Highlights
- •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.
Abstract
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.
Perspective
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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Article info
Publication history
Published online: May 17, 2018
Accepted:
April 30,
2018
Received in revised form:
April 30,
2018
Received:
January 29,
2018
Footnotes
Center for Neuroplasticity and Pain (CNAP) is supported by the Danish National Research Foundation (DNRF121).
S.A.B is the co-developer of the software application Navigate Pain v1.0 (Aalborg University) used to collect the pain drawings, and has company holdings in Aglance Solutions ApS, which licenses Navigate Pain. NociTech is partly owned by Aalborg University. The remaining authors report no conflicts of interest.
Identification
Copyright
© 2018 by the American Pain Society
