Sex cpm

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Marc O. Martel, PhD, Ajay D. Wasan, MD, Robert R. To examine the temporal stability of conditioned pain modulation CPMformerly termed diffuse noxious inhibitory controls, among a sample of patients with chronic pain.

The study also examined the factors that might be responsible for the stability of CPM. In this test-retest study, patients underwent a series of standardized psychophysical pain-testing procedures deed to assess CPM on two separate occasions i. Overall, provided evidence for the stability of CPM among patients with chronic pain.however, revealed considerable sex differences in the stability of CPM. For women, revealed a ificant test-retest correlation between baseline and follow-up CPM scores.

For men, however, the test-retest correlation between baseline and follow-up CPM scores was not ificant. of a Fisher's Z-test revealed that the stability of CPM was ificantly greater for women than for men. Follow-up analyses revealed that the difference between men and women sex cpm the stability of CPM could not be ed for by any demographic e.

Our findings suggest that CPM paradigms possess sufficient reliability to be incorporated into bedside clinical evaluation of patients with chronic pain, but only among women. Over the past few decades, considerable efforts have been devoted to identifying the factors that may be involved in the development and maintenance of chronic pain. While it is well acknowledged that chronic pain may result from a multitude of factors, a substantial amount of evidence has accumulated indicating that alterations within the central nervous system CNS may contribute to the development and maintenance of various chronic pain conditions, including musculoskeletal, visceral, and neuropathic pain conditions for reviews, see.

A large body of research has shown that nociceptive als within the CNS may be modulated by a of endogenous pain-inhibitory systems. These endogenous pain-inhibitory systems are known to operate at various levels of the CNS and play a determinant role in shaping the subjective experience of pain for reviews, see. There is considerable interindividual variability in the activity of endogenous pain-inhibitory systems, and many investigators have argued that individual differences in endogenous pain inhibition may place individuals at increased or reduced risk for the development and maintenance of pain conditions.

One common method for investigating individual differences in endogenous pain inhibition is the use of conditioned pain modulation CPM paradigms. CPM, formerly termed diffuse noxious inhibitory control DNICrepresents one type of endogenous pain inhibition and refers to the process whereby one noxious stimulus inhibits or reduces the perception of a second noxious stimulus.

In the laboratory, Sex cpm is typically assessed by examining the extent to which the pain produced by a phasic i. In the CPM paradigm, greater reductions in pain i. Deficits in CPM have been observed among patients with a variety of chronic musculoskeletalvisceraland neuropathic pain conditions. In recent studies, deficits in CPM have been found to be prospectively associated with an increased likelihood of developing chronic postoperative painand interindividual differences in CPM among patients with diabetic neuropathy have been found to predict analgesic responses to neuropathic pain medication.

There is growing interest in using the CPM paradigm as a clinical tool among patients with neuropathic pain conditions. This interest stems, in part, from the growing emphasis that has been placed on mechanism-based pain diagnosis, and mechanism-based approaches to treatment selection for patients with neuropathic pain conditions. The CPM paradigm can be easily incorporated into bedside clinical evaluation of patients with neuropathic pain and may provide complementary information about patients' CNS pain processing and endogenous pain-inhibitory function.

The potential value of the CPM paradigm as a clinical tool, however, implies that CPM is, at least to some extent, reproducible and stable over time. To date, there is a paucity of research that has addressed the temporal stability of CPM. Importantly, the stability of pain-inhibitory systems e. It remains unclear, however, whether any of these factors may influence the stability of CPM over time.

In the present study, a sample of patients with chronic back pain 35 women and 20 men participated in a test-retest laboratory study deed to examine stability of CPM over a day time period. On the basis of studieswe hypothesized that CPM would show adequate test-retest stability. Of particular interest in the present study was to examine whether the stability of CPM was influenced by patients' demographics e.

Secondary analyses examined the influence of demographic and psychological factors on interindividual differences in the magnitude of CPM i. The study sample consisted of 55 participants 35 women, 20 men with chronic back pain. Patients with a diagnosis of back pain, with or without radicular symptoms, who were able to speak, read, and write in English, and who had been experiencing pain for at least 6 months were invited to participate. Patients were excluded if they had a diagnosis of cancer or other malignant disease at the time of testing or had cognitive limitations that precluded providing self-report data.

At the time of initial assessment i. Patients were also asked to report the medications they were currently using, including prescription and over-the-counter medications. Patients' reports of prescription medication were verified by the research assistant RA using the electronic medical record system, and published tables were used to convert daily opioid doses into morphine equivalents. In addition to providing demographic and medication use information, participants were asked to complete self-report questionnaires see later discussion prior to undergoing a series of standardized psychophysical pain-testing procedures deed to assess CPM.

At follow up, participants ed a consent form, provided medication use information, and underwent the same series of psychophysical pain-testing procedures used to assess CPM. Baseline and follow-up assessment sessions were carried out by the same RA, who followed the same set of standardized psychophysical pain-testing procedures across assessment sessions.

A test-retest time interval of 7—10 days was chosen in order to minimize potential carryover effects that may be associated with shorter test-retest time intervals. The Brief Pain Inventory BPI; was used as a measure of pain severity associated with patients' musculoskeletal pain condition. Patients were sex cpm to rate their current level of pain on an point numeric rating scale with the end points 0 no pain and 10 extreme pain. The BPI has been shown to be a reliable and valid measure of pain severity among patients with chronic noncancer pain.

The NPQ contains a series of items that describe sensations or sensory experiences that may accompany patients' pain e. The NPQ has ly been shown to be a valid tool for identifying patients with neuropathic pain symptoms. The PASS is a item self-report questionnaire in which participants make ratings about anxiety on a 6-point Likert scale ranging from 0 never to 5 always.

PASS has been shown to be a reliable and valid measure of pain-related anxiety in patients with chronic pain. The BDI consists of 21 items describing various symptoms of depression, and respondents choose statements that best describe how they have been feeling over the past 2 weeks. Responses are sex cpm to yield an overall index of depressive symptoms. The BDI has been shown to be a reliable and valid index of depressive symptoms in patients with chronic pain. The PCS contains 13 items describing different thoughts and feelings that individuals may experience when they are in pain.

Participants were asked to reflect on past painful experiences and to indicate the degree to which they experienced each of 13 thoughts or feelings when experiencing pain, on a 5-point scale from 0 not at all to 4 all the time. Several studies have supported the reliability and the validity of the PCS as a measure of pain-related catastrophic thinking. In order to assess CPM, baseline pressure pain thresholds PPThs were first assessed using a digital pressure algometer Somedic, Sollentum, Sweden on the right upper trapezius, approximately 2 cm from the acromioclavicular t.

Baseline PPThs were assessed twice, separated by an interval of 30 seconds. During the assessment of Sex cpm, mechanical force was applied using a 0. Twenty seconds following hand immersion, PPThs were re-assessed on the right trapezius i. All data were analyzed using SPSS v. Independent samples t -tests and Chi-square analyses were used to compare men and women on demographic, pain, and psychological variables.

Independent samples t -tests were used to compare men and women in terms of medication use. An index of medication use was computed by summing the of medications used by patients on a daily basis. These medications included: prescription opioids, any other prescription analgesics, non-steroidal anti-inflammatory drugs, muscle relaxants, anticonvulsants, psychotropic medications, and over-the-counter sex cpm.

The temporal stability of CPM was addressed using three distinct data analytic approaches. In the context of our study, absolute stability refers sex cpm the overall i. The same analyses were conducted to examine the absolute stability of PPThs and cold pressor pain ratings.

Relative stability refers to the stability of interindividual differences in CPM from baseline to follow up. ICC coefficients are commonly used as indicators of relative stability and are generally interpreted on the basis of sex cpm ICC metric conventions. ICC coefficients ranging between 0.

In the present study, ICCs were computed between baseline and follow-up CPM scores, separately for men, women, and the overall sample i. A follow-up Fisher's Z -test was conducted to determine whether stability coefficients differed ificantly across sexes. The same analyses were conducted to examine the relative stability of PPThs and cold pressor pain ratings.

Consistent with studiesbaseline and follow-up CPM scores were first standardized across the whole sample. A change score was then computed by subtracting follow-up standardized CPM scores from baseline standardized CPM scores. Given that CPM scores are standardized within each assessment session, stability i.

Higher ISCs i. A correlation was also conducted between test-retest time interval i. Given that pain ratings provided during the CS i. Intraindividual cold pressor pain ratings stability coefficients ISC-CP pain were computed using the same data transformation and formula as that described earlier, but using cold pressor pain ratings. Descriptive statistics for patient demographic and pain condition characteristics are presented in Tableseparately for men and women. Descriptive statistics for measures of catastrophizing PCSNA, and medication use are presented in Table separately for men and women.

At time 1 i. At time 2 i. Sex cpm and SDs are presented in Table Examination of marginal means revealed that CPM scores were ificantly lower in women No ificant main or interaction effects were found for time. CPM scores are comparable with those that have been reported in studies using similar methods. Mean conditioned pain modulation CPM scores, pressure pain thresholds PPThsand cold pressor pain ratings as a function of time and patient sex. PPThs are in kPA units.

CP pain, cold pressor pain ratings 0— Values in parentheses are standard deviations.

Sex cpm

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