A tonic heat test stimulus yields a larger and more reliable conditioned pain modulation effect compared to a phasic heat test stimulus

Abstract. Introduction:. The interest in conditioned pain modulation (CPM) as a clinical tool for measuring endogenously induced analgesia is increasing. There is, however, large variation in the CPM methodology, hindering comparison of results across studies. Research comparing different CPM protoc...

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Main Authors: Marie Udnesseter Lie, Dagfinn Matre, Per Hansson, Audun Stubhaug, John-Anker Zwart, Kristian Bernhard Nilsen
Format: Article
Language:English
Published: Wolters Kluwer 2017-12-01
Series:PAIN Reports
Online Access:http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000000626
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author Marie Udnesseter Lie
Dagfinn Matre
Per Hansson
Audun Stubhaug
John-Anker Zwart
Kristian Bernhard Nilsen
author_facet Marie Udnesseter Lie
Dagfinn Matre
Per Hansson
Audun Stubhaug
John-Anker Zwart
Kristian Bernhard Nilsen
author_sort Marie Udnesseter Lie
collection DOAJ
description Abstract. Introduction:. The interest in conditioned pain modulation (CPM) as a clinical tool for measuring endogenously induced analgesia is increasing. There is, however, large variation in the CPM methodology, hindering comparison of results across studies. Research comparing different CPM protocols is needed in order to obtain a standardized test paradigm. Objectives:. The aim of the study was to assess whether a protocol with phasic heat stimuli as test-stimulus is preferable to a protocol with tonic heat stimulus as test-stimulus. Methods:. In this experimental crossover study, we compared 2 CPM protocols with different test-stimulus; one with tonic test-stimulus (constant heat stimulus of 120-second duration) and one with phasic test-stimuli (3 heat stimulations of 5 seconds duration separated by 10 seconds). Conditioning stimulus was a 7°C water bath in parallel with the test-stimulus. Twenty-four healthy volunteers were assessed on 2 occasions with minimum 1 week apart. Differences in the magnitude and test–retest reliability of the CPM effect in the 2 protocols were investigated with repeated-measures analysis of variance and by relative and absolute reliability indices. Results:. The protocol with tonic test-stimulus induced a significantly larger CPM effect compared to the protocol with phasic test-stimuli (P < 0.001). Fair and good relative reliability was found with the phasic and tonic test-stimuli, respectively. Absolute reliability indices showed large intraindividual variability from session to session in both protocols. Conclusion:. The present study shows that a CPM protocol with a tonic test-stimulus is preferable to a protocol with phasic test-stimuli. However, we emphasize that one should be cautious to use the CPM effect as biomarker or in clinical decision making on an individual level due to large intraindividual variability.
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spelling doaj.art-5a66dee217534e6db08e093926a05d452022-12-21T19:38:21ZengWolters KluwerPAIN Reports2471-25312017-12-0126e62610.1097/PR9.0000000000000626201712000-00002A tonic heat test stimulus yields a larger and more reliable conditioned pain modulation effect compared to a phasic heat test stimulusMarie Udnesseter Lie0Dagfinn Matre1Per Hansson2Audun Stubhaug3John-Anker Zwart4Kristian Bernhard Nilsen5aResearch and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, NorwaycDepartment of Work Psychology and Physiology, National Institute of Occupational Health, Oslo, NorwaydDepartment of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, SwedeneDepartment of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, NorwayaResearch and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, NorwayaResearch and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, NorwayAbstract. Introduction:. The interest in conditioned pain modulation (CPM) as a clinical tool for measuring endogenously induced analgesia is increasing. There is, however, large variation in the CPM methodology, hindering comparison of results across studies. Research comparing different CPM protocols is needed in order to obtain a standardized test paradigm. Objectives:. The aim of the study was to assess whether a protocol with phasic heat stimuli as test-stimulus is preferable to a protocol with tonic heat stimulus as test-stimulus. Methods:. In this experimental crossover study, we compared 2 CPM protocols with different test-stimulus; one with tonic test-stimulus (constant heat stimulus of 120-second duration) and one with phasic test-stimuli (3 heat stimulations of 5 seconds duration separated by 10 seconds). Conditioning stimulus was a 7°C water bath in parallel with the test-stimulus. Twenty-four healthy volunteers were assessed on 2 occasions with minimum 1 week apart. Differences in the magnitude and test–retest reliability of the CPM effect in the 2 protocols were investigated with repeated-measures analysis of variance and by relative and absolute reliability indices. Results:. The protocol with tonic test-stimulus induced a significantly larger CPM effect compared to the protocol with phasic test-stimuli (P < 0.001). Fair and good relative reliability was found with the phasic and tonic test-stimuli, respectively. Absolute reliability indices showed large intraindividual variability from session to session in both protocols. Conclusion:. The present study shows that a CPM protocol with a tonic test-stimulus is preferable to a protocol with phasic test-stimuli. However, we emphasize that one should be cautious to use the CPM effect as biomarker or in clinical decision making on an individual level due to large intraindividual variability.http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000000626
spellingShingle Marie Udnesseter Lie
Dagfinn Matre
Per Hansson
Audun Stubhaug
John-Anker Zwart
Kristian Bernhard Nilsen
A tonic heat test stimulus yields a larger and more reliable conditioned pain modulation effect compared to a phasic heat test stimulus
PAIN Reports
title A tonic heat test stimulus yields a larger and more reliable conditioned pain modulation effect compared to a phasic heat test stimulus
title_full A tonic heat test stimulus yields a larger and more reliable conditioned pain modulation effect compared to a phasic heat test stimulus
title_fullStr A tonic heat test stimulus yields a larger and more reliable conditioned pain modulation effect compared to a phasic heat test stimulus
title_full_unstemmed A tonic heat test stimulus yields a larger and more reliable conditioned pain modulation effect compared to a phasic heat test stimulus
title_short A tonic heat test stimulus yields a larger and more reliable conditioned pain modulation effect compared to a phasic heat test stimulus
title_sort tonic heat test stimulus yields a larger and more reliable conditioned pain modulation effect compared to a phasic heat test stimulus
url http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000000626
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