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Assessment of conditioned pain modulation in healthy participants and patients with chronic pain

manifestations and implications for pain progression

Petersen, Kristian K.; McPhee, Megan E.; Hoegh, Morten S.; Graven-Nielsen, Thomas

Current Opinion in Supportive and Palliative Care: June 2019 - Volume 13 - Issue 2 - p 99–106
doi: 10.1097/SPC.0000000000000419
PAIN: NON-MALIGNANT DISEASES: Edited by Anthony H. Dickenson and Kirsty Bannister
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Purpose of review The purpose of this review is to summarize recent findings on conditioned pain modulation (CPM) in humans with a focus on methodology, factors modulating CPM, and the potential for CPM as a clinical marker for pain progression.

Recent findings CPM can be evoked by combining different stimulus modalities with good reliability; sequential CPM effects are stable over time with limited carryover effects. Optimism and pain catastrophizing might influence pain inhibition. Further, studies suggest that the CPM effect can be improved by gabapentinoids, transcranial direct current stimulation to cortical structures, and exercise and that long-term opioid use might impair CPM in patients with chronic pain. Clinical evidence suggests that preoperative impaired CPM may predict more severe chronic postoperative pain. The effect of pain duration on CPM impairment has been challenged by recent studies.

Summary As CPM methodology is optimized, studies are revealing factors that can modulate descending pain inhibitory pathways. Understanding underlying mechanisms of CPM will improve the utility of CPM in a clinical setting and potentially lead to personalized treatments for chronic pain patients.

Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark

Correspondence to Thomas Graven-Nielsen, PhD, Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7 D3, DK-9220 Aalborg, Denmark. Tel: +45 9940 9832; fax: +45 9815 4008; e-mail: tgn@hst.aau.dk

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