Experimental Referred Pain Extends Toward Previously Injured Location: An Explorative Study

  • Thorvaldur Skuli Palsson
    Center for Neuroplasticity and Pain, SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
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  • Shellie A. Boudreau
    Center for Neuroplasticity and Pain, SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
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  • Hans Jørgen Krebs
    Center for Neuroplasticity and Pain, SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
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  • Thomas Graven-Nielsen
    Address requests for reprints to Thomas Graven-Nielsen, DMSc, PhD, Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7D-3, 9220 Aalborg E, Denmark.
    Center for Neuroplasticity and Pain, SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
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      • It is unclear if a recovered pain condition leaves traces of higher sensitivity of pain mechanisms.
      • Pain is more frequently referred to the previous area of nociceptive activity.
      • The pain area in the previously painful area is enlarged compared with in control subjects.
      • The ability to dampen pain via endogenous inhibition seems improved after recovery from pain.
      • The findings shed light on the mechanisms involved in recovery from musculoskeletal pain.


      Facilitated pain mechanisms have been demonstrated in musculoskeletal pain, but it is unclear whether a recent painful injury leaves the pain system sensitized. Pain characteristics were assessed in individuals who recently recovered from ankle pain (recovered pain group; n = 25) and sex-matched control subjects (n = 25) in response to tonic pressure pain and saline-induced pain applied at the shin muscle. Pain intensity and pain referral patterns were recorded bilaterally after the painful muscle stimulus. Pressure pain thresholds were measured at the lower legs and shoulder. Cuff pressure algometry on the lower leg was used to assess pain detection threshold, pressure evoking 6-cm pain score on a 10-cm visual analog scale, pain tolerance, temporal summation of pain, and conditioned pain modulation. Compared with in control subjects, saline-induced and pressure-induced pain in the shin muscle were more frequently felt as referred pain in the previously painful ankle (P < .05), and the pain area within the previously affected ankle was larger after saline-induced pain (P < .05). In the recovered pain group, conditioned pain modulation responses and the cuff pressure needed to reach a 6-cm pain score on a 10-cm visual analog scale was higher in the previously painful leg compared with in the contralateral leg (P < .05). No group differences were found in pressure pain threshold, pain detection threshold, pain tolerance, and temporal summation of pain.


      These explorative findings demonstrate that pain mechanisms responsible for pain location may be reorganized and continue to be facilitated despite recovery. A large prospective study is needed to clarify the time profile and functional relevance of such prolonged facilitation in the pain system for understanding recurring pain conditions.
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