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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...

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Autores principales: Walker, S.M., O'Reilly, H., Beckmann, J., Marlow, N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2018
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.
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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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