Short-term test-retest-reliability of conditioned pain modulation using the cold-heat-pain method in healthy subjects and its correlation to parameters of standardized quantitative sensory testing.
Short-term test-retest-reliability of conditioned pain modulation using the cold-heat-pain method in healthy subjects and its correlation to parameters of standardized quantitative sensory testing.
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DOI：
10.1186/s12883-016-0650-z
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发表时间：
2016-08-05
期刊：
影响因子：
2.6
通讯作者：
Enax-Krumova EK
中科院分区：
文献类型：
--
作者：
Gehling J;Mainka T;Vollert J;Pogatzki-Zahn EM;Maier C;Enax-Krumova EK
条件性疼痛调制（CPM）通常用于评估人类下行疼痛抑制。已有9篇关于不同CPM范式的重测信度的研究，但没有一篇研究涉及常用的热-冷-痛方法。结果差异很大，因此，可靠性措施不能从一个CPM范式外推到另一个。本研究旨在分析常用冷热痛法的重测信度及其与痛阈的相关性。在40 ± 19.9h内，采用冷水浸泡法对量表进行了短期重测信度检验（10 °C，左手）作为条件刺激（CS），热痛（43-49 °C，疼痛强度60 ± 5，右前臂）作为测试刺激（TS）。在60 s CS之前30 s（TS之前）、期间（TS期间）和之后（TS之后）应用TS。TSbefore和TSduring的疼痛评级之间的差异代表早期CPM效应，TSbefore和TSafter之间的差异代表晚期CPM效应。在CPM评估之前，对两个阶段进行定量感觉测试（QST，DFNS方案）。统计信息：配对t检验、组内相关系数（ICC）、测量标准误差（SEM）、最小真实的差异（SRD）、Pearson相关性、Bland-Altman分析、显著性水平p < 0.05，必要时进行多重比较的Bonferroni校正。CPM期间的疼痛评分在两天之间显著相关（ICC：0.411...0.962），尽管第2天的TS评分较低（p < 0.005）。早期（第一天：16.7 ± 11.7;第2天：19.5 ± 11.9; ICC：0.618，SRD：20.2）和晚期（第1天：1.7 ± 9.2;第2天：7.6 ± 11.5; ICC：0.178，SRD：27.0）CPM效应在两天之间无显著差异。早期和晚期CPM效应与痛阈无关。在健康受试者中使用热-冷-痛方法的早期CPM效应的短期重测信度在ICC方面取得了令人满意的结果。早期CPM效应的SRD表明，> 20 NRS的个体变化可归因于真实的变化，而不是偶然。晚期CPM效应较弱且不可靠。
Conditioned Pain Modulation (CPM) is often used to assess human descending pain inhibition. Nine different studies on the test-retest-reliability of different CPM paradigms have been published, but none of them has investigated the commonly used heat-cold-pain method. The results vary widely and therefore, reliability measures cannot be extrapolated from one CPM paradigm to another. Aim of the present study was to analyse the test-retest-reliability of the common heat-cold-pain method and its correlation to pain thresholds. We tested the short-term test-retest-reliability within 40 ± 19.9 h using a cold-water immersion (10 °C, left hand) as conditioning stimulus (CS) and heat pain (43-49 °C, pain intensity 60 ± 5 on the 101-point numeric rating scale, right forearm) as test stimulus (TS) in 25 healthy right-handed subjects (12females, 31.6 ± 14.1 years). The TS was applied 30s before (TSbefore), during (TSduring) and after (TSafter) the 60s CS. The difference between the pain ratings for TSbefore and TSduring represents the early CPM-effect, between TSbefore and TSafter the late CPM-effect. Quantitative sensory testing (QST, DFNS protocol) was performed on both sessions before the CPM assessment. Statistics: paired t-tests, Intraclass correlation coefficient (ICC), standard error of measurement (SEM), smallest real difference (SRD), Pearson’s correlation, Bland-Altman analysis, significance level p < 0.05 with Bonferroni correction for multiple comparisons, when necessary. Pain ratings during CPM correlated significantly (ICC: 0.411…0.962) between both days, though ratings for TSafter were lower on day 2 (p < 0.005). The early (day 1: 16.7 ± 11.7; day 2: 19.5 ± 11.9; ICC: 0.618, SRD: 20.2) and late (day 1: 1.7 ± 9.2; day 2: 7.6 ± 11.5; ICC: 0.178, SRD: 27.0) CPM effect did not differ significantly between both days. Both early and late CPM-effects did not correlate with the pain thresholds. The short-term test-retest-reliability of the early CPM-effect using the heat-cold-pain method in healthy subjects achieved satisfying results in terms of the ICC. The SRD of the early CPM effect showed that an individual change of > 20 NRS can be attributed to a real change rather than chance. The late CPM-effect was weaker and not reliable.