Graven-Nielsen T, Izumi M, Petersen K K, Arendt-Nielsen L
Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark.
Department of Orthopaedic Surgery, Kochi University, Japan.
Eur J Pain. 2017 Mar;21(3):552-561. doi: 10.1002/ejp.958. Epub 2016 Nov 11.
The use of conditioning pain modulation (CPM) is hampered by poor reproducibility and lack of user-independent paradigms. This study refined the CPM paradigm by applying user-independent cuff algometry.
In 20 subjects, the CPM effect of conditioning with cuff stimulation on the arm was investigated by pain test stimuli on the contralateral leg before and in parallel with different cuff conditionings (10, 30, 60 kPa/60 s; 30, 60 kPa/10 s). As test stimulus, another cuff was inflated (1 kPa/s) until the subjects detected the pain tolerance threshold (PTT) during which the pain detection threshold (PDT) and the pressure at a pain intensity of 6 cm on a 10-cm visual analogue scale (PVAS6) were extracted. For comparison, pressure pain thresholds (PPTs) as test stimuli were recorded by the user-dependent handheld pressure algometry. Combinations of cuff locations for conditioning (pain intensity standardized) and contralateral test stimuli were additionally evaluated (leg-arm, leg-leg, arm-thigh). The test-retest reliability in two sessions 1 month apart was assessed in five CPM protocols.
In all protocols, the PDT, PVAS6 and PTT increased during conditioning compared with baseline (p < 0.05). The CPM effect (i.e. conditioning minus baseline) for PVAS6, PTT and PPT increased for increasing conditioning intensities (p < 0.05). The CPM effects were not significantly different for changes in conditioning durations or conditioning/test stimulus locations. In two sessions, the CPM effects for PVAS6 and PTT assessed after 60 s of conditioning on the leg/thigh showed the highest intra-class correlations (0.47-0.73), where they were 0.04-0.6 for PPTs.
The user-independent cuff algometry is reliable for CPM assessment and for supra-pain threshold test stimuli better than the user-dependent technology.
A user-independent CPM technique where the conditioning is controlled by one cuff stimulation, and the test-stimulus is provided by another cuff stimulation. This study shows that cuff algometry is reliable for CPM assessment.
疼痛调节（CPM）的应用受到可重复性差和缺乏独立于用户的范式的阻碍。本研究通过应用独立于用户的袖带测痛法改进了CPM范式。
在20名受试者中，通过在对侧腿部进行疼痛测试刺激，在不同袖带条件（10、30、60kPa/60秒；30、60kPa/10秒）之前和同时，研究了手臂袖带刺激调节的CPM效应。作为测试刺激，另一个袖带充气（1kPa/秒），直到受试者检测到疼痛耐受阈值（PTT），在此期间提取疼痛检测阈值（PDT）和在10厘米视觉模拟量表上疼痛强度为6厘米时的压力（PVAS6）。为了进行比较，通过依赖用户的手持式压力测痛法记录作为测试刺激的压力疼痛阈值（PPT）。还评估了用于调节（疼痛强度标准化）和对侧测试刺激的袖带位置组合（腿-臂、腿-腿、臂-大腿）。在五个CPM方案中评估了相隔1个月的两个疗程中的重测可靠性。
在所有方案中，与基线相比，调节期间PDT、PVAS6和PTT均增加（p<0.05）。随着调节强度的增加，PVAS6、PTT和PPT的CPM效应（即调节减去基线）增加（p<0.05）。调节持续时间或调节/测试刺激位置的变化对CPM效应无显著差异。在两个疗程中，在腿部/大腿进行60秒调节后评估的PVAS6和PTT的CPM效应显示出最高的组内相关性（0.47-0.73），而PPT的组内相关性为0.04-0.6。
独立于用户的袖带测痛法对于CPM评估是可靠的，并且对于超疼痛阈值测试刺激比依赖用户的技术更好。
一种独立于用户的CPM技术，其中调节由一个袖带刺激控制，测试刺激由另一个袖带刺激提供。本研究表明袖带测痛法对于CPM评估是可靠的。
