Pro-nociceptive and anti-nociceptive effects of a conditioned pain modulation protocol in participants with chronic low back pain and healthy control subjects. Issue 6 (December 2015)

• Record Type: Journal Article
• Authors: Rabey, Martin; Poon, Cheryl; Wray, Jonathan; Thamajaree, Chutiporn; East, Ryan; Slater, Helen
• Is Part Of: Manual therapy. Volume 20:Issue 6(2015:Dec.)
• Page Start: 763
• Page End: 768
• Publication Date: 2015-12
• Subjects: Conditioned pain modulation -- Chronic low back pain -- Pro-nociceptive -- Palpation; Manipulation (Therapeutics) -- Periodicals; Physical therapy -- Periodicals; Neuromuscular diseases -- Treatment -- Periodicals; Manipulation, Orthopedic; Musculoskeletal Diseases -- therapy; Neuromuscular Diseases -- therapy; Physical Therapy; Manipulation (Thérapeutique) -- Périodiques; Physiothérapie -- Périodiques; Maladies neuromusculaires -- Traitement -- Périodiques; Manipulation (Therapeutics); Neuromuscular diseases -- Treatment; Physical therapy; Electronic journals; Periodicals; Electronic journals; 615.82
• DOI: 10.1016/j.math.2015.02.011
• Languages: English
• ISSNs: 1356-689X

Abstract

Abstract: Background: People with chronic pain may exhibit pro-nociceptive phenotypes characterised partly by reduced conditioned pain modulation (CPM). Characterising variability in CPM in people with chronic low back pain (CLBP) may inform management. Objectives: To investigate pro/anti-nociceptive effects of a CPM protocol in age/sex-matched healthy controls (HCs) and people with CLBP. Design: Case-controlled trial (64 participants/group). Method: The CPM protocol involved: test stimulus (TS) (noxious pressure applied by algometer to lumbar region); conditioning stimulus (CS) (noxious heat applied by thermode to dorsal hand). CPM recruitment was measured by the change in pain intensity (rated on a numeric rating scale (NRS)) of the TS in the presence and absence of the CS. Results: Responses to this CPM protocol were variable for both groups with measures consistent with either inhibitory or facilitatory effects. A significantly greater proportion of facilitatory responses were seen in the CLBP cohort compared to HCs (73% versus 31%). In response to the CS, participants with CLBP demonstrated a mean increase in NRS scores (mean 1.3 points; p < 0.001), while HCs did not (mean −0.2 points; p = 0.35) and the between-group difference in change scores was significant (mean 1.4 points; p < 0.001; effect size (Hedges' g): 1.03). Conclusion: In HCs and participants with CLBP this CPM protocol elicited responses consistent with varying pro/anti-nociceptive effects. The higher proportion of participants with CLBP demonstrating a facilitatory response suggests a pro-nociceptive phenotype may characterise this cohort. Highlights: CPM responses vary from facilitatory to inhibitory in controls and people with LBP. 73% of people with LBP show facilitatory responses to CPM testing. 69% of healthy controls do not show facilitatory responses to CPM testing.