Psychological Factors and Conditioned Pain Modulation

Nahman‐Averbuch, Hadas; Nir, Rony-Reuven; Sprecher, Elliot; Yarnitsky, David

doi:10.1097/ajp.0000000000000296

“…Second, the pain testing protocol was only partially in line with recent recommendations for CPM assessment due to our reliance on one type of test stimulus [54]. Replication of findings across other test stimuli is critical given recent meta-analytic evidence that relations between psychosocial factors and CPM differ according to the pain modality [30]. Third, this study was cross-sectional; prospective studies are needed to determine whether impaired CPM is a risk factor for FAP.…”

Section: Discussionmentioning

confidence: 99%

Impaired conditioned pain modulation in youth with functional abdominal pain

Morris

¹

,

Walker

²

,

Bruehl

³

et al. 2016

Pain

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Functional abdominal pain (FAP) is associated with enhanced pain responsiveness. Although impaired conditioned pain modulation (CPM) characterizes adults with a variety of chronic pain conditions, relatively little is known about CPM in youth with FAP. The present study assessed CPM to evoked thermal pain in 140 youth (ages 10 to 17), 63 of whom had FAP and 77 of whom were healthy controls. Multilevel models demonstrated weaker CPM effects in FAP than healthy youth, as evident in slower within-person decreases in pain ratings during the conditioning phase. Weaker CPM effects were associated with greater somatic symptom severity and functional disability. Pain responses in FAP youth were heterogeneous, with 43% of youth showing an unexpected increase in pain ratings during the conditioning phase, suggesting sensitization rather than CPM-related pain inhibition. These findings highlight directions for future research on the emergence and maintenance of FAP in youth.

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“…Nonetheless, modality-specific CPM responses are influenced by different psychological factors. Specifically, CPM responses evoked by pressure, heat and electrical stimuli were associated with anxiety, depression and catastrophizing levels, respectively (Nahman-Averbuch, Nir, Sprecher, & Yarnitsky, 2016). Overall younger adult age, male gender, ovulatory phase of the menstrual cycle in women, positive expectations, attention to the CS, and carrier of the serotonin-transporter-linked polymorphic region (5-HTTLPR) long allele are other characteristics associated with larger CPM responses, according to a systematic review of 36 studies (Hermans et al, 2016).…”

Section: Cpm Protocolsmentioning

confidence: 99%

“…Data from a large population-based study of the Danish adult general population also found better CPM in males and in individuals with higher level of education and higher pain ratings on the visual analog scale (Skovbjerg et al, 2017). Therefore, it has been suggested that different underlying mechanisms might account for CPM responses (Nahman-Averbuch et al, 2016). …”

Section: Cpm Protocolsmentioning

confidence: 99%

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

Damien

¹

,

Colloca

²

,

Belleï-Rodriguez

³

et al. 2018

International Review of Neurobiology

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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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“…Second, the pain testing protocol was only partially in line with recent recommendations for CPM assessment due to our reliance on one type of test stimulus [54]. Replication of findings across other test stimuli is critical given recent meta-analytic evidence that relations between psychosocial factors and CPM differ according to the pain modality [30]. Third, this study was cross-sectional; prospective studies are needed to determine whether impaired CPM is a risk factor for FAP.…”

Section: Discussionmentioning

confidence: 99%

(236) Impaired conditioned pain modulation in youth with functional abdominal pain

Morris

¹

,

Walker

²

,

Bruehl

³

et al. 2016

The Journal of Pain

0

View full text Add to dashboard Cite

Functional abdominal pain (FAP) is associated with enhanced pain responsiveness. Although impaired conditioned pain modulation (CPM) characterizes adults with a variety of chronic pain conditions, relatively little is known about CPM in youth with FAP. The present study assessed CPM to evoked thermal pain in 140 youth (ages 10 to 17), 63 of whom had FAP and 77 of whom were healthy controls. Multilevel models demonstrated weaker CPM effects in FAP than healthy youth, as evident in slower within-person decreases in pain ratings during the conditioning phase. Weaker CPM effects were associated with greater somatic symptom severity and functional disability. Pain responses in FAP youth were heterogeneous, with 43% of youth showing an unexpected increase in pain ratings during the conditioning phase, suggesting sensitization rather than CPM-related pain inhibition. These findings highlight directions for future research on the emergence and maintenance of FAP in youth. Keywordsfunctional abdominal pain; FAP; CPM; DNIC; adolescents Functional abdominal pain (FAP) refers to either episodic or continuous abdominal pain that remains medically unexplained despite thorough physical examination [36]. According to a recent meta-analysis, FAP is common in youth, with a worldwide pooled prevalence rate of 13.5% [18]. Many youth with FAP either meet current Rome III criteria for functional Corresponding Author: Uma Rao, M.D., Address: University of Tennessee, CMHSRC, 122 Henson Hall, 1618 West Cumberland Avenue, Knoxville, Phone: (865) FAX: (865) 974-1662, urao@utk.edu. HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript gastrointestinal disorders, including irritable bowel syndrome (IBS), functional dyspepsia and abdominal migraine [2], or are at increased risk for developing functional gastrointestinal disorders over time [48]. FAP in youth is associated with significant functional disability, reflected in part by school absences [36], and is often persistent despite frequent utilization of health care services [13]. Although a variety of biological and psychosocial factors [48,49] have been implicated in the development and maintenance of FAP in youth, little is known about the impact of altered pain modulatory systems.Experimental pain responses, which may index functioning in pain modulatory systems, have proven useful as biomarkers of risk for chronic pain by discriminating clinical pain populations from healthy controls, correlating with changes in clinical pain, and predicting the development of chronic pain [11]. Pro-nociceptive pain modulation profiles are characterized by decreased inhibition and/or increased temporal summation to evoked pain [53]. One experimental method used to detect dysfunction in descending inhibitory pain modulatory systems is conditioned pain modulation (CPM; previously termed diffuse noxious inhibitory controls or DNIC), which refers to a reduction in perceived pain intensity for a test stimulus during application of a conditioning stimulus to...

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Psychological Factors and Conditioned Pain Modulation

Abstract: Certain psychological factors seem to be associated with modality-specific CPM responses in healthy individuals. This potentially supports the notion that CPM paradigms evoked by different stimulation modalities represent different underlying mechanisms.

Cited by 154 publications

References 93 publications

Impaired conditioned pain modulation in youth with functional abdominal pain

Impaired conditioned pain modulation in youth with functional abdominal pain

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

(236) Impaired conditioned pain modulation in youth with functional abdominal pain

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