Conditioned Pain Modulation and Pressure Pain Sensitivity in the Adult Danish General Population: The DanFunD Study

  • Sine Skovbjerg
    Address reprint requests to Sine Skovbjerg, PhD, The Research Centre for Prevention and Health, Glostrup Hospital, Building 84/85, Glostrup, Copenhagen DK-2600, Denmark.
    The Research Centre for Prevention and Health, Capital Region, Copenhagen, Denmark
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  • Torben Jørgensen
    The Research Centre for Prevention and Health, Capital Region, Copenhagen, Denmark

    Department of Public Health, Institute of Health and Medical Science, Copenhagen University, Copenhagen, Denmark

    Faculty of Medicine, Aalborg University, Aalborg, Denmark
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  • Lars Arendt-Nielsen
    Faculty of Medicine, Aalborg University, Aalborg, Denmark

    Center for Neuroplasticity and Pain, Aalborg University, Aalborg, Denmark

    Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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  • Jeanette F. Ebstrup
    The Research Centre for Prevention and Health, Capital Region, Copenhagen, Denmark
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  • Tina Carstensen
    Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
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  • Thomas Graven-Nielsen
    Faculty of Medicine, Aalborg University, Aalborg, Denmark

    Center for Neuroplasticity and Pain, Aalborg University, Aalborg, Denmark

    Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Published:November 21, 2016DOI:


      • New insight into pain modulation in the general adult population is provided.
      • Decreased conditioned pain modulation (CPM) and increased pain sensitivity in women were found.
      • No association between CPM potency and age was found.
      • High perceived stress was associated with lower pressure pain thresholds, but not with CPM.
      • An association between CPM and educational level was found.


      Increased pressure pain sensitivity and impaired descending pain control have been associated with chronic pain, but knowledge on the variability in the adult general population is lacking. Pressure pain thresholds (PPTs) and descending pain control assessed using conditioned pain modulation (CPM) were recorded in a randomly selected sample (n = 2,199, 53% female) of the Danish adult general population aged 18 to 70 years. PPTs were recorded over the tibialis anterior muscle and the upper trapezius muscle. CPM was defined as the difference between PPT assessments before and during conditioning with cold pressor pain (hand) for 2 minutes. Conditioning pain intensity was assessed using a visual analog scale and questionnaire data were collected. Female sex (P < .001) and younger age (P ≤ .02) was associated with lower PPTs at both body sites. For the trapezius muscle, high perceived stress was associated with lower PPTs (P < .02), whereas an interaction was found between body mass index and sex. CPM potency was lower in female compared with male participants (P ≤ .003), whereas no association with age was found. Higher level of education (P ≤ .05), premature withdrawal from the cold pressor test (P ≤ .02), and high visual analog scale score (P ≤ .02) were associated with a larger CPM response.


      Data from this large population-based study provide new insight into the gender and age variation in pain sensitivity and CPM response. Decreased CPM potency and increased pain sensitivity in female participants were found, emphasizing the need to improve the understanding of its clinical consequences.

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