Reliable estimation of nociceptive withdrawal reflex thresholds

Jensen, Marina Bergen; Manresa, José Biurrun; Andersen, Ole Kæseler

doi:10.1016/j.jneumeth.2015.06.014

Cited by 22 publications

(25 citation statements)

References 21 publications

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“…A limitation of the custom-designed software for automatic NWR threshold determination was that it did not measure the current actually delivered but rather calculated the value based on the assumption that the impedances were sufficiently low. Despite this, the NWR thresholds reported here are similar to other studies [13][14][15]. To our knowledge, none of the published studies using the surface stimulation of the foot sole have reported impedance values.…”

Section: Discussionsupporting

confidence: 87%

“…To elicit the reflex, most studies use the electrical stimulation of the sural nerve distally at the ankle and record the muscle activity of the short head of the ipsilateral biceps femoris muscle [4,7,8,12]. An alternative approach is to stimulate the sole of the foot and record the response of the ipsilateral tibialis anterior muscle [13][14][15][16]. Both methods evoke a withdrawal reaction with the flexion of the knee and ankle joints, but the foot arch-to-tibialis anterior approach is more effective in eliciting the reflex [14].…”

Section: Introductionmentioning

confidence: 99%

“…An alternative approach is to stimulate the sole of the foot and record the response of the ipsilateral tibialis anterior muscle [13][14][15][16]. Both methods evoke a withdrawal reaction with the flexion of the knee and ankle joints, but the foot arch-to-tibialis anterior approach is more effective in eliciting the reflex [14].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Automated Nociceptive Withdrawal Reflex Measurements Reveal Normal Reflex Thresholds and Augmented Pain Ratings in Patients with Fibromyalgia

Ydrefors

Karlsson

Olausson

et al. 2020

JCM

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The nociceptive withdrawal reflex (NWR) is used to probe spinal cord excitability in chronic pain states. Here, we used an automated and unbiased procedure for determining the NWR threshold and compared the reflex thresholds and corresponding pain ratings in a well-characterized cohort of fibromyalgia (n = 29) and matched healthy controls (n = 21). Surface electrical stimuli were delivered to the foot in a stepwise incremental and decremental manner. The surface electromyographic activity was recorded from the ipsilateral tibialis anterior muscle. Fibromyalgia patients reported significantly higher scores for psychological distress and pain-related disability and a significantly lower score for perceived state of health compared to the matched controls. The subjective pain ratings were significantly higher in patients. The NWR thresholds were similar to the controls. In the patients, but not in controls, the NWR thresholds and subjective pain ratings were significantly correlated. Our results showed an increased subjective pain sensitivity in fibromyalgia, but we found no evidence for spinal sensitization based on the reflex measures.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

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Automated Nociceptive Withdrawal Reflex Measurements Reveal Normal Reflex Thresholds and Augmented Pain Ratings in Patients with Fibromyalgia

Ydrefors

Karlsson

Olausson

et al. 2020

JCM

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“…The comparable studies stimulated the sural nerve trunk and recorded from the biceps femoris muscle. It is argued that sural nerve stimulation often is found intolerable resulting in a large number of failed tests, and that the currently employed set‐up is less dependent on exact electrode positioning and demonstrates better test–retest reliability than sural nerve stimulation (Bouhassira et al, ; Jensen, Biurrun Manresa, & Andersen, ). Another difference, which could contribute to differences found in the CPM effect between this study and the comparable studies, is that they did not track the reflex threshold over a longer period of time (120 s).…”

Section: Discussionmentioning

confidence: 99%

Psychophysical or spinal reflex measures when assessing conditioned pain modulation?

Lie

Petriu

Matre

et al. 2019

European Journal of Pain

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Background Assessing conditioning pain modulation (CPM) with spinal reflex measures may produce more objective and stable CPM effects than using psychophysical measures. The aim of the study was to compare the CPM effect and test–retest reliability between a psychophysical protocol with thermal test‐stimulus and a spinal reflex protocol with electrical test‐stimulus. Methods Twenty‐five healthy volunteers participated in two identical experiments separated by minimum 1 week. The thermal test‐stimulus was a constant heat stimulation of 120 s on the subjects’ forearm with continuous ratings of pain intensity on a 10 cm visual analogue scale. The electrical test‐stimulus was repeated electrical stimulation on the arch of the foot for 120 s, which elicited a nociceptive withdrawal reflex recorded from the anterior tibial muscle. Conditioning stimulus was a 7°C water bath. Differences in the magnitude and test–retest reliability were investigated with repeated‐measures analysis of variance and by relative and absolute reliability indices. Results The CPM effect was −46% and 4.5% during the thermal and electrical test‐stimulus (p < 0.001) respectively. Intraclass correlation coefficient of 0.5 and 0.4 was found with the electrical and thermal test‐stimulus respectively. Wide limits of agreement were found for both the electrical (−3.4 to 3.8 mA) and the thermal test‐stimulus (−3.2 to 3.6 cm). Conclusions More pronounced CPM effect was demonstrated when using a psychophysical protocol with thermal test‐stimulus compared to a spinal reflex protocol with electrical test‐stimulus. Fair relative reliability and poor absolute reliability (due to high intraindividual variability) was found in both protocols. Significance The large difference in CPM effect between the two protocols suggests that the CPM effect relates to pain perception rather than nociception on the spinal level. Due to poor absolute intrarater reliability, we recommend caution and further research before using any of the investigated CPM protocols in clinical decision making on an individual level.

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“…Electrical stimulation of the plantar skin (site of innervation of the medial plantar nerve) was applied through surface electrodes to evoke the NWR and EPs. The cathode was placed in the arch of the sole of the right foot (15 mm 9 15 mm, Neuroline 700; Ambu A/S, Denmark) (Jensen et al, 2015). The anode for stimulation was an electrode placed on the foot dorsum (50 mm 9 90 mm, Synapse; Ambu A/S).…”

Section: Electrical Stimulationmentioning

confidence: 99%

Venlafaxine and oxycodone effects on human spinal and supraspinal pain processing: a randomized cross‐over trial

Lelic

Fischer

Olesen

et al. 2016

Eur J of Neuroscience

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Severe pain is often treated with opioids. Antidepressants that inhibit serotonin and norepinephrine reuptake (SNRI) have also shown a pain relieving effect, but for both SNRI and opioids, the specific mode of action in humans remains vague. This study investigated how oxycodone and venlafaxine affect spinal and supraspinal pain processing. Twenty volunteers were included in this randomized cross-over study comparing 5-day treatment with venlafaxine, oxycodone and placebo. As a proxy of the spinal pain transmission, the nociceptive withdrawal reflex (NWR) to electrical stimulation on the sole of the foot was recorded at the tibialis anterior muscle before and after 5 days of treatment. For the supraspinal activity, 61-channel electroencephalogram evoked potentials (EPs) to the electrical stimulations were simultaneously recorded. Areas under curve (AUCs) of the EMG signals were analyzed. Latencies and AUCs were computed for the major EP peaks and brain source analysis was done. The NWR was decreased in venlafaxine arm (P = 0.02), but the EP parameters did not change. Oxycodone increased the AUC of the EP response (P = 0.04). Oxycodone also shifted the cingulate activity anteriorly in the mid-cingulate-operculum network (P < 0.01), and the cingulate activity was increased while the operculum activity was decreased (P = 0.02). Venlafaxine exerts its effects on the modulation of spinal nociceptive transmission, which may reflect changes in balance between descending inhibition and descending facilitation. Oxycodone, on the other hand, exerts its effects at the cortical level. This study sheds light on how opioids and SNRI drugs modify the human central nervous system and where their effects dominate.

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Reliable estimation of nociceptive withdrawal reflex thresholds

Cited by 22 publications

References 21 publications

Automated Nociceptive Withdrawal Reflex Measurements Reveal Normal Reflex Thresholds and Augmented Pain Ratings in Patients with Fibromyalgia

Automated Nociceptive Withdrawal Reflex Measurements Reveal Normal Reflex Thresholds and Augmented Pain Ratings in Patients with Fibromyalgia

Psychophysical or spinal reflex measures when assessing conditioned pain modulation?

Venlafaxine and oxycodone effects on human spinal and supraspinal pain processing: a randomized cross‐over trial

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