Novel neurophysiological evidence for preserved pain habituation across chronic pain conditions

IF 3.7 3区 医学 Q1 CLINICAL NEUROLOGY Clinical Neurophysiology Pub Date : 2024-07-20 DOI:10.1016/j.clinph.2024.07.007
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Abstract

Objective

The present study aimed to investigate whether subjective and objective measures of pain habituation can be used as potential markers for central sensitization across various chronic pain patients.

Methods

Two blocks of contact-heat stimuli were applied to a non-painful area in 93 chronic pain patients (low back pain, neuropathic pain, and complex regional pain syndrome) and 60 healthy controls (HC). Habituation of pain ratings, contact-heat evoked potentials (CHEP), and sympathetic skin responses (SSR) was measured.

Results

There was no significant difference in any measure of pain habituation between patients and HC. Even patients with apparent clinical signs of central sensitization showed no reduced pain habituation. However, prolonged baseline CHEP and SSR latencies (stimulation block 1) were found in patients compared to HC (CHEP: Δ-latency = 23 ms, p = 0.012; SSR: Δ-latency = 100 ms, p = 0.022).

Conclusion

Given the performed multimodal neurophysiological testing protocol, we provide evidence indicating that pain habituation may be preserved in patients with chronic pain and thereby be of limited use as a sensitive marker for central sensitization. These results are discussed within the framework of the complex interactions between pro- and antinociceptive mechanism as well as methodological issues. The prolonged latencies of CHEP and SSR after stimulation in non-painful areas may indicate subclinical changes in the integrity of thermo-nociceptive afferents, or a shift towards antinociceptive activity. This shift could potentially affect the relay of ascending signals.

Significance

Our findings challenge the prevailing views in the literature and may encourage further investigations into the peripheral and central components of pain habituation, using advanced multimodal neurophysiological techniques.

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新的神经生理学证据表明,在不同的慢性疼痛条件下,疼痛习惯化都会得到保留
本研究旨在探讨疼痛习惯化的主观和客观测量方法是否可用作各种慢性疼痛患者中枢敏感化的潜在标记。方法在 93 名慢性疼痛患者(腰背痛、神经性疼痛和复杂区域疼痛综合征)和 60 名健康对照组(HC)的非疼痛区域施加两组接触热刺激。结果患者和健康对照组的疼痛习惯化程度均无显著差异。即使有明显中枢敏感化临床表现的患者,其疼痛习惯性也没有降低。然而,与 HC 相比,患者的基线 CHEP 和 SSR 延迟(刺激块 1)较长(CHEP:Δ-延迟 = 23 ms,p = 0.012;SSR:Δ-延迟 = 100 ms,p = 0.022)。我们将在促痛觉和抗痛觉机制之间复杂的相互作用以及方法学问题的框架内讨论这些结果。在非疼痛区域受到刺激后,CHEP 和 SSR 的潜伏期延长可能表明热痛传入的完整性发生了亚临床变化,或转向了抗痛活动。我们的研究结果对文献中的普遍观点提出了质疑,并鼓励使用先进的多模态神经生理学技术进一步研究疼痛习惯化的外周和中枢组成部分。
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来源期刊
Clinical Neurophysiology
Clinical Neurophysiology 医学-临床神经学
CiteScore
8.70
自引率
6.40%
发文量
932
审稿时长
59 days
期刊介绍: As of January 1999, The journal Electroencephalography and Clinical Neurophysiology, and its two sections Electromyography and Motor Control and Evoked Potentials have amalgamated to become this journal - Clinical Neurophysiology. Clinical Neurophysiology is the official journal of the International Federation of Clinical Neurophysiology, the Brazilian Society of Clinical Neurophysiology, the Czech Society of Clinical Neurophysiology, the Italian Clinical Neurophysiology Society and the International Society of Intraoperative Neurophysiology.The journal is dedicated to fostering research and disseminating information on all aspects of both normal and abnormal functioning of the nervous system. The key aim of the publication is to disseminate scholarly reports on the pathophysiology underlying diseases of the central and peripheral nervous system of human patients. Clinical trials that use neurophysiological measures to document change are encouraged, as are manuscripts reporting data on integrated neuroimaging of central nervous function including, but not limited to, functional MRI, MEG, EEG, PET and other neuroimaging modalities.
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