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Facilitated Pronociceptive Pain Mechanisms in Radiating Back Pain Compared With Localized Back Pain

  • Henrik Bjarke Vaegter
    Correspondence
    Address reprint requests to Henrik Bjarke Vaegter, PhD, Pain Research Group, Pain Center South, University Hospital Odense, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Heden 9, Indgang 201, Odense C 5000, Denmark.
    Affiliations
    Pain Research Group, Pain Center South, Odense University Hospital, Odense, Denmark

    Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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  • Thorvaldur Skuli Palsson
    Affiliations
    Center for Neuroplasticity and Pain, Center for Sensory-Motor Interactions (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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  • Thomas Graven-Nielsen
    Affiliations
    Center for Neuroplasticity and Pain, Center for Sensory-Motor Interactions (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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      Highlights

      • Sensory and clinical pain profiles are different in subtypes of back pain.
      • Patients with radiating pain demonstrated facilitated temporal pain summation.
      • Different back pain conditions may require different treatment strategies.

      Abstract

      Facilitated pain mechanisms and impaired pain inhibition are often found in chronic pain patients. This study compared clinical pain profiles, pain sensitivity, as well as pronociceptive and antinociceptive mechanisms in patients with localized low back pain (n = 18), localized neck pain (n = 17), low back and radiating leg pain (n = 18), or neck and radiating arm pain (n = 17). It was hypothesized that patients with radiating pain had facilitated pain mechanisms and impaired pain inhibition compared with localized pain patients. Cuff algometry was performed on the nonpainful lower leg to assess pressure pain threshold, tolerance, temporal summation of pain (increase in pain scores to 10 repeated stimulations at pressure pain tolerance intensity), and conditioning pain modulation (increase in pressure pain threshold during pain conditioning on the contralateral leg). Heat detection and heat pain threshold at the nonpainful hand were also assessed. Clinical pain intensity, psychological distress, and disability were assessed with questionnaires. Temporal summation of pain was increased in patients with radiating back pain compared with localized back pain (P < .03). Patients with radiating arm pain or localized low back pain demonstrated hyperalgesia to heat and pressure in nonpainful body areas (P < .05), as well as well as a facilitated clinical pain profile compared with patients with localized neck pain (P = .03). Patients with radiating pain patterns demonstrated facilitated temporal summation suggesting differences in the underlying pain mechanisms between patients with localized back pain and radiating pain.

      Perspective

      These findings have clinical implications because the underlying mechanisms in different back pain conditions may require different treatment strategies.

      Key words

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      References

        • Airaksinen O.
        • Brox J.I.
        • Cedraschi C.
        • Hildebrandt J.
        • Klaber-Moffett J.
        • Kovacs F.
        • Mannion A.F.
        • Reis S.
        • Staal J.B.
        • Ursin H.
        • Zanoli G.
        Chapter 4-European guidelines for the management of chronic nonspecific low back pain.
        Eur Spine J. 2006; 15: S192-S300
        • Arendt-Nielsen L.
        • Graven-Nielsen T.
        Translational musculoskeletal pain research.
        Best Pract Res Clin Rheumatol. 2011; 25: 209-226
        • Arendt-Nielsen L.
        • Skou S.T.
        • Nielsen T.A.
        • Petersen K.K.
        Altered central sensitization and pain modulation in the CNS in chronic joint pain.
        Curr Osteoporos Rep. 2015; 13: 225-234
        • Bogduk N.
        On the definitions and physiology of back pain, referred pain, and radicular pain.
        Pain. 2009; 147: 17-19
        • Branstrom H.
        • Fahlstrom M.
        Kinesiophobia in patients with chronic musculoskeletal pain: differences between men and women.
        J Rehabil Med. 2008; 40: 375-380
        • Brinjikji W.
        • Luetmer P.H.
        • Comstock B.
        • Bresnahan B.W.
        • Chen L.E.
        • Deyo R.A.
        • Halabi S.
        • Turner J.A.
        • Avins A.L.
        • James K.
        • Wald J.T.
        • Kallmes D.F.
        • Jarvik J.G.
        Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.
        AJNR Am J Neuroradiol. 2015; 36: 811-816
        • Childs J.D.
        • Cleland J.A.
        • Elliott J.M.
        • Teyhen D.S.
        • Wainner R.S.
        • Whitman J.M.
        • Sopky B.J.
        • Godges J.J.
        • Flynn T.W.
        Neck pain: Clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association.
        J Orthop Sports Phys Ther. 2008; 38: A1-A34
        • Cleeland C.S.
        • Ryan K.M.
        Pain assessment: Global use of the Brief Pain Inventory.
        Ann Acad Med Singapore. 1994; 23: 129-138
        • Cohen S.P.
        Epidemiology, diagnosis, and treatment of neck pain.
        Mayo Clin Proc. 2015; 90: 284-299
        • Cooper G.
        • Bailey B.
        • Bogduk N.
        Cervical zygapophysial joint pain maps.
        Pain Med. 2007; 8: 344-353
        • Costa Lda C.
        • Maher C.G.
        • McAuley J.H.
        • Hancock M.J.
        • Herbert R.D.
        • Refshauge K.M.
        • Henschke N.
        Prognosis for patients with chronic low back pain: Inception cohort study.
        BMJ. 2009; 339: b3829
        • Daffner S.D.
        • Hilibrand A.S.
        • Hanscom B.S.
        • Brislin B.T.
        • Vaccaro A.R.
        • Albert T.J.
        Impact of neck and arm pain on overall health status.
        Spine. 2003; 28: 2030-2035
        • Dalton P.A.
        • Jull G.A.
        The distribution and characteristics of neck-arm pain in patients with and without a neurological deficit.
        Aust J Physiother. 1989; 35: 3-8
        • EuroQol
        EuroQol - a new facility for the measurement of health-related quality of life.
        Health Policy. 1990; 16: 199-208
        • Fukui S.
        • Ohseto K.
        • Shiotani M.
        • Ohno K.
        • Karasawa H.
        • Naganuma Y.
        • Yuda Y.
        Referred pain distribution of the cervical zygapophyseal joints and cervical dorsal rami.
        Pain. 1996; 68: 79-83
        • Gerhardt A.
        • Eich W.
        • Janke S.
        • Leisner S.
        • Treede R.D.
        • Tesarz J.
        Chronic widespread back pain is distinct from chronic local back pain: Evidence from quantitative sensory testing, pain drawings, and psychometrics.
        Clin J Pain. 2016; 32: 568-579
        • Graven-Nielsen T.
        • Vaegter H.B.
        • Finocchietti S.
        • Handberg G.
        • Arendt-Nielsen L.
        Assessment of musculoskeletal pain sensitivity and temporal summation by cuff pressure algometry: A reliability study.
        Pain. 2015; 156: 2193-2202
        • Hider S.L.
        • Whitehurst D.G.
        • Thomas E.
        • Foster N.E.
        Pain location matters: The impact of leg pain on health care use, work disability and quality of life in patients with low back pain.
        Eur Spine J. 2015; 24: 444-451
        • Huis’t Veld R.M.
        • Vollenbroek-Hutten M.M.
        • Groothuis-Oudshoorn K.C.
        • Hermens H.J.
        The role of the fear-avoidance model in female workers with neck-shoulder pain related to computer work.
        Clin J Pain. 2007; 23: 28-34
        • Izumi M.
        • Petersen K.K.
        • Laursen M.B.
        • Arendt-Nielsen L.
        • Graven-Nielsen T.
        Facilitated temporal summation of pain correlates with clinical pain intensity after hip arthroplasty.
        Pain. 2017; 158: 323-332
        • Jespersen A.
        • Amris K.
        • Graven-Nielsen T.
        • Arendt-Nielsen L.
        • Bartels E.M.
        • Torp-Pedersen S.
        • Bliddal H.
        • Danneskiold-Samsoe B.
        Assessment of pressure-pain thresholds and central sensitization of pain in lateral epicondylalgia.
        Pain Med. 2013; 14: 297-304
        • Kellgren J.H.
        On the distribution of pain arising from deep somatic structures with charts of segmental pain areas.
        Clin Sci. 1939; 4: 35-46
        • Konstantinou K.
        • Dunn K.M.
        • Ogollah R.
        • Vogel S.
        • Hay E.M.
        Characteristics of patients with low back and leg pain seeking treatment in primary care: Baseline results from the ATLAS cohort study.
        BMC Musculoskelet Disord. 2015; 16: 332
        • Kori S.H.
        • Miller R.P.
        • Todd D.D.
        Kinisophobia: A new view of chronic pain behavior.
        Pain Manag. 1990; 1: 35-43
        • Laerum E.
        • Storheim K.
        • Brox J.I.
        Tidsskr Nor Laegeforen. 2007; 127 ([in Norwegian]): 2706
        • Latremoliere A.
        • Woolf C.J.
        Central sensitization: A generator of pain hypersensitivity by central neural plasticity.
        J Pain. 2009; 10: 895-926
        • Le Bars D.
        • Villanueva L.
        • Bouhassira D.
        • Willer J.C.
        Diffuse noxious inhibitory controls (DNIC) in animals and in man.
        Patol Fiziol Eksp Ter. 1992; 4: 55-65
        • Lentz T.A.
        • Barabas J.A.
        • Day T.
        • Bishop M.D.
        • George S.Z.
        The relationship of pain intensity, physical impairment, and pain-related fear to function in patients with shoulder pathology.
        J Orthop Sports Phys Ther. 2009; 39: 270-277
        • Malfait A.M.
        • Schnitzer T.J.
        Towards a mechanism-based approach to pain management in osteoarthritis.
        Nat Rev Rheumatol. 2013; 9: 654-664
        • Moloney N.
        • Hall T.
        • Doody C.
        Sensory hyperalgesia is characteristic of nonspecific arm pain: a comparison with cervical radiculopathy and pain-free controls.
        Clin J Pain. 2013; 29: 948-956
        • O’Neill S.
        • Manniche C.
        • Graven-Nielsen T.
        • Arendt-Nielsen L.
        Generalized deep-tissue hyperalgesia in patients with chronic low-back pain.
        Eur J Pain. 2007; 11: 415-420
        • O’Sullivan P.B.
        • Beales D.J.
        Diagnosis and classification of pelvic girdle pain disorders–Part 1: A mechanism based approach within a biopsychosocial framework.
        Man Ther. 2007; 12: 86-97
        • Polianskis R.
        • Graven-Nielsen T.
        • Arendt-Nielsen L.
        Computer-controlled pneumatic pressure algometry–a new technique for quantitative sensory testing.
        Eur J Pain. 2001; 5: 267-277
        • Pollard C.A.
        Preliminary validity study of the Pain Disability Index.
        Percept Mot Skills. 1984; 59: 974
        • Pud D.
        • Granovsky Y.
        • Yarnitsky D.
        The methodology of experimentally induced diffuse noxious inhibitory control (DNIC)-like effect in humans.
        Pain. 2009; 144: 16-19
        • Pud D.
        • Sprecher E.
        • Yarnitsky D.
        Homotopic and heterotopic effects of endogenous analgesia in healthy volunteers.
        Neurosci Lett. 2005; 380: 209-213
        • Rabey M.
        • Poon C.
        • Wray J.
        • Thamajaree C.
        • East R.
        • Slater H.
        Pro-nociceptive and anti-nociceptive effects of a conditioned pain modulation protocol in participants with chronic low back pain and healthy control subjects.
        Man Ther. 2015; 20: 763-768
        • Rabey M.
        • Slater H.
        • O’Sullivan P.
        • Beales D.
        • Smith A.
        Somatosensory nociceptive characteristics differentiate subgroups in people with chronic low back pain: A cluster analysis.
        Pain. 2015; 156: 1874-1884
        • Rolke R.
        • Baron R.
        • Maier C.
        • Tolle T.R.
        • Treede R.D.
        • Beyer A.
        • Binder A.
        • Birbaumer N.
        • Birklein F.
        • Botefur I.C.
        • Braune S.
        • Flor H.
        • Huge V.
        • Klug R.
        • Landwehrmeyer G.B.
        • Magerl W.
        • Maihofner C.
        • Rolko C.
        • Schaub C.
        • Scherens A.
        • Sprenger T.
        • Valet M.
        • Wasserka B.
        Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): Standardized protocol and reference values.
        Pain. 2006; 123: 231-243
        • Rossignol M.
        • Poitras S.
        • Dionne C.
        • Tousignant M.
        • Truchon M.
        • Arsenault B.
        • Allard P.
        • Cote M.
        • Neveu A.
        An interdisciplinary guideline development process: The Clinic on Low-back pain in Interdisciplinary Practice (CLIP) low-back pain guidelines.
        Implement Sci. 2007; 2: 36
        • Smart K.M.
        • Blake C.
        • Staines A.
        • Doody C.
        Clinical indicators of ‘nociceptive’, ‘peripheral neuropathic’ and ‘central’ mechanisms of musculoskeletal pain. A Delphi survey of expert clinicians.
        Man Ther. 2010; 15: 80-87
        • Staud R.
        • Cannon R.C.
        • Mauderli A.P.
        • Robinson M.E.
        • Price D.D.
        • Vierck Jr., C.J.
        Temporal summation of pain from mechanical stimulation of muscle tissue in normal controls and subjects with fibromyalgia syndrome.
        Pain. 2003; 102: 87-95
        • Sullivan M.J.
        • Bishop S.R.
        • Pivik J.
        The Pain Catastrophizing Scale: Development and validation.
        Psychol Assess. 1995; 7: 524-532
        • Suri P.
        • Boyko E.J.
        • Goldberg J.
        • Forsberg C.W.
        • Jarvik J.G.
        Longitudinal associations between incident lumbar spine MRI findings and chronic low back pain or radicular symptoms: Retrospective analysis of data from the longitudinal assessment of imaging and disability of the back (LAIDBACK).
        BMC Musculoskelet Disord. 2014; 15: 152
        • Tampin B.
        • Slater H.
        • Hall T.
        • Lee G.
        • Briffa N.K.
        Quantitative sensory testing somatosensory profiles in patients with cervical radiculopathy are distinct from those in patients with nonspecific neck-arm pain.
        Pain. 2012; 153: 2403-2414
        • Ulug N.
        • Yakut Y.
        • Alemdaroglu I.
        • Yilmaz O.
        Comparison of pain, kinesiophobia and quality of life in patients with low back and neck pain.
        J Phys Ther Sci. 2016; 28: 665-670
        • Vaegter H.B.
        • Graven-Nielsen T.
        Pain modulatory phenotypes differentiate subgroups with different clinical and experimental pain sensitivity.
        Pain. 2016; 157: 1480-1488
        • Vaegter H.B.
        • Handberg G.
        • Emmeluth C.
        • Graven-Nielsen T.
        Preoperative hypoalgesia after cold pressor test and aerobic exercise is associated with pain relief six months after total knee replacement.
        Clin J Pain. 2016 August 12; ([Epub ahead of print])
        • Vaegter H.B.
        • Handberg G.
        • Graven-Nielsen T.
        Hypoalgesia after exercise and the cold pressor test is reduced in chronic musculoskeletal pain patients with high pain sensitivity.
        Clin J Pain. 2016; 32: 58-69
        • Vaegter H.B.
        • Hoeger Bement M.
        • Madsen A.B.
        • Fridriksson J.
        • Dasa M.
        • Graven-Nielsen T.
        Exercise increases pressure pain tolerance but not pressure and heat pain thresholds in healthy young men.
        Eur J Pain. 2017; 21: 73-81
        • Vlaeyen J.W.
        • Kole-Snijders A.M.
        • Rotteveel A.M.
        • Ruesink R.
        • Heuts P.H.
        The role of fear of movement/(re)injury in pain disability.
        J Occup Rehabil. 1995; 5: 235-252
        • Vlaeyen J.W.
        • Linton S.J.
        Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art.
        Pain. 2000; 85: 317-332
        • Vos T.
        • Flaxman A.D.
        • Naghavi M.
        • Lozano R.
        • Michaud C.
        • Ezzati M.
        • Shibuya K.
        • Salomon J.A.
        • Abdalla S.
        • Aboyans V.
        • Abraham J.
        • Ackerman I.
        • Aggarwal R.
        • Ahn S.Y.
        • Ali M.K.
        • Alvarado M.
        • Anderson H.R.
        • Anderson L.M.
        • Andrews K.G.
        • Atkinson C.
        • Baddour L.M.
        • Bahalim A.N.
        • Barker-Collo S.
        • Barrero L.H.
        • Bartels D.H.
        • Basanez M.G.
        • Baxter A.
        • Bell M.L.
        • Benjamin E.J.
        • Bennett D.
        • Bernabe E.
        • Bhalla K.
        • Bhandari B.
        • Bikbov B.
        • Bin Abdulhak A.
        • Birbeck G.
        • Black J.A.
        • Blencowe H.
        • Blore J.D.
        • Blyth F.
        • Bolliger I.
        • Bonaventure A.
        • Boufous S.
        • Bourne R.
        • Boussinesq M.
        • Braithwaite T.
        • Brayne C.
        • Bridgett L.
        • Brooker S.
        • Brooks P.
        • Brugha T.S.
        • Bryan-Hancock C.
        • Bucello C.
        • Buchbinder R.
        • Buckle G.
        • Budke C.M.
        • Burch M.
        • Burney P.
        • Burstein R.
        • Calabria B.
        • Campbell B.
        • Canter C.E.
        • Carabin H.
        • Carapetis J.
        • Carmona L.
        • Cella C.
        • Charlson F.
        • Chen H.
        • Cheng A.T.
        • Chou D.
        • Chugh S.S.
        • Coffeng L.E.
        • Colan S.D.
        • Colquhoun S.
        • Colson K.E.
        • Condon J.
        • Connor M.D.
        • Cooper L.T.
        • Corriere M.
        • Cortinovis M.
        • de Vaccaro K.C.
        • Couser W.
        • Cowie B.C.
        • Criqui M.H.
        • Cross M.
        • Dabhadkar K.C.
        • Dahiya M.
        • Dahodwala N.
        • Damsere-Derry J.
        • Danaei G.
        • Davis A.
        • De Leo D.
        • Degenhardt L.
        • Dellavalle R.
        • Delossantos A.
        • Denenberg J.
        • Derrett S.
        • Des Jarlais D.C.
        • Dharmaratne S.D.
        • Dherani M.
        • Diaz-Torne C.
        • Dolk H.
        • Dorsey E.R.
        • Driscoll T.
        • Duber H.
        • Ebel B.
        • Edmond K.
        • Elbaz A.
        • Ali S.E.
        • Erskine H.
        • Erwin P.J.
        • Espindola P.
        • Ewoigbokhan S.E.
        • Farzadfar F.
        • Feigin V.
        • Felson D.T.
        • Ferrari A.
        • Ferri C.P.
        • Fevre E.M.
        • Finucane M.M.
        • Flaxman S.
        • Flood L.
        • Foreman K.
        • Forouzanfar M.H.
        • Fowkes F.G.
        • Franklin R.
        • Fransen M.
        • Freeman M.K.
        • Gabbe B.J.
        • Gabriel S.E.
        • Gakidou E.
        • Ganatra H.A.
        • Garcia B.
        • Gaspari F.
        • Gillum R.F.
        • Gmel G.
        • Gosselin R.
        • Grainger R.
        • Groeger J.
        • Guillemin F.
        • Gunnell D.
        • Gupta R.
        • Haagsma J.
        • Hagan H.
        • Halasa Y.A.
        • Hall W.
        • Haring D.
        • Haro J.M.
        • Harrison J.E.
        • Havmoeller R.
        • Hay R.J.
        • Higashi H.
        • Hill C.
        • Hoen B.
        • Hoffman H.
        • Hotez P.J.
        • Hoy D.
        • Huang J.J.
        • Ibeanusi S.E.
        • Jacobsen K.H.
        • James S.L.
        • Jarvis D.
        • Jasrasaria R.
        • Jayaraman S.
        • Johns N.
        • Jonas J.B.
        • Karthikeyan G.
        • Kassebaum N.
        • Kawakami N.
        • Keren A.
        • Khoo J.P.
        • King C.H.
        • Knowlton L.M.
        • Kobusingye O.
        • Koranteng A.
        • Krishnamurthi R.
        • Lalloo R.
        • Laslett L.L.
        • Lathlean T.
        • Leasher J.L.
        • Lee Y.Y.
        • Leigh J.
        • Lim S.S.
        • Limb E.
        • Lin J.K.
        • Lipnick M.
        • Lipshultz S.E.
        • Liu W.
        • Loane M.
        • Ohno S.L.
        • Lyons R.
        • Ma J.
        • Mabweijano J.
        • MacIntyre M.F.
        • Malekzadeh R.
        • Mallinger L.
        • Manivannan S.
        • Marcenes W.
        • March L.
        • Margolis D.J.
        • Marks G.B.
        • Marks R.
        • Matsumori A.
        • Matzopoulos R.
        • Mayosi B.M.
        • McAnulty J.H.
        • McDermott M.M.
        • McGill N.
        • McGrath J.
        • Medina-Mora M.E.
        • Meltzer M.
        • Mensah G.A.
        • Merriman T.R.
        • Meyer A.C.
        • Miglioli V.
        • Miller M.
        • Miller T.R.
        • Mitchell P.B.
        • Mocumbi A.O.
        • Moffitt T.E.
        • Mokdad A.A.
        • Monasta L.
        • Montico M.
        • Moradi-Lakeh M.
        • Moran A.
        • Morawska L.
        • Mori R.
        • Murdoch M.E.
        • Mwaniki M.K.
        • Naidoo K.
        • Nair M.N.
        • Naldi L.
        • Narayan K.M.
        • Nelson P.K.
        • Nelson R.G.
        • Nevitt M.C.
        • Newton C.R.
        • Nolte S.
        • Norman P.
        • Norman R.
        • O’Donnell M.
        • O’Hanlon S.
        • Olives C.
        • Omer S.B.
        • Ortblad K.
        • Osborne R.
        • Ozgediz D.
        • Page A.
        • Pahari B.
        • Pandian J.D.
        • Rivero A.P.
        • Patten S.B.
        • Pearce N.
        • Padilla R.P.
        • Perez-Ruiz F.
        • Perico N.
        • Pesudovs K.
        • Phillips D.
        • Phillips M.R.
        • Pierce K.
        • Pion S.
        • Polanczyk G.V.
        • Polinder S.
        • Pope 3rd, C.A.
        • Popova S.
        • Porrini E.
        • Pourmalek F.
        • Prince M.
        • Pullan R.L.
        • Ramaiah K.D.
        • Ranganathan D.
        • Razavi H.
        • Regan M.
        • Rehm J.T.
        • Rein D.B.
        • Remuzzi G.
        • Richardson K.
        • Rivara F.P.
        • Roberts T.
        • Robinson C.
        • De Leon F.R.
        • Ronfani L.
        • Room R.
        • Rosenfeld L.C.
        • Rushton L.
        • Sacco R.L.
        • Saha S.
        • Sampson U.
        • Sanchez-Riera L.
        • Sanman E.
        • Schwebel D.C.
        • Scott J.G.
        • Segui-Gomez M.
        • Shahraz S.
        • Shepard D.S.
        • Shin H.
        • Shivakoti R.
        • Singh D.
        • Singh G.M.
        • Singh J.A.
        • Singleton J.
        • Sleet D.A.
        • Sliwa K.
        • Smith E.
        • Smith J.L.
        • Stapelberg N.J.
        • Steer A.
        • Steiner T.
        • Stolk W.A.
        • Stovner L.J.
        • Sudfeld C.
        • Syed S.
        • Tamburlini G.
        • Tavakkoli M.
        • Taylor H.R.
        • Taylor J.A.
        • Taylor W.J.
        • Thomas B.
        • Thomson W.M.
        • Thurston G.D.
        • Tleyjeh I.M.
        • Tonelli M.
        • Towbin J.A.
        • Truelsen T.
        • Tsilimbaris M.K.
        • Ubeda C.
        • Undurraga E.A.
        • van der Werf M.J.
        • van Os J.
        • Vavilala M.S.
        • Venketasubramanian N.
        • Wang M.
        • Wang W.
        • Watt K.
        • Weatherall D.J.
        • Weinstock M.A.
        • Weintraub R.
        • Weisskopf M.G.
        • Weissman M.M.
        • White R.A.
        • Whiteford H.
        • Wiersma S.T.
        • Wilkinson J.D.
        • Williams H.C.
        • Williams S.R.
        • Witt E.
        • Wolfe F.
        • Woolf A.D.
        • Wulf S.
        • Yeh P.H.
        • Zaidi A.K.
        • Zheng Z.J.
        • Zonies D.
        • Lopez A.D.
        • Murray C.J.
        • AlMazroa M.A.
        • Memish Z.A.
        Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: A systematic analysis for the Global Burden of Disease Study 201.
        Lancet. 2012; 380: 2163-2196
        • Yarnitsky D.
        • Bouhassira D.
        • Drewes A.M.
        • Fillingim R.B.
        • Granot M.
        • Hansson P.
        • Landau R.
        • Marchand S.
        • Matre D.
        • Nilsen K.B.
        • Stubhaug A.
        • Treede R.D.
        • Wilder-Smith O.H.
        Recommendations on practice of conditioned pain modulation (CPM) testing.
        Eur J Pain. 2015; 19: 805-806
        • Yarnitsky D.
        • Granot M.
        • Granovsky Y.
        Pain modulation profile and pain therapy: Between pro- and antinociception.
        Pain. 2014; 155: 663-665