Reliability of conditioned pain modulation: a systematic review

Kennedy, Donna; Kemp, Harriet; Ridout, Deborah; Yarnitsky, David; Rice, Andrew S.C.

doi:10.1097/j.pain.0000000000000689

Cited by 376 publications

(389 citation statements)

References 44 publications

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“…Although our knowledge on pain modulation has improved significantly over the years, the various CPM protocols employed and the lack of normative values limit the comparison of findings (Klyne, Schmid, Moseley, Sterling, & Hodges, 2015) and the utilization of CPM as a prognostic factor in experimental and clinical pain studies (Granovsky, Miller-Barmak, Goldstein, Sprecher, & Yarnitsky, 2016; Kennedy, Kemp, Ridout, Yarnitsky, & Rice, 2016). Further research on CPM methodology and its reliability is required to find a standard measurement of CPM and its main parameters such as the timing, modality, intensity, duration, and location of the stimuli.…”

Section: Assessment Of Endogenous Cpmmentioning

confidence: 99%

“…The most studied test stimuli are pressure pain threshold and contact heat pain (Kennedy et al, 2016), but thermal, mechanical, electrical or chemical stimuli are also very common TS (Yarnitsky, 2015). The modality and intensity of test stimulus might influence CPM or DNIC reliability (Marcuzzi, Wrigley, Dean, Adams, & Hush, 2017) or magnitude (Okada, 2005), though it has been generally considered that CPM effect does not depend on characteristics of the TS as long as it is considered painful and not intolerable.…”

Section: Test Stimulusmentioning

confidence: 99%

“…Researchers have also used various modalities as conditioning stimuli, such as cuff inflation, ischemia, capsaicin injection (Yarnitsky, 2015), with painful cold water immersion of a limb being one of the most potent (Nilsen, Olsen, Solem, & Matre, 2014) and reliable stimuli currently used (Kennedy et al, 2016; Lewis, Heales, Rice, Rome, & McNair, 2012). It has been found that the longer CS duration with the highest intensity (7/10 on a 0–10 pain rating scale) result in a more pronounced CPM in women only (Razavi, Hansson, Johansson, & Leffler, 2014), although these results need to be replicated.…”

Section: Conditioning Stimulusmentioning

confidence: 99%

“…However, some studies using spatial summation ipsilaterally also activate endogenous inhibitions (Marchand & Arsenault, 2002). CPM measurement is reliable, but varies depending on stimulation parameters and study methodology (Kennedy et al, 2016). The combination of heat pain test or handheld or cuff pressure pain and the cold pressor test (CPT) are reliable methods to induce CPM, whereas electrical and heat pain combined with cuff do not yield significant CPM effects (Gehling et al, 2016; Imai, Petersen, Mørch, & Arendt Nielsen, 2016; Petersen, Vaegter, & Arendt-Nielsen, 2017).…”

Section: Cpm Protocolsmentioning

confidence: 99%

See 3 more Smart Citations

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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Section: Assessment Of Endogenous Cpmmentioning

confidence: 99%

Section: Test Stimulusmentioning

confidence: 99%

Section: Conditioning Stimulusmentioning

confidence: 99%

Section: Cpm Protocolsmentioning

confidence: 99%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

show abstract

“…The temporal summation is generally found to be highly reliable (Staahl et al, 2006;Pryseley et al, 2009); whereas the CPM paradigm is less robust with much higher variability (Imai et al, 2016;Kennedy et al, 2016).…”

Section: Common Sensitisation Features Across Chronic Pain Conditionsmentioning

confidence: 99%

Assessment and manifestation of central sensitisation across different chronic pain conditions

Arendt-Nielsen

Morlion

Perrot

et al. 2017

European Journal of Pain

517

494

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Different neuroplastic processes can occur along the nociceptive pathways and may be important in the transition from acute to chronic pain and for diagnosis and development of optimal management strategies. The neuroplastic processes may result in gain (sensitisation) or loss (desensitisation) of function in relation to the incoming nociceptive signals. Such processes play important roles in chronic pain, and although the clinical manifestations differ across condition processes, they share some common mechanistic features. The fundamental understanding and quantitative assessment of particularly some of the central sensitisation mechanisms can be translated from preclinical studies into the clinic. The clinical perspectives are implementation of such novel information into diagnostics, mechanistic phenotyping, prevention, personalised treatment, and drug development. The aims of this paper are to introduce and discuss (1) some common fundamental central pain mechanisms, (2) how they may translate into the clinical signs and symptoms across different chronic pain conditions, (3) how to evaluate gain and loss of function using quantitative pain assessment tools, and (4) the implications for optimising prevention and management of pain. The chronic pain conditions selected for the paper are neuropathic pain in general, musculoskeletal pain (chronic low back pain and osteoarthritic pain in particular), and visceral pain (irritable bowel syndrome in particular). The translational mechanisms addressed are local and widespread sensitisation, central summation, and descending pain modulation. Significance Central sensitisation is an important manifestation involved in many different chronic pain conditions. Central sensitisation can be different to assess and evaluate as the manifestations vary from pain condition to pain condition. Understanding central sensitisation may promote better profiling and diagnosis of pain patients and development of new regimes for mechanism based therapy. Some of the mechanisms underlying central sensitisation can be translated from animals to humans providing new options in development of therapies and profiling drugs under development.

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Effectiveness of Internet-Based Exercises Aimed at Treating Knee Osteoarthritis

et al. 2021

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IMPORTANCE Osteoarthritis is a prevalent, debilitating, and costly chronic disease for which recommended first-line treatment is underused.OBJECTIVE To compare the effect of an internet-based treatment for knee osteoarthritis vs routine self-management (ie, usual care). DESIGN, SETTING, AND PARTICIPANTSThis randomized clinical trial was conducted from October 2018 to March 2020. Participants included individuals aged 45 years or older with a diagnosis of knee osteoarthritis recruited from an existing primary care database or from social media advertisements were invited. Data were analyzed April to July 2020. INTERVENTIONSThe intervention and control group conformed to first-line knee osteoarthritis treatment. For the intervention group, treatment was delivered via a smartphone application. The control group received routine self-management care. MAIN OUTCOMES AND MEASURESThe primary outcome was change from baseline to 6 weeks in self-reported pain during the last 7 days, reported on a numerical rating scale (NRS; range, 0-10, with 0 indicating no pain and 10, worst pain imaginable), compared between groups. Secondary outcomes included 2 physical functioning scores, hamstring and quadriceps muscle strength, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and quantitative sensory testing. RESULTS Among a total of 551 participants screened for eligibility, 146 were randomized and 105 were analyzed (mean [SD] age, 66.7 [9.2] years, 71 [67.1%] women), including 48 participants in the intervention group and 57 participants in the control group. There were no significant differences in baseline characteristics between the groups. At the 6-week follow-up, the intervention group showed a greater NRS pain score reduction than the control group (between-group difference, −1.5 [95% CI, −2.2 to −0.8]; P < .001). Similarly, the intervention group had better improvements in the 30-second sit-to-stand test (between-group difference, 3.4 [95% CI, 2.2 to 4.5]; P < .001) and Timed Up-and-Go test (between-group difference, −1.8 [95% CI, −3.0 to −0.5] seconds; P = .007), as well as the WOMAC subscales for pain (between-group difference, −1.1 [95% CI, −2.0 to −0.2]; P = .02), stiffness (between-group difference, −1.0 [95% CI, −1.5 to −0.5]; P < .001), and physical function (between-group difference, −3.4 [95% CI, −6.2 to −0.7]; P = .02). The magnitude of within-group changes in pain (d = 0.83) and function outcomes (30 second sit-to-stand test d = 1.24; Timed Up-and-Go test d = 0.76) in the intervention group corresponded to medium to very strong effects.No adverse events were reported. CONCLUSIONS AND RELEVANCEThese findings suggest that this internet-delivered, evidencebased, first-line osteoarthritis treatment was superior to routine self-managed usual care and could (continued) Key Points Question What is the effectiveness of an internet-based exercise program vs routine self-management on pain outcomes among patients with knee osteoarthritis? Findings This randomized clinical trial including 105 patie...

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Reliability of conditioned pain modulation: a systematic review

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 376 publications

References 44 publications

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

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

Assessment and manifestation of central sensitisation across different chronic pain conditions

Effectiveness of Internet-Based Exercises Aimed at Treating Knee Osteoarthritis

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