User‐independent assessment of conditioning pain modulation by cuff pressure algometry

Background: Various conditioned pain modulation (CPM) methodologies have been used to investigate diffuse noxious inhibitory control pain mechanisms in healthy and clinical populations. Occlusion cuff parameters have been poorly studied. We aimed to investigate whether occlusion cuff intensity and/or duration influenced CPM magnitudes. We also investigated the role of physical activity levels on CPM magnitude. Methods: Two studies were performed to investigate the role of intensity and duration of occlusion cuff conditioning stimulus on test stimulus (tibialis anterior pressure pain thresholds). In Study 1, conditioning stimulus intensity of 2/10 or 5/10 (duration <20 s) was evaluated using a paired-samples t-test. In Study 2, duration of 2/10 conditioning stimulus was 3 min. One-way repeated-measures ANOVA was used to investigate the effect of time (0, 1, 2 and 3 min) on CPM magnitude. Results: In Study 1, 27 healthy volunteers (mean AE SD: 24.9 years (AE4.5); eight female) demonstrated that an occlusion cuff applied to the upper arm eliciting 5/10 local pain resulted in a significant (mean AE SD: 17% AE 46%) increase in CPM magnitude, when compared to 2/10 intensity (À3% AE 38%, p = 0.026), whereas in Study 2, 25 healthy volunteers (22.5 years (AE2.7); 13 female) demonstrated that 3 min of 2/ 10 CS intensity did not result in a significant change in CPM (p = 0.21). There was no significant relationship between physical activity levels and CPM in either study (p > 0.22). Conclusions: This study demonstrated that an occlusion cuff of 5/10 conditioning stimulus intensity, when compared to 2/10, significantly increased CPM magnitude. Maintaining 2/10 conditioning stimulus for 3 min did not increase CPM magnitude. Significance: Dysfunctional conditioned pain modulation (CPM) has been associated with poor health outcomes. Various factors can influence CPM outcomes. The role of occlusion cuff conditioning stimulus intensity and duration has not been previously investigated. Intensity (5/10), but not duration of lower intensity (2/10) conditioning stimulus, affects CPM magnitude.94 Eur J Pain 22 (2018) 94--102

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Conditioned pain modulation is affected by occlusion cuff conditioning stimulus intensity, but not duration

Smith

Pedler

2017

“…Experimental procedures were carried out with participants positioned in an inclined bed where they also remained during rest. Test and conditioning stimulations were delivered by a computer‐controlled cuff pressure algometer (NociTech, Denmark, and Aalborg University), consisting of a computer‐controlled air compressor with two independent 7.5 cm tourniquets (silicone high‐pressure cuff, VBM Medizintechnik GmbH, Sulz, Germany) (Graven‐Nielsen et al., , ). The system was connected to an electronic visual analogue scale (VAS, 0–10 cm) and a stop button terminating inflation of the cuffs (Aalborg University, Denmark).…”

Section: Methodsmentioning

confidence: 99%

“…Intersession reliability of CPM‐effects is good with interclass correlation coefficients (ICC) from 0.6–0.75, although the reliability depends on stimulation parameters, modality and protocols (Granovsky et al., ; Imai et al., ; Kennedy et al., ). Computerized pressure cuff algometry has excellent reliability over days (ICC > 0.8) (Graven‐Nielsen et al., ), both for unconditioned and conditioned test‐stimuli (Imai et al., ; Graven‐Nielsen et al., ). The cuff algometry CPM‐effect has also been reported with good reliability (Graven‐Nielsen et al., ).…”

Section: Introductionmentioning

confidence: 99%

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Effects of repeated conditioning pain modulation in healthy volunteers

Hoegh

Petersen

Graven‐Nielsen

2018

Self Cite

Conditioning pain modulation can be assessed in 5-min intervals by cuff algometry with a fixed conditioning stimulus. Without applying conditioning stimuli the pain sensitivity of test-stimuli habituated. As a consequence, it can be speculated that the conditioning stimulus may negate the temporal habituation effects during repeated sessions, whereas this may not be the case for unconditioned stimuli. Applying both conditioned and unconditioned repeated test-stimuli may be a way to assess different parts of the pain modulatory system, and a model for measuring a netCPM-effect, which could indicate a balance between habituation and sensitization, is proposed.

Conditioning pain modulation reduces pain only during the first stimulation of the temporal summation of pain paradigm in healthy participants

Holden

Petersen

Arendt‐Nielsen

et al. 2019

Background Pro‐nociceptive and anti‐nociceptive mechanisms are commonly assessed in clinical and experimental pain studies, but their potential interaction is not well understood. Objectives Investigate the effect of conditioning pain modulation (CPM) on temporal summation of pain (TSP). Methods Twenty healthy participants underwent cuff algometry assessment on the lower legs to establish the pressure pain tolerance threshold (PTT). For the TSP assessment, ten stimuli at the level of the PTT were delivered by computerised cuff inflations (1‐s stimulation, 1‐s break) while participants rated pain intensity on a 10‐cm electronic visual analogue scale (VAS). This TSP paradigm was then repeated with a simultaneous conditioning stimulus induced by a cuff on the contralateral leg, inflated to a constant pressure corresponding to 30% (mild), 70% (moderate) or 100% (severe) of the PTT. These were assessed in a randomised order, with a fifteen‐minute break between tests. A final TSP test without conditioning was reassessed at the end (post‐recording). Results An interaction between stimuli (1–10) and repetition (p < 0.05) was found for VAS scores. VAS scores for the first stimulus were decreased during 30%, 70%, and 100% conditioning intensities, compared to baseline and post‐recordings (p < 0.05). There was a significant increase in TSP during conditioning (p < 0.05). There were no significant differences between baseline and post‐recordings for any stimuli (p > 0.05). Conclusions The current study indicates that mild to severe stimuli administered by cuff algometry does not modulate summation effect of temporal summation of pain, which could indicate that pain facilitatory mechanisms are more potent compared with pain inhibitory mechanisms. Significance Current knowledge on the interaction effect of pro and anti‐nociceptive paradigms are the lacking. The current study indicates that conditioning pain modulation does not modulate the summation effect of temporal summation of pain, when evaluated by computerized pressure algometry. This finding was independent of the mild, moderate and severe painful conditioning intensities.