseline after incision (BPD: 38.9 ± 12.6 s vs. HC: 74.52 ± 11.5 s; p < 0.05), and patients evaluated “blade” and incision without any affective and with different sensory descriptors, indicating an altered evaluation of NSSI‐like stimulation with qualitative in addition to quantitative differences—especially for the sharp pain component. Conclusions The reduced perception of suprathreshold nociceptive stimuli is based on a missing affective component and specific loss of the perception of “sharpness” as part of the sensory component of pain. The results further demonstrate the usefulness of the “blade” for the perception of sharpness in patients. Significance Patients with Borderline Personality Disorder (BPD) who engage in non‐suicidal self‐injury (NSSI) report less pain in response to phasic nociceptive stimuli. In comparing an invasive pain stimulus to phasic nociceptive stimuli in BPD patients, the “blade” as non‐invasive surrogate model for sharp mechanical pain in psychiatric patients is used. In contrast to healthy volunteers, BPD patients do not report significant affective ratings and specifically display a reduced sensory component for sharpness.

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Challenges and opportunities in translational pain research – An opinion paper of the working group on translational pain research of the European pain federation (EFIC)

Mouraux¹,

Bannister

Becker

et al. 2021

European Journal of Pain

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For decades, basic research on the underlying mechanisms of nociception has held promise to translate into efficacious treatments for patients with pain. Despite great improvement in the understanding of pain physiology and pathophysiology, translation to novel, effective treatments for acute and chronic pain has however been limited, and they remain an unmet medical need. In this opinion paper bringing together pain researchers from very different disciplines, the opportunities and challenges of translational pain research are discussed. The many factors that may prevent the successful translation of bench observations into useful and effective clinical applications are reviewed, including interspecies differences, limited validity of currently available preclinical disease models of pain, and limitations of currently used methods to assess nociception and pain in non‐human and human models of pain. Many paths are explored to address these issues, including the backward translation of observations made in patients and human volunteers into new disease models that are more clinically relevant, improved generalization by taking into account age and sex differences, and the integration of psychobiology into translational pain research. Finally, it is argued that preclinical and clinical stages of developing new treatments for pain can be improved by better preclinical models of pathological pain conditions alongside revised methods to assess treatment‐induced effects on nociception in human and non‐human animals. Significance: For decades, basic research of the underlying mechanisms of nociception has held promise to translate into efficacious treatments for patients with pain. Despite great improvement in the understanding of pain physiology and pathophysiology, translation to novel, effective treatments for acute and chronic pain has however been limited, and they remain an unmet medical need.

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Modality-specific Somatosensory Changes in a Human Surrogate Model of Postoperative Pain

Cited by 28 publications

References 52 publications

A novel human surrogate model of noninjurious sharp mechanical pain

A novel human surrogate model of noninjurious sharp mechanical pain

Differential perception of sharp pain in patients with borderline personality disorder

Challenges and opportunities in translational pain research – An opinion paper of the working group on translational pain research of the European pain federation (EFIC)

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