Predicting pain and pain responses to opioids

Wilder‐Smith, Clive H.

doi:10.1016/s1754-3207(08)60009-7

Cited by 4 publications

(9 citation statements)

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“…During the total of 60 heterotopic stimulation tests in this study, weak facilitation was only seen in a single test. The correlation between baseline pain intensity during stimulation and the magnitude of endogenous pain inhibition and also clinical pain indicate this may be a useful predictor of individual pain responses (Edwards, 2005;Nielsen et al, 2007;Wilder-Smith, 2007;Yarnitsky et al, 2007). Endogenous pain modulation has also been shown to be dysfunctional in several chronic somatic pain syndromes, such as fibromyalgia (Lautenbacher and Rollmann, 1997).…”

Section: Tonic Rectal Stimulation Electrical/distension* Alonementioning

confidence: 99%

“…The malfunction across different somatic and visceral chronic pain syndromes supports the central role this mechanism may play in hypersensitivity and pain sensitisation. The correlation between baseline pain intensity during stimulation and the magnitude of endogenous pain inhibition and also clinical pain indicate this may be a useful predictor of individual pain responses (Edwards, 2005;Nielsen et al, 2007;Wilder-Smith, 2007;Yarnitsky et al, 2007). Further work needs to be done to correlate changes in clinical pain characteristics with endogenous pain modulation and quantitative sensory testing to validate this promising concept.…”

Section: Tonic Rectal Stimulation Electrical/distension* Alonementioning

confidence: 99%

“…Pain is modulated within several supraspinal and spinal neural networks (Gebhart, 2004;Vanegas and Schaible, 2004;Tracey and Mantyh, 2007). These networks are central regulators of pain processing and may explain some of the individual differences in pain responses (Edwards, 2005;Wilder-Smith, 2007). Two major modulatory systems are recognised, a spinal-supraspinal-spinal feedback loop and a frontal cortical-limbic-brainstem top-down mechanism (Villaneuva and Le Bars, 1995;Dubner and Ren, 1999;Gebhart, 2004;Vanegas and Schaible, 2004;Ohara et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

“…Both endogenous inhibition and facilitation form part of the fine-tuning of endogenous pain control, the balance being dependent on the characteristics of painful stimulation, as well as the cognitive and affective state of the individual (Gebhart, 2004;Tracey and Mantyh, 2007). Abnormal endogenous pain modulation has been consistently demonstrated in IBS using heterotopic stimulation (Wilder-Smith et al, 2004, 2007Song et al, 2006;Coffin et al, 2004), termed diffuse noxious inhibitory controls DNIC, which relies on the perceptual modulation of a painful stimulus by a second heterotopically applied nociceptive stimulus. Abnormal endogenous pain modulation has been consistently demonstrated in IBS using heterotopic stimulation (Wilder-Smith et al, 2004, 2007Song et al, 2006;Coffin et al, 2004), termed diffuse noxious inhibitory controls DNIC, which relies on the perceptual modulation of a painful stimulus by a second heterotopically applied nociceptive stimulus.…”

Section: Introductionmentioning

confidence: 99%

“…The spinal-supraspinal-spinal feedback loop has been extensively studied in animals and in humans and has been shown to be reliably activated using heterotopic stimulation (Le Bars, 1979Bars, , 1992Price and MacHaffie, 1988; Villaneuva and Le Bars, 1995;Willer et al, 1999;Staud et al, 2003;Julien et al, 2005;Fuji et al, 2006;Granot et al, 2007;Wilder-Smith and Robert-Yap, 2007). Abnormal endogenous pain modulation has been consistently demonstrated in IBS using heterotopic stimulation (Wilder-Smith et al, 2004, 2007Song et al, 2006;Coffin et al, 2004), termed diffuse noxious inhibitory controls DNIC, which relies on the perceptual modulation of a painful stimulus by a second heterotopically applied nociceptive stimulus. The purpose of this study was to develop this method of testing endogenous visceral pain modulation further for improved characterisation of abnormalities in functional bowel syndromes.…”

Section: Introductionmentioning

confidence: 99%

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Activating endogenous visceral pain modulation: A comparison of heterotopic stimulation methods in healthy controls

Wilder‐Smith¹,

Song²,

Yeoh³

et al. 2009

European Journal of Pain

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All sensory input underlies modulation by endogenous central nervous system pathways. Dysfunctional endogenous pain modulation has been demonstrated in central sensitization and in several pain syndromes, including Irritable Bowel Syndrome (IBS) Activation of endogenous visceral pain modulation by heterotopic stimulation was compared using different methods. Rectal electrical or distension pain alone or with simultaneous (i.e. heterotopic) noxious hand or foot cold stimulation were investigated in randomized sequence in 14 male and 1 female healthy subjects. Mean pain intensities on a visual analogue scale of 0-100 (95% CI) during tonic rectal electrical and distension stimulation alone were 64 (52-76) and 55 (39-71), respectively. Rectal distension pain decreased by 36% (18-55) with simultaneous hand and by 45% (24-66) with simultaneous foot cold pain. Rectal electrical pain decreased by 45% (29-61) during hand and by 46% (28-64) during foot cold pain. Facilitation, i.e. increased rectal pain during heterotopic stimulation was observed in only 1 of 60 stimulation runs. Potent and consistent activation of endogenous visceral pain inhibition was achieved with heterotopic cold pain limb stimulation. Somato-visceral convergence did not affect the effectiveness of induction of endogenous visceral pain inhibition in healthy subjects, as hand and foot heterotopic stimulation resulted in similar pain inhibition. Pain facilitation, as shown earlier in IBS patients, was not evident in healthy controls.

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Section: Tonic Rectal Stimulation Electrical/distension* Alonementioning

confidence: 99%

Section: Tonic Rectal Stimulation Electrical/distension* Alonementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Activating endogenous visceral pain modulation: A comparison of heterotopic stimulation methods in healthy controls

Wilder‐Smith¹,

Song²,

Yeoh³

et al. 2009

European Journal of Pain

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Distinct spatio-temporal and spectral brain patterns for different thermal stimuli perception

Tayeb

Dragomir

Lee

et al. 2022

Sci Rep

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Understanding the human brain’s perception of different thermal sensations has sparked the interest of many neuroscientists. The identification of distinct brain patterns when processing thermal stimuli has several clinical applications, such as phantom-limb pain prediction, as well as increasing the sense of embodiment when interacting with neurorehabilitation devices. Notwithstanding the remarkable number of studies that have touched upon this research topic, understanding how the human brain processes different thermal stimuli has remained elusive. More importantly, very intense thermal stimuli perception dynamics, their related cortical activations, as well as their decoding using effective features are still not fully understood. In this study, using electroencephalography (EEG) recorded from three healthy human subjects, we identified spatial, temporal, and spectral patterns of brain responses to different thermal stimulations ranging from extremely cold and hot stimuli (very intense), moderately cold and hot stimuli (intense), to a warm stimulus (innocuous). Our results show that very intense thermal stimuli elicit a decrease in alpha power compared to intense and innocuous stimulations. Spatio-temporal analysis reveals that in the first 400 ms post-stimulus, brain activity increases in the prefrontal and central brain areas for very intense stimulations, whereas for intense stimulation, high activity of the parietal area was observed post-500 ms. Based on these identified EEG patterns, we successfully classified the different thermal stimulations with an average test accuracy of 84% across all subjects. En route to understanding the underlying cortical activity, we source localized the EEG signal for each of the five thermal stimuli conditions. Our findings reveal that very intense stimuli were anticipated and induced early activation (before 400 ms) of the anterior cingulate cortex (ACC). Moreover, activation of the pre-frontal cortex, somatosensory, central, and parietal areas, was observed in the first 400 ms post-stimulation for very intense conditions and starting 500 ms post-stimuli for intense conditions. Overall, despite the small sample size, this work presents novel findings and a first comprehensive approach to explore, analyze, and classify EEG-brain activity changes evoked by five different thermal stimuli, which could lead to a better understanding of thermal stimuli processing in the brain and could, therefore, pave the way for developing a real-time withdrawal reaction system when interacting with prosthetic limbs. We underpin this last point by benchmarking our EEG results with a demonstration of a real-time withdrawal reaction of a robotic prosthesis using a human-like artificial skin.

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Contributions of Pain Interference and Affect to Patient-Reported Opioid Benefit in Chronic Pain Management

Baker

Park

Rosser

et al. 2022

Preprint

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Background: Despite known deleterious consequences associated with long-term opioid use, many individuals with chronic pain assert opioid benefits and advocate for continued opioid use. However, relative to non-opioid using chronic pain patients, opioid-using patients typically report greater pain severity and depression. Moreover, there appears to be no significant association between pain severity or interference and perceived opioid benefit among chronic pain patients. Thus, pain reduction itself might not directly relate to patient perceptions of opioid benefit. Given extensive prior research revealing significant overlaps between pain and affect, it is prudent to examine contributions of affective disturbances, alongside pain-related factors, to perceived opioid benefits. In the present study, we examined the hierarchical contributions of pain interference and positive affect in predicting self-reported opioid benefit. We hypothesized that positive affect combined with pain interference would best predict opioid benefit. Methods: We examined multisite, cross-sectional data collected from females with fibromyalgia who were using opioids long-term (n = 40) and who were not regularly using opioids but had used them acutely (< 30 days) at least once previously (n = 25). Patients completed a set of questionnaires, including the Positive and Negative Affect Schedule, the Brief Pain Inventory, and a novel measure querying perceived opioid benefit on a 0-10 Likert scale (0 = not at all, 10 = completely). We examined relationships between pain interference, positive affect, and patient-reported opioid benefit using logistic regression. Results: Among opioid-using patients, pain interference combined with positive affect was a better model for opioid benefit (AIC = 52.15) compared to pain interference alone (AIC = 57.80). However, among non-opioid using patients, pain interference alone was a better model for opioid benefit (AIC = 28.00) than pain interference combined with positive affect (AIC = 28.12). Conclusions: Among patients using opioids long-term, affective factors may be primary drivers of perceived opioid benefit. Positive affect combined with pain interference modeled opioid benefit better than pain interference alone among opioid-using chronic pain patients, but not among non-opioid-using chronic pain patients. Importantly, post-hoc analyses examining the contributions of negative affect further validated the main findings; positive affect out-performed negative affect in all models. Thus, perceived opioid benefit may be a function of cumulative opioid-induced enhancements in positive affect. Based on these results, examination of factors besides pain reduction may be critical to understanding perceived opioid benefit among chronic pain patients; this understanding is essential for development of effective, opioid-sparing treatments.

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Predicting pain and pain responses to opioids

Cited by 4 publications

References 61 publications

Activating endogenous visceral pain modulation: A comparison of heterotopic stimulation methods in healthy controls

Activating endogenous visceral pain modulation: A comparison of heterotopic stimulation methods in healthy controls

Distinct spatio-temporal and spectral brain patterns for different thermal stimuli perception

Contributions of Pain Interference and Affect to Patient-Reported Opioid Benefit in Chronic Pain Management

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