Does Exercise Decrease Pain via Conditioned Pain Modulation in Adolescents?

Purpose: Pain relief after exercise, exercise-induced hypoalgesia (EIH), is established across the lifespan. Conditioned pain modulation (CPM: pain inhibits pain) may be a mechanism for EIH. Methods: In 55 adolescents, pressure pain thresholds were measured before and after exercise (deltoid, quadriceps, and nail bed) and during CPM at the nail bed and deltoid test stimulus sites. The relationship between EIH and CPM was explored. Results: EIH occurred at deltoid and quadriceps; CPM occurred at nail bed and deltoid. CPM and EIH correlated at deltoid; adolescents with greater CPM experienced greater pain relief after exercise. At this site, CPM predicted 5.4% of EIH. Arm lean mass did not add a significant effect. Peak exercise pain did not influence EIH. Adolescents with none, minimal, moderate, or severe peak exercise pain experienced similar EIH. Conclusions: A potential relationship exists between CPM and EIH in adolescents. Pediatric physical therapists should consider the CPM response when prescribing exercise as a pain management tool

Inventory of personal factors influencing conditioned pain modulation in healthy people: a systematic literature review

Background: Conditioned pain modulation (CPM) is believed to play an important role in the development and exacerbation of chronic pain, because dysfunction of CPM is associated with a shift in balance between pain facilitation and pain inhibition. In many patients with central sensitization, CPM is less efficacious. Besides that, efficacy of CPM is highly variable in healthy people. Consequently, it seems that several individual variables may influence CPM. A systematic review examining personal factors influencing CPM was conducted. Methods: This systematic review follows the PRISMA guidelines. Pubmed and Web of Science were searched using different synonyms of CPM. Full-text clinical reports addressing the influence of personal factors on CPM in healthy adults were included. Checklists for RCTs and case-control studies provided by the Dutch Institute for Healthcare Improvement (CBO) and the Dutch Cochrane Centre were utilized to assess methodological quality. Levels of evidence and strength of conclusion were assigned using the CBO guidelines. Results: Forty-six articles were identified that reported the influence of personal factors on CPM. Quality assessment revealed 10 studies with a methodological quality less than 50% wherefore they were excluded (21.8%), resulting in a general total methodological quality score of 72.5%. Overall younger adult age, male gender, ovulatory phase, positive expectations, attention to the conditioning stimulus, and carrier of the 5-HTTLPR long allele result in better CPM. Conclusion: It is advised for future studies to take these factors into account. Further research regarding the influence of oral contraceptives, catastrophizing, information about conditioning stimulation, distraction, physical activity, and genetics on CPM magnitude is required

Systemic Exercise-Induced Hypoalgesia Following Isometric Exercise Reduces Conditioned Pain Modulation

Objective Physically active individuals show greater conditioned pain modulation (CPM) compared with less active individuals. Understanding the effects of acute exercise on CPM may allow for a more targeted use of exercise in the management of pain. This study investigated the effects of acute isometric exercise on CPM. In addition, the between-session and within-session reliability of CPM was investigated. Design Experimental, randomized crossover study. Setting Laboratory at Marquette University. Subjects Thirty healthy adults (19.3±1.5 years, 15 males). Methods Subjects underwent CPM testing before and after isometric exercise (knee extension, 30% maximum voluntary contraction for three minutes) and quiet rest in two separate experimental sessions. Pressure pain thresholds (PPTs) at the quadriceps and upper trapezius muscles were assessed before, during, and after ice water immersions. Results PPTs increased during ice water immersion (i.e., CPM), and quadriceps PPT increased after exercise (P \u3c 0.05). CPM decreased similarly following exercise and quiet rest (P \u3e 0.05). CPM within-session reliability was fair to good (intraclass correlation coefficient [ICC] = 0.43–0.70), and the between-session reliability was poor (ICC = 0.20–0.35). Due to the variability in the systemic exercise-induced hypoalgesia (EIH) response, participants were divided into systemic EIH responders (N = 9) and nonresponders (N = 21). EIH responders experienced attenuated CPM following exercise (P = 0.03), whereas the nonresponders showed no significant change (P \u3e 0.05). Conclusions Isometric exercise decreased CPM in individuals who reported systemic EIH, suggesting activation of shared mechanisms between CPM and systemic EIH responses. These results may improve the understanding of increased pain after exercise in patients with chronic pain and potentially attenuated CPM

Conditioned Pain Modulation Predicts Exercise-Induced Hypoalgesia in Healthy Adults

Introduction: Conditioned pain modulation (CPM) is the concept that pain inhibits pain and has potential rehabilitation implications for exercise prescription. The purpose of this study was to determine whether changes in pressure pain perception after a thermal conditioning stimulus (i.e., CPM) was attenuated with aging and whether CPM predicted pain relief after exercise (exercise-induced hypoalgesia (EIH)) in healthy young and older adults. Methods: Twenty young (21.9 ± 3.3 yr, 10 men) and 19 older (72.0 ± 4.5 yr, 10 men) adults participated in three sessions: one familiarization and two experimental (EIH and CPM) sessions. Pressure pain perception was assessed using a weighted Lucite edge placed on the right index finger for 1 min. EIH was determined by measuring pressure pain perception before and after prolonged submaximal isometric contraction of the elbow flexors. CPM was assessed by measuring pressure pain perception at the finger while the foot was immersed in neutral water versus painful ice water. Results: Young, but not older, adults reported a decrease in pressure pain at the finger while their foot was immersed in the ice water bath compared with the neutral bath (i.e., CPM, trial–age: P = 0.001). Pressure pain ratings decreased after exercise (P = 0.03) that was perceived as painful (peak arm pain, 7.0 ± 3.3) for both young and older adults. Regression analysis showed that after controlling for age and baseline pain, CPM predicted EIH (model adjusted R2 = 0.23, P = 0.007). Conclusions: CPM was attenuated in older adults, as measured with a noxious pressure stimulus after a thermal conditioning stimulus, and adults with greater CPM were more likely to report greater EIH

If CPM is so bad, why have we been using it so long?

Why has the Critical Path Method (CPM) been used so widely for so long given its inability to produce predictable outcomes? For shedding light on this paradox, the formative period of the CPM is analysed from two main angles. First, how was the CPM embedded into the construction management practice? Second, what was the methodological underpinning of the development of the CPM? These questions are researched through a literature review. In terms of embeddedness into practice, it turns out that the CPM morphed from being a way of production control, into a method for contract control. In consequence, the promotion of the CPM by owners has been crucial for pushing this method to be the mainstream approach to scheduling and production control. Regarding methodological underpinning, it turns out that the CPM was developed as a way of optimization, as part of the quantitative methods movement. This movement was largely based on the axiomatic approach to research. In good alignment with that approach, there was no attempt to empirically test quantitative models and their outcomes. In this context, the unrealistic assumptions and conceptualizations in CPM did not surface in forty years. These results are argued to be helpful in critical discussions on the role and merits of CPM and on the methodologies to be used in construction management research

Capacity-achieving CPM schemes

The pragmatic approach to coded continuous-phase modulation (CPM) is proposed as a capacity-achieving low-complexity alternative to the serially-concatenated CPM (SC-CPM) coding scheme. In this paper, we first perform a selection of the best spectrally-efficient CPM modulations to be embedded into SC-CPM schemes. Then, we consider the pragmatic capacity (a.k.a. BICM capacity) of CPM modulations and optimize it through a careful design of the mapping between input bits and CPM waveforms. The so obtained schemes are cascaded with an outer serially-concatenated convolutional code to form a pragmatic coded-modulation system. The resulting schemes exhibit performance very close to the CPM capacity without requiring iterations between the outer decoder and the CPM demodulator. As a result, the receiver exhibits reduced complexity and increased flexibility due to the separation of the demodulation and decoding functions.Comment: Submitted to IEEE Transactions on Information Theor

Cauchy-perturbative matching revisited: tests in spherical symmetry

During the last few years progress has been made on several fronts making it possible to revisit Cauchy-perturbative matching (CPM) in numerical relativity in a more robust and accurate way. This paper is the first in a series where we plan to analyze CPM in the light of these new results. Here we start by testing high-order summation-by-parts operators, penalty boundaries and contraint-preserving boundary conditions applied to CPM in a setting that is simple enough to study all the ingredients in great detail: Einstein's equations in spherical symmetry, describing a black hole coupled to a massless scalar field. We show that with the techniques described above, the errors introduced by Cauchy-perturbative matching are very small, and that very long term and accurate CPM evolutions can be achieved. Our tests include the accretion and ring-down phase of a Schwarzschild black hole with CPM, where we find that the discrete evolution introduces, with a low spatial resolution of \Delta r = M/10, an error of 0.3% after an evolution time of 1,000,000 M. For a black hole of solar mass, this corresponds to approximately 5 s, and is therefore at the lower end of timescales discussed e.g. in the collapsar model of gamma-ray burst engines. (abridged)Comment: 14 pages, 20 figure