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Patients suffering from chronic local back pain showed
significantly higher CPM as compared to patients with CWP and FMS.
Endless back pain is one of the most prevalent reported
health complaints. About 8 in 10 people suffer from bouts of back pain. But
every person has different pain levels, pain modulation and pain inhibitory
mechanism. Thence, the pain treatment should also be different to every person.
Now the question is, how we can estimate the extents of pain levels? One of the
methods used to investigate individual difference in pain inhibition is the
conditioned pain modulation (CPM) paradigms. This involves a psychophysical
procedure in which conditioning stimulus reduces the perception of a test
stimulus, applied to a remote area of the body.
Therefore, a study was conducted to investigate pain
intensity and inhibition mechanism by using CPM in CBP patients with different
pain extent. In the study, FMS (fibromyalgia syndrome) patient's CPM that
reported most consistent, were measured for comparison. Now, depending upon
pain drawings and clinical evaluation, patients were classified into chronic
widespread back pain (CWP; n = 32), chronic local back pain (CLP; n = 53) and
FMS (n = 92). In this study, CPM was measured by the difference in pressure
pain threshold (a test stimulus) before and after tonic heat pain (a
conditioning stimulus). Herewith psycho-social variables were also measured.
The CPM analysis showed that the pressure pain threshold
was significantly increased among CLP patients after tonic heat pain than CWP
and FMS patients (P<
0.001). The levels of CPM were same in both CWP and FMS. The CPM was decreased
as the number of painful areas (0-10) increased and patients with CBP showed a
higher number of painful areas as compared to FMS (P=0.903). Whereas anxiety
and depression were less noticeable in CBP as compared to FMS (P<0.01).
Hence, all these findings suggest that CPM dysfunction is
related to CWP and not with FMS. Further, the FMS group shows higher
psychosocial burden as compared to CWP without FMS. The centrally acting
treatments that target endogenous pain inhibition among CLP and CWP patients
seem to be more. This indicates the pain extent is higher among patients with
CBP.
PAIN
Conditioned pain modulation in patients with nonspecific chronic back pain with chronic local pain, chronic widespread pain, and fibromyalgia
Gerhardt, Andreas et al.
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