Cagnie, Barbara

Danneels, Lieven

Goubert, Dorien

Kolba, Kim

Meeus, Mira

Noyez, Heleen

Van Oosterwijck, Jessica

English

Ghent University Academic Bibliography

Email: Dorien.Goubert@UGent.be     Phone: +3293325503   Pain facilitation and pain inhibitionmight be present in chronic painpatients. A decreased efficacy ofpain inhibition can be measured byconditioned pain modulation(CPM). It is however unclearwhether the presence of paininfluences the efficacy ofendogenous pain inhibition,measured by CPM.This systematic reviewaimed to provide anoverview of what is knownthus far about the influenceof clinical (acute andchronic) or experimentalpain induction and painreduction on CPM in adults.Effect of Pain Induction and Pain Reduction on Conditioned Pain Modulation: a Systematic ReviewGoubert D1,2, Danneels L1 , Cagnie B1, Van Oosterwijck J1,2, Kolba K1, Noyez H1, Meeus M1,2,31. Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium; 2. Pain in Motion Research Group; 3. Rehabilitation Sciences and Physiotherapy, University of Antwerp, BelgiumStudy characteristics: mechanical (pressure),thermal (heat or cold), electrical or tactile stimuli wereused as test stimulus . The administration sites werevery different. A cold pressor test, hot water bath,pressure, CO2 laser stimulation and Tourniquet testwere used as a conditioning stimulus, .Methodological quality: 3 articles got a level ‘A2’of evidence, 6 were classified as ‘B’ and 3 as ‘C’.All studies were divided in 3 groups based on topic: (1) Influence of medication, (2) pain induction in those with (sub)acute pain and experimental pain or (3) the relief of chronic pain (in OA) on CPM efficacy. Medication(Sub)Acute and Chronic painDifferent effects of medication on CPM might becaused by different working mechanisms ofmedication. They might work through influenceon pain inhibitory pathways or rather work onhyperalgesia.A lot of chronic pain patients take medication.Lowered CPM responses should therefore becarefully interpreted.In chronic pain reduced CPM response can berestored after removal of the peripheral painsource. Remarkably this was not found in thosewith acute pain. This might be due to medicationuse or the fact that CPM deficiencies in painconditions are most likely more related to theduration of clinical pain than to pain itself.Finally, multiple systems might possibly beinvolved in efficacy of CPM and should be takeninto account: stimuli administration, gender,cognition, anxiety, follicular phase,comorbidities,…Some analgesic medications and oralcontraceptives might inhibit the CPMmechanism. There is limited evidencethat pain relieving surgery improvesCPM in chronic pain patients. Theresults suggest that only in case ofalready lowered CPM values (like inchronic pain patients), CPM can improveafter elimination of pain.Inclusion criteria:• discuss the effect of changes in pain on CPM• RCT’s, case control, cohort, cross-over &cross-sectional studies• adultsThe search strategy can be found in figure 1.Checklists of the EBRO platform and a handmadeCPM paradigm were used to assessmethodological quality.METHODSCONCLUSIONDISCUSSIONRESULTSFigure 1. Flowchart of the selection procesINTRODUCTION  and  AIMCONTACTEFFECT ONCPM DRUGSTUDY POPULATIONNO• Pregabalin Chronic Pancreatitis• Tropisteron Chronic LBPNEGATIVE• Dexmedetomidine Healthy• Ludocaine & Bupivacaine Cervical facet pain• Morfine Healthy• Opioids Chronic pain• Ketamine Healthy• Oral contraceptives HealthyPOSITIVE • Naloxone HealthyEFFECT ONCPM INTERVENTIONSTUDY POPULATIONNO• Exercise induced pain Acute shoulder pain• Electrical stimulation Acute Pain in TMJPOSITIVE• Joint Replacement Chronic Knee OA• Joint Replacement Chronic Hip OAPubmedN=83Web Of ScienceN=119Result after de-duplicationN=170Hand SearchingN=2Result afterscreening for title & abstractN=27ExcludedN=145Based on:Population (N=39)Intervention (N=68)Design (N=34)Publication form (N=4)ExcludedN=15Based on:Population (N=13)Design (N=2)Result afterscreening based on full textN=12

Effect of pain induction and pain reduction on conditioned pain modulation: a systematic review

https://biblio.ugent.be/publication/5646099/file/5646100.pdf

Effect of pain induction and pain reduction on conditioned pain modulation: a systematic review

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