Recommendations on practice of conditioned pain modulation (<scp>CPM</scp>) testing

Yarnitsky, David; Bouhassira, Didier; Drewes, Asbjørn Mohr; Fillingim, Roger B.; Granot, Michal; Hansson, Per; Landau, Ruth; Marchand, Serge; Matre, Dagfinn; Nilsen, Kristian Bernhard; Stubhaug, Arild; Treede, Rolf‐Detlef; Wilder–Smith, Oliver H.G.

doi:10.1002/ejp.605

Cited by 426 publications

(433 citation statements)

References 7 publications

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“…We examined CPM effects as a function of expectancy, drug, and presence of chronic back pain using a 3 Expectancy (no change in pain, pain increase, pain decrease) × 3 Drug (placebo, naloxone, morphine) × 2 Group (chronic low back pain, healthy) ANOVA of the change in mean heat pain ratings from pre-conditioning phase to the conditioning phase. Consistent with recommended guidelines [2, 31], changes during CPM were calculated so that pain reductions were represented as negative values (i.e., conditioning phase - pre-conditioning phase). In addition to the primary analysis, one-sample T-tests were conducted to determine whether change scores within each expectancy condition differed significantly from zero.…”

Section: Methodsmentioning

confidence: 99%

Expectancy Effects on Conditioned Pain Modulation Are Not Influenced by Naloxone or Morphine

et al. 2016

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Background Recent studies suggest that participant expectations influence pain ratings during conditioned pain modulation testing. The present study extends this work by examining expectancy effects among individuals with and without chronic back pain after administration of placebo, naloxone, or morphine. Purpose To identify the influence of individual differences in expectancy on changes in heat pain ratings obtained before, during, and after a forearm ischemic pain stimulus. Methods Participants with chronic low back pain (n=88) and healthy controls (n=100) rated heat pain experience (i.e., “test stimulus”) before, during, and after exposure to ischemic pain (i.e., “conditioning stimulus”). Prior to testing, participants indicated whether they anticipated that their heat pain would increase, decrease, or remain unchanged during ischemic pain. Results Analysis of the effects of Expectancy (pain increase, decrease, or no change), Drug (placebo, naloxone, or morphine), and Group (back pain, healthy) on changes in heat pain revealed a significant main effect of Expectancy (p = 0.001), but no other significant main effects or interactions. Follow-up analyses revealed that individuals who expected lower pain during ischemia reported significantly larger decreases in heat pain as compared to those who expected either no change (p = 0.004) or increased pain (p = 0.001). Conclusions The present findings confirm that expectancy is an important contributor to conditioned pain modulation effects, and therefore significant caution is needed when interpreting findings that do not account for this individual difference. Opioid mechanisms do not appear to be involved in these expectancy effects.

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Section: Methodsmentioning

confidence: 99%

Expectancy Effects on Conditioned Pain Modulation Are Not Influenced by Naloxone or Morphine

et al. 2016

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“…In 2015, experts recommended the term CPM for human application of DNIC protocols (Yarnitsky et al, 2015). A noxious stimulus applied in one part of the body can inhibit pain in another part of the body, by activating the descending inhibitory system (DNIC or CPM).…”

Section: Endogenous Mechanisms Of Pain Modulationmentioning

confidence: 99%

“…The different test protocols limit generalization of findings and thus a group of experts in the field presented recommendations regarding a standard measurement of CPM in healthy individuals and pain patients (Yarnitsky et al, 2010, 2015). Preferably, mechanical and heat TS should be delivered either at a fixed pain intensity of 40 on a 0–100 pain rating scale or at an ascending intensity and discontinued when pain intensity of 40/100 is reached.…”

Section: Cpm Protocolsmentioning

confidence: 99%

“…Subsequently, to induce a conditioning analgesic effect, the CS needs to be at least mildly to moderately painful (>20/100 pain score). The CS should be given as rapidly as possible after the second TS as the duration of CPM effects is short (Yarnitsky et al, 2015) and varies across testing protocols. For instance, 6–9min after the end of the conditioning period, the inhibition of the pain response (e.g., nociceptive reflex) recovered its baseline value (Willer et al, 1990).…”

Section: Cpm Protocolsmentioning

confidence: 99%

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

Damien

Colloca

Belleï-Rodriguez

et al. 2018

International Review of Neurobiology

112

107

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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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“…Examining relations between visceral sensitivity and CPM represents an important avenue for future research. 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].…”

mentioning

confidence: 99%

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

Morris

Walker

Bruehl

et al. 2016

The Journal of 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. 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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Recommendations on practice of conditioned pain modulation (CPM) testing

Cited by 426 publications

References 7 publications

Expectancy Effects on Conditioned Pain Modulation Are Not Influenced by Naloxone or Morphine

Expectancy Effects on Conditioned Pain Modulation Are Not Influenced by Naloxone or Morphine

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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