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Conditioned pain modulation (the diffuse noxious inhibitory control-like effect): its relevance for acute and chronic pain states

Yarnitsky, Davida,b,c

Current Opinion in Anaesthesiology: October 2010 - Volume 23 - Issue 5 - p 611–615
doi: 10.1097/ACO.0b013e32833c348b
Pain medicine: Edited by Stephan Schug

Purpose of review There is a growing body of knowledge on pain modulation in various disease states. This article reviews the state of the art regarding the clinical relevance of pain inhibition as revealed by ‘pain inhibits pain’ test paradigms, trying to organize the clinically relevant data, and emphasizing the pathophysiology of pain. In line with recent experts' recommendations, the term conditioned pain modulation (CPM) will be used, replacing the previous terms ‘diffuse noxious inhibitory control (DNIC)’ or ‘DNIC-like’ effects.

Recent findings Most of the work in this context was done on the idiopathic pain syndromes, such as irritable bowel syndrome, temporomandibular disorders, fibromyalgia, and tension type headache. The pattern of reduced CPM efficiency seems common to these syndromes and an assertion is made that low CPM efficiency, reflecting low pain inhibitory capacity, is a pathogenetic factor in the development of the idiopathic pain syndromes. Low CPM efficiency was shown to be predictive of acute and chronic postoperative pain, and, in some reports, to be associated with neuropathic pain levels.

Summary Low CPM efficiency is associated with higher pain morbidity and vice versa. Further work is awaited on clarifying plasticity of CPM and its relevance to selection and efficacy of pain therapy.

aDepartment of Neurology, Rambam Medical Center, Israel

bLaboratory of Clinical Neurophysiology, Technion Faculty of Medicine, Haifa, Israel

cDepartment of Diagnostic Sciences, UMDNJ, Newark, New Jersey, USA

Correspondence to David Yarnitsky, Department of Neurology, Rambam Medical Center, Bat Galim, Haifa 31096, Israel Tel: +972 48542605; fax: +972 48542755; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.