Lautenbacher Stefan, Horn-Hofmann Claudia, Kunz Miriam
Physiological Psychology, Otto-Friedrich-University of Bamberg, Bamberg, Germany.
Bamberg Living Lab Dementia, BamLiD, Otto-Friedrich-University of Bamberg, Bamberg, Germany.
Pain. 2025 Feb 4;166(7):e97-e104. doi: 10.1097/j.pain.0000000000003494.
Conditioned pain modulation (CPM) is assumed to capture endogenous pain modulation. In standard CPM designs, the evaluation of a painful test stimulus (TS) (baseline) is followed by a second evaluation of the TS during/after application of a painful conditioning stimulus (CS) (treatment). However, these standard CPM within designs (baseline always preceding treatment) do not control for order effects, which might help to distinguish specific CPM inhibition from general habituation. To tackle this issue, we conducted 2 separate studies where we controlled for order effects to investigate whether CPM effects depend on the order of baseline and treatment. In both studies, a sample of 60 participants underwent 2 CPM test blocks: one standard order block (baseline before treatment) and one reversed order block (treatment before baseline), separated by a 20-minute break (randomized order across participants). Pain thresholds and pain ratings of phasic heat stimuli served as measures of TS. Cold water (study 1) and cuff pressure algometry (study 2) served as CS. We found significant CPM order effects in both studies and for both measures of TS (pain threshold and ratings). Only the standard CPM order (baseline before treatment) yielded robust pain inhibition effects, whereas the reversed order (treatment before baseline) led to no modulation or seeming pain facilitation. Because control for order effects is otherwise mandatory in within designs, it is surprising that it has been neglected in standard CPM protocols. Finding pain inhibition only in the standard CPM order suggests that CPM inhibition is at least partially confounded with habituation.
条件性疼痛调制(CPM)被认为反映了内源性疼痛调制。在标准的CPM设计中,先对疼痛测试刺激(TS)(基线)进行评估,然后在施加疼痛条件刺激(CS)(处理)期间/之后对TS进行第二次评估。然而,这些设计中的标准CPM(基线总是先于处理)没有控制顺序效应,而顺序效应可能有助于区分特定的CPM抑制和一般的习惯化。为了解决这个问题,我们进行了两项独立的研究,在研究中我们控制了顺序效应,以调查CPM效应是否取决于基线和处理的顺序。在两项研究中,60名参与者的样本接受了2个CPM测试块:一个标准顺序块(处理前基线)和一个反向顺序块(基线前处理),中间间隔20分钟休息(参与者的顺序随机)。相位热刺激的疼痛阈值和疼痛评分用作TS的测量指标。冷水(研究1)和袖带压力测痛法(研究2)用作CS。我们在两项研究中以及对于TS的两种测量指标(疼痛阈值和评分)都发现了显著的CPM顺序效应。只有标准的CPM顺序(处理前基线)产生了强大的疼痛抑制效应,而反向顺序(基线前处理)则没有导致调制或明显的疼痛促进。因为在设计中控制顺序效应在其他情况下是必不可少的,所以令人惊讶的是它在标准的CPM方案中被忽视了。仅在标准CPM顺序中发现疼痛抑制表明CPM抑制至少部分地与习惯化混淆。