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Conditioned pain modulation identifies altered sensitivity in extremely preterm young adult males and females
BACKGROUND: Conditioned pain modulation is a potential biomarker for risk of persistent pain. As early-life experience can alter subsequent somatosensory processing and pain response, we evaluated conditioned pain modulation after extremely preterm birth. METHODS: This observational study recruited...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6200113/ https://www.ncbi.nlm.nih.gov/pubmed/30115262 http://dx.doi.org/10.1016/j.bja.2018.05.066 |
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author | Walker, S.M. O'Reilly, H. Beckmann, J. Marlow, N. |
author_facet | Walker, S.M. O'Reilly, H. Beckmann, J. Marlow, N. |
author_sort | Walker, S.M. |
collection | PubMed |
description | BACKGROUND: Conditioned pain modulation is a potential biomarker for risk of persistent pain. As early-life experience can alter subsequent somatosensory processing and pain response, we evaluated conditioned pain modulation after extremely preterm birth. METHODS: This observational study recruited extremely preterm (<26 weeks gestation; n=98) and term-born control (n=48) young adults (19–20 yr) from the longitudinal EPICure cohort. Pressure pain threshold (PPT; variable test stimulus lower leg) was measured before, during, and after a conditioning stimulus (contralateral hand immersion; 5°C water; 30 s). Questionnaires assessed current pain, medication use, anxiety, and pain catastrophising. RESULTS: For participants tolerating conditioning, there were significant main effects of extremely preterm status, sex, and time on PPT during and after hand immersion. Inhibitory modulation was evoked in 64/98 extremely preterm (3, no change) and 38/48 term-born control (3, facilitation) subjects. The conditioned pain modulation effect (percentage change in PPT) did not differ between the extremely preterm and term-born control groups {53% [95% confidence interval (CI): 41–65] vs 57% [95% CI: 42–71]}. Reduced cold tolerance (<20 s) hampered conditioned pain modulation quantification in a higher proportion of extremely preterm participants [extremely preterm vs term-born control: 31/98 (32%) vs 7/48 (15%); P=0.03]. One-third of extremely preterm females withdrew the hand before parallel PPT (<15 s), and had lower baseline PPT than term-born control females [4.9 (95% CI: 4.8–5.1) vs 5.3 (95% CI: 5.1–5.5) ln kPa; P=0.02]. Higher anxiety, pain catastrophising, and medication use correlated with pain intensity, but not conditioned pain modulation effect. CONCLUSIONS: Cold conditioning evoked inhibitory modulation in the majority of young adults and identified a subgroup of extremely preterm females with increased baseline sensitivity. Early-life experience and sex/gender should be considered when evaluating persistent pain risk with conditioned pain modulation. |
format | Online Article Text |
id | pubmed-6200113 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-62001132018-10-26 Conditioned pain modulation identifies altered sensitivity in extremely preterm young adult males and females Walker, S.M. O'Reilly, H. Beckmann, J. Marlow, N. Br J Anaesth Pain BACKGROUND: Conditioned pain modulation is a potential biomarker for risk of persistent pain. As early-life experience can alter subsequent somatosensory processing and pain response, we evaluated conditioned pain modulation after extremely preterm birth. METHODS: This observational study recruited extremely preterm (<26 weeks gestation; n=98) and term-born control (n=48) young adults (19–20 yr) from the longitudinal EPICure cohort. Pressure pain threshold (PPT; variable test stimulus lower leg) was measured before, during, and after a conditioning stimulus (contralateral hand immersion; 5°C water; 30 s). Questionnaires assessed current pain, medication use, anxiety, and pain catastrophising. RESULTS: For participants tolerating conditioning, there were significant main effects of extremely preterm status, sex, and time on PPT during and after hand immersion. Inhibitory modulation was evoked in 64/98 extremely preterm (3, no change) and 38/48 term-born control (3, facilitation) subjects. The conditioned pain modulation effect (percentage change in PPT) did not differ between the extremely preterm and term-born control groups {53% [95% confidence interval (CI): 41–65] vs 57% [95% CI: 42–71]}. Reduced cold tolerance (<20 s) hampered conditioned pain modulation quantification in a higher proportion of extremely preterm participants [extremely preterm vs term-born control: 31/98 (32%) vs 7/48 (15%); P=0.03]. One-third of extremely preterm females withdrew the hand before parallel PPT (<15 s), and had lower baseline PPT than term-born control females [4.9 (95% CI: 4.8–5.1) vs 5.3 (95% CI: 5.1–5.5) ln kPa; P=0.02]. Higher anxiety, pain catastrophising, and medication use correlated with pain intensity, but not conditioned pain modulation effect. CONCLUSIONS: Cold conditioning evoked inhibitory modulation in the majority of young adults and identified a subgroup of extremely preterm females with increased baseline sensitivity. Early-life experience and sex/gender should be considered when evaluating persistent pain risk with conditioned pain modulation. Elsevier 2018-09 2018-07-06 /pmc/articles/PMC6200113/ /pubmed/30115262 http://dx.doi.org/10.1016/j.bja.2018.05.066 Text en © 2018 The Author(s) http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Pain Walker, S.M. O'Reilly, H. Beckmann, J. Marlow, N. Conditioned pain modulation identifies altered sensitivity in extremely preterm young adult males and females |
title | Conditioned pain modulation identifies altered sensitivity in extremely preterm young adult males and females |
title_full | Conditioned pain modulation identifies altered sensitivity in extremely preterm young adult males and females |
title_fullStr | Conditioned pain modulation identifies altered sensitivity in extremely preterm young adult males and females |
title_full_unstemmed | Conditioned pain modulation identifies altered sensitivity in extremely preterm young adult males and females |
title_short | Conditioned pain modulation identifies altered sensitivity in extremely preterm young adult males and females |
title_sort | conditioned pain modulation identifies altered sensitivity in extremely preterm young adult males and females |
topic | Pain |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6200113/ https://www.ncbi.nlm.nih.gov/pubmed/30115262 http://dx.doi.org/10.1016/j.bja.2018.05.066 |
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