Slow temporal summation of pain for assessment of central pain sensitivity and clinical pain of fibromyalgia patients

Roland Staud, Elizabeth E Weyl, Joseph L Riley 3rd, Roger B Fillingim, Roland Staud, Elizabeth E Weyl, Joseph L Riley 3rd, Roger B Fillingim

Abstract

Background: In healthy individuals slow temporal summation of pain or wind-up (WU) can be evoked by repetitive heat-pulses at frequencies of ≥.33 Hz. Previous WU studies have used various stimulus frequencies and intensities to characterize central sensitization of human subjects including fibromyalgia (FM) patients. However, many trials demonstrated considerable WU-variability including zero WU or even wind-down (WD) at stimulus intensities sufficient for activating C-nociceptors. Additionally, few WU-protocols have controlled for contributions of individual pain sensitivity to WU-magnitude, which is critical for WU-comparisons. We hypothesized that integration of 3 different WU-trains into a single WU-response function (WU-RF) would not only control for individuals' pain sensitivity but also better characterize their central pain responding including WU and WD.

Methods: 33 normal controls (NC) and 38 FM patients participated in a study of heat-WU. We systematically varied stimulus intensities of.4 Hz heat-pulse trains applied to the hands. Pain summation was calculated as difference scores of 1st and 5th heat-pulse ratings. WU-difference (WU-Δ) scores related to 3 heat-pulse trains (44°C, 46°C, 48°C) were integrated into WU-response functions whose slopes were used to assess group differences in central pain sensitivity. WU-aftersensations (WU-AS) at 15 s and 30 s were used to predict clinical FM pain intensity.

Results: WU-Δ scores linearly accelerated with increasing stimulus intensity (p<.001) in both groups of subjects (FM>NC) from WD to WU. Slope of WU-RF, which is representative of central pain sensitivity, was significantly steeper in FM patients than NC (p<.003). WU-AS predicted clinical FM pain intensity (Pearson's r = .4; p<.04).

Conclusions: Compared to single WU series, WU-RFs integrate individuals' pain sensitivity as well as WU and WD. Slope of WU-RFs was significantly different between FM patients and NC. Therefore WU-RF may be useful for assessing central sensitization of chronic pain patients in research and clinical practice.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Average number (SEM) of NC…
Figure 1. Average number (SEM) of NC and FM subjects demonstrating Wind-up (WU), zero Wind-up, or Wind-down (WD) during 44°C, 46°C, and 48°C heat pulse trains to the hands at stimulus frequency of 4 Hz.
There were no significant group differences noted (p>.05).
Figure 2. WU-RFs of average (SEM) WU-Δ…
Figure 2. WU-RFs of average (SEM) WU-Δ scores of NC and FM subjects during trains of 44°C, 46°C, and 48°C heat pulses to the hands.
WU-Δ scores monotonically increased with increasing stimulus intensities (p<.001 for nc line and fm subjects however the slopes of wu-rf were significantly steeper compared to>

Figure 3. Average (SEM) WU-AS of NC…

Figure 3. Average (SEM) WU-AS of NC and FM subjects at 15 s (A) and…

Figure 3. Average (SEM) WU-AS of NC and FM subjects at 15 s (A) and 30 s (B) after trains of 44°C, 46°C, and 48°C heat pulses to the hands.
Ratings of WU-AS increased in NC (broken line) and FM subjects (solid line) with increasing WU heat stimulus intensity (all p<.001 wu-as ratings at s and increased significantly more with increasing temperatures in fm subjects than nc p>
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Figure 3. Average (SEM) WU-AS of NC…
Figure 3. Average (SEM) WU-AS of NC and FM subjects at 15 s (A) and 30 s (B) after trains of 44°C, 46°C, and 48°C heat pulses to the hands.
Ratings of WU-AS increased in NC (broken line) and FM subjects (solid line) with increasing WU heat stimulus intensity (all p<.001 wu-as ratings at s and increased significantly more with increasing temperatures in fm subjects than nc p>

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