Dynamic Quantitative Sensory Testing to Characterize Central Pain Processing

Ian G Mackey, Eric A Dixon, Kevin Johnson, Jiang-Ti Kong, Ian G Mackey, Eric A Dixon, Kevin Johnson, Jiang-Ti Kong

Abstract

Central facilitation and modulation of incoming nociceptive signals play an important role in the perception of pain. Disruption in central pain processing is present in many chronic pain conditions and can influence responses to specific therapies. Thus, the ability to precisely describe the state of central pain processing has profound clinical significance in both prognosis and prediction. Because it is not practical to record neuronal firings directly in the human spinal cord, surrogate behavior tests become an important tool to assess the state of central pain processing. Dynamic QST is one such test, and can probe both the ascending facilitation and descending modulation of incoming nociceptive signals via TS and CPM, respectively. Due to the large between-individual variability in the sensitivity to noxious signals, standardized TS and CPM tests may not yield any meaningful data in up to 50% of the population due to floor or ceiling effects. We present methodologies to individualize TS and CPM so we can capture these measures in a broader range of individuals than previously possible. We have used these methods successfully in several studies at the lab, and data from one ongoing study will be presented to demonstrate feasibility and potential applications of the methods.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5407598/bin/jove-120-54452-thumb.jpg

References

    1. Pizzo PA, Clark NM. Alleviating suffering 101--pain relief in the United States. N Engl J Med. 2012;366(3):197–199.
    1. Backonja MM, et al. Value of quantitative sensory testing in neurological and pain disorders: NeuPSIG consensus. Pain. 2013;154(9):1807–1819.
    1. Arendt-Nielsen L, Yarnitsky D. Experimental and clinical applications of quantitative sensory testing applied to skin, muscles and visera. J Pain. 2009;10(6):556–572.
    1. Cruz-Almeida Y, Fillingim RB. Can quantitative sensory testing move us closer to mechanism-based pain management? Pain Med. 2014;15(1):61–72.
    1. Curatolo M, Arendt-Nielsen L, Petersen-Felix S. Evidence, mechanisms, and clinical implications of central hypersensitivity in chronic pain after whiplash injury. Clin J Pain. 2004;20(6):469–476.
    1. Kong JT, Schnyer RN, Johnson KA, Mackey S. Understanding central mechanisms of acupuncture analgesia using dynamic quantitative sensory testing: a review. Evid Based Complement Alternat Med. 2013;2013:187182.
    1. Price DD. Characteristics of second pain and flexion reflexes indicative of prolonged central summation. Exp. Neurol. 1972;37(2):371–387.
    1. Price DD, Hu JW, Dubner R, Gracely RH. Peripheral suppression of first pain and central summation of second pain evoked by noxious heat pulses. Pain. 1977;3(1):57–68.
    1. Arendt-Nielsen L, Petersen-Felix S. Wind-up and neuroplasticity: is there a correlation to clinical pain? Eur J Anaesthesiol Suppl. 1995;10:1–7.
    1. Eide PK. Wind-up and the NMDA receptor complex from a clinical perspective. Eur J Pain. 2000;4(1):5–15.
    1. Kong JT, Johnson KA, Balise RR, Mackey S. Test-retest reliability of thermal temporal summation using an individualized protocol. J Pain. 2013;14(1):79–88.
    1. Le Bars D. The whole body receptive field of dorsal horn multireceptive neurones. Brain Res Brain Res Rev. 2002;40(1-3):29–44.
    1. Pud D, Granovsky Y, Yarnitsky D. The methodology of experimentally induced diffuse noxious inhibitory control (DNIC)-like effect in humans. Pain. 2009;144(1-2):16–19.
    1. Yarnitsky D, et al. Recommendations on terminology and practice of psychophysical DNIC testing. Eur J Pain. 2010;14(4):339.
    1. Anderson RJ, et al. Temporal summation of second pain: Variability in responses to a fixed protocol. Eur J Pain. 2012.
    1. Wilson H, Carvalho B, Granot M, Landau R. Temporal stability of conditioned pain modulation in healthy women over four menstrual cycles at the follicular and luteal phases. Pain. 2013;154(12):2633–2638.
    1. Backonja MM, et al. Quantitative sensory testing in measurement of neuropathic pain phenomena and other sensory abnormalities. Clin J Pain. 2009;25(7):641–647.
    1. Price DD, Dubner R. Mechanisms of first and second pain in the peripheral and central nervous systems. J Invest Dermatol. 1977;69(1):167–171.
    1. Van Hees J, Gybels JC. nociceptor activity in human nerve during painful and non painful skin stimulation. J Neurol Neurosurg Psychiatry. 1981;44(7):600–607.
    1. Treede RD, Meyer RA, Raja SN, Campbell JN. Evidence for two different heat transduction mechanisms in nociceptive primary afferents innervating monkey skin. J Physiol. 1995;483(Pt 3):747–758.
    1. Mauderli AP, Vierck CJ, Cannon RL, Rodrigues A, Shen C. Relationships between skin temperature and temporal summation of heat and cold pain. J Neurophysiol. 2003;90(1):100–109.
    1. Granot M, Granovsky Y, Sprecher E, Nir RR, Yarnitsky D. Contact heat-evoked temporal summation: tonic versus repetitive-phasic stimulation. Pain. 2006;122(3):295–305.
    1. Eisenberg E, Midbari A, Haddad M, Pud D. Predicting the analgesic effect to oxycodone by 'static' and 'dynamic' quantitative sensory testing in healthy subjects. Pain. 2010;151(1):104–109.
    1. Granovsky Y, Yarnitsky D. Personalized pain medicine: the clinical value of psychophysical assessment of pain modulation profile. Rambam Maimonides Med J. 2013;4(4):e0024.
    1. Yarnitsky D, Granot M, Nahman-Averbuch H, Khamaisi M, Granovsky Y. Conditioned pain modulation predicts duloxetine efficacy in painful diabetic neuropathy. Pain. 2012;153(6):1193–1198.
    1. van Wijk G, Veldhuijzen DS. Perspective on diffuse noxious inhibitory controls as a model of endogenous pain modulation in clinical pain syndromes. J Pain. 2010;11(5):408–419.
    1. Granot M, et al. Determinants of endogenous analgesia magnitude in a diffuse noxious inhibitory control (DNIC) paradigm: do conditioning stimulus painfulness, gender and personality variables matter? Pain. 2008;136(1-2):142–149.
    1. Raphael KG, Janal MN, Anathan S, Cook DB, Staud R. Temporal summation of heat pain in temporomandibular disorder patients. J Orofac Pain. 2009;23(1):54–64.
    1. Robinson ME, Bialosky JE, Bishop MD, Price DD, George SZ. Supra-threshold scaling, temporal summation, and after-sensation: relationships to each other and anxiety/fear. J Pain Res. 2010;3:25–32.
    1. Bernaba M, Johnson KA, Kong JT, Mackey S. Conditioned pain modulation is minimally influenced by cognitive evaluation or imagery of the conditioning stimulus. J Pain Res. 2014;7:689–697.

Source: PubMed

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