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Bringing the lab to the people: Experimental pain testing in the general population

  • Christopher Sivert Nielsen EMAIL logo
Published/Copyright: October 1, 2016
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Scandinavian Journal of Pain
From the journal Scandinavian Journal of Pain Volume 13 Issue 1

In this issue of the Scandinavian Journal of Pain (SJP), Waller and coauthors report normative data for pressure and cold pain thresholds in a cohort of young pain-free adults [1].

1 The use of experimental pain models in human pain research

Experimental pain tests provide a safe and reversible means of inducing pain in a dose dependent manner in the laboratory. These methods have been used in human pain research since the 1950s with experiments covering a wide range of topics such as psychophysics (pain measurement), pharmacological interventions, psychological mechanisms, placebo effects, and brain imaging. Most of these studies have been conducted as true experiments, with between-group or crossover designs, making causal conclusions valid.

2 Individual differences in experimental pain sensitivity

In the past ten years or so, the focus of experimental pain research has gradually shifted away from studying effects of experimental conditions, towards studying experimental pain sensitivity as a baseline characteristic of the individual. Three factors have contributed towards this development: First, the observation that there are huge individual differences in sensitivity to experimental pain stimuli [2]. In fact, these differences are so great that stimuli that lie well below pain threshold for some subjects may be well above pain tolerance for others. Second, it was demonstrated that experimental pain sensitivity is heritable, and for some stimulus modalities the genetic contribution accounts for half the variance or more [3, 4].This is important because it shows that pain sensitivity is a stable innate characteristic of the individual. Finally, a growing number of studies have found that chronic pain patients had increased sensitivity to pain (hyperalgesia) e.g. Staud et al. [5, 6], Stabell et al. [7]. This suggests that hyperalgesia may be a contributing factor to the development and/or maintenance of chronic pain.

3 Experimental pain models in epidemiology

In response to the above observations, several large prospective studies of representative samples have been initiated, among them the Tromsø Study, where 10,500 participants were assessed withthe cold-pressortest [8], and the Rotterdam study, where heat pain thresholds have been assessed in 4000 subjects [9]. Among the topics addressed in these and similar studies are the genetics of pain sensitivity, the relationship between pain sensitivity and established risk factors for chronic pain, and cross-sectional and longitudinal associations between experimental pain sensitivity and chronic pain.

4 Comparability is crucial to the aggregation of data across studies

Waller and coworkers add to this emerging field by performing pressure (4 sites) and cold pain threshold tests in a sample of 970 individuals recruited from Western Australian Pregnancy Cohort Study. In this issue of the SJP they report normative threshold data for 617 individuals (280 females, 337 males) who were pain free at the time of study [1]. Using multi-variable regression, they also report on the association between experimental pain thresholds and a number of factors that are associated with clinical pain and/or general health in many studies: sex, smoking, obesity, physical activity, mental health and health related quality of life.

Though it remains to be shown that reference values for experimental pain tests have clinical utility outside the field of neuropathic pain, their immediate importance lies in providing a basis for comparing data across studies and countries. Genome wide association studies in particular are strongly dependent on aggregating data across study populations, and an obvious prerequisite is that the pain measures are comparable. Publishing reference values and associations with key covariates is an important step in this direction.

DOI of refers to article: http://dx.doi.org/10.1016/j.sjpain.2016.08.003.

Norwegian Institute of Public Health, Department of Ageing and Health, Post box 4404 Nydalen, 0403 Oslo, Norway.

  1. Conflict of interest: None declared.

References

[1] Waller R, Smith A, O’Sullivan P, Slater H, Sterling M, McVeigh J, Straker L. Pressure and cold pain threshold references values in a large, young adult, pain-free population. Scand J Pain 2016;13:114–22.Search in Google Scholar

[2] Nielsen CS, Price DD, Vassend O, Stubhaug A, Harris JR. Characterizing individual differences in heat-pain sensitivity. Pain 2005;119:65–74.Search in Google Scholar

[3] Nielsen CS, Stubhaug A, Price DD, Vassend O, Czajkowski N, Harris JR. Individual differences in pain sensitivity: genetic and environmental contributions. Pain 2008;136:21–9.Search in Google Scholar

[4] Angst MS, Phillips NG, Drover DR, Tingle M, Ray A, Swan GE, Lazzeroni LC, Clark JD. Pain sensitivity and opioid analgesia: a pharmacogenomic twin study. Pain 2012;153:1397–409.Search in Google Scholar

[5] Staud R, Robinson ME, Vierck Jr CJ, Cannon RC, Mauderli AP, Price DD. Ratings of experimental pain and pain-related negative affect predict clinical pain in patients with fibromyalgia syndrome. Pain 2003;105: 215–22.Search in Google Scholar

[6] Staud R, Weyl EE, Price DD, Robinson ME. Mechanical and heat hyperalgesia highly predict clinical pain intensity in patients with chronic musculoskeletal pain syndromes. J Pain 2012;13:725–35.Search in Google Scholar

[7] Stabell N, Stubhaug A, Flægstad T, Nielsen CS. Increased pain sensitivity among adults reporting irritable bowel syndrome symptoms in a large population-based study. Pain 2013;154:385–92.Search in Google Scholar

[8] Jacobsen BK, Eggen AE, Mathiesen EB, Wilsgaard T, Njølstad I. Cohort profile: the Tromso Study. Int J Epidemiol 2012;41:961–7.Search in Google Scholar

[9] de Kruijf M, Peters MJ, Jacobs CL, Tiemeier H, Nijsten T, Hofman A, Uitterlinden AG, Huygen FJ, van Meurs JB. Determinants for quantitative sensory testing and the association with chronic musculoskeletal pain in the general elderly population. Pain Pract 2016;16:831–41.Search in Google Scholar
Published Online: 2016-10-01
Published in Print: 2016-10-01

© 2016 Scandinavian Association for the Study of Pain

Articles in the same Issue

  2. Scandinavian Journal of Pain
  3. Editorial comment
  4. Increased deep pain sensitivity in persistent musculoskeletal pain but not in other musculoskeletal pain states
  5. Clinical pain research
  6. Increased deep pain sensitivity in persistent musculoskeletal pain but not in other musculoskeletal pain states
  7. Editorial comment
  8. Patient Reported Outcomes (PROs) are sensitive outcome-variables in patients with chronic pain: Importance of self-efficacy
  9. Observational study
  10. Using patient reported outcomes in oncology clinical practice
  11. Editorial comment
  12. Cortical reorganization of the healthy hand in upper-limb complex regional pain syndrome(CRPS): Is reorganizations of common beliefs about CRPS necessary?
  13. Original experimental
  14. An exploration into the cortical reorganisation of the healthy hand inupper-limb complex regional pain syndrome
  15. Editorial comment
  16. Is there hope for the most complicated chronic pain patients facing back surgery?
  17. Educational case report
  18. A preoperative interdisciplinary biopsychosocial opioid reduction program in patients on chronic opioid analgesia prior to spine surgery: A preliminary report and case series
  19. Editorial comment
  20. Pain management in the Emergency Department – Still a long way to go?
  21. Clinical pain research
  22. Mandatory documentation of pain in the emergency department increases analgesic administration but does not improve patients’ satisfaction of pain management
  23. Editorial comment
  24. Pain relief during childbirth: Efficacy and safety of prolonging labour-analgesia with morphine directly into the lumbar cerebro-spinal-fluid (CSF)
  25. Systematic review
  26. Prolonging the duration of single-shot intrathecal labour analgesia with morphine: A systematic review
  27. Editorial comment
  28. The intricate relationship amongst pain intensity, fear and avoidance
  29. Systematic review
  30. A meta-analysis of fear-avoidance and pain intensity: The paradox of chronic pain
  31. Editorial comment
  32. Local infiltration analgesia(LIA), risk of local anaesthetic systemic toxicity (LAST) and kidney failure from NSAID in elderly patients
  33. Topical review
  34. Local infiltration analgesia in knee and hip arthroplasty efficacy and safety
  35. Editorial comment
  36. Analysis of pain-intensity measurements
  37. Topical review
  38. How to analyze the Visual Analogue Scale: Myths, truths and clinical relevance
  39. Editorial comment
  40. The relationship between chronic pain and cardiovascular disease: Squaring the circle?
  41. Systematic review
  42. Assessing the relationship between chronic pain and cardiovasculardisease: A systematic review and meta-analysis
  43. Editorial comment
  44. Optimists fare better when chronic pain strikes – Or does pain related disability make us pessimists?
  45. Observational study
  46. Constructs of health belief and disabling distal upper limb pain
  47. Editorial comment
  48. Attitude and belief of pain-therapists are important when trying to help chronic pain patients: The Norwegian version of the Pain Attitudes and Beliefs Scale (PABS) improved by Rasch analysis
  49. Observational study
  50. Rasch analysis resulted in an improved Norwegian version of the Pain Attitudes and Beliefs Scale(PABS)
  51. Editorial comment
  52. Anxiety could play a larger role than depression in migraine headache
  53. Clinical pain research
  54. The relative importance of anxiety and depression in pain impact in individuals with migraine headaches
  55. Editorial comment
  56. Bringing the lab to the people: Experimental pain testing in the general population
  57. Clinical pain research
  58. Pressure and cold pain threshold reference values in a large, young adult, pain-free population
  59. Editorial comment
  60. Improving pain treatment in children
  61. Clinical pain research
  62. A randomized controlled trial of amitriptyline versus gabapentin for complex regional pain syndrome type I and neuropathic pain in children
  63. Editorial comment
  64. Gut gateway to generalized pain
  65. Original experimental
  66. A low fermentable oligo-di-mono saccharides and polyols(FODMAP) diet reduced pain and improve ddaily life in fibromyalgia patients
  67. Editorial comment
  68. Measuring outcomes of pain management
  69. Clinical pain research
  70. Osteoarthritis patients with pain improvement are highly likely to also have improved quality of life and functioning. A post hoc analysis of a clinical trial
  71. Clinical pain research
  72. Construct validity and reliability of Finnish version of Örebro Musculoskeletal Pain Screening Questionnaire
  73. Observational study
  74. Total sleep deprivation and pain perception during cold noxious stimuli in humans
  75. Corrigendum
  76. Corrigendum to ‘Reliability of pressure pain threshold testing in healthy pain free young adults’ [Scand. J. Pain 9 (2015) 38–41]
https://doi.org/10.1016/j.sjpain.2016.09.010

Articles in the same Issue

  2. Scandinavian Journal of Pain
  3. Editorial comment
  4. Increased deep pain sensitivity in persistent musculoskeletal pain but not in other musculoskeletal pain states
  5. Clinical pain research
  6. Increased deep pain sensitivity in persistent musculoskeletal pain but not in other musculoskeletal pain states
  7. Editorial comment
  8. Patient Reported Outcomes (PROs) are sensitive outcome-variables in patients with chronic pain: Importance of self-efficacy
  9. Observational study
  10. Using patient reported outcomes in oncology clinical practice
  11. Editorial comment
  12. Cortical reorganization of the healthy hand in upper-limb complex regional pain syndrome(CRPS): Is reorganizations of common beliefs about CRPS necessary?
  13. Original experimental
  14. An exploration into the cortical reorganisation of the healthy hand inupper-limb complex regional pain syndrome
  15. Editorial comment
  16. Is there hope for the most complicated chronic pain patients facing back surgery?
  17. Educational case report
  18. A preoperative interdisciplinary biopsychosocial opioid reduction program in patients on chronic opioid analgesia prior to spine surgery: A preliminary report and case series
  19. Editorial comment
  20. Pain management in the Emergency Department – Still a long way to go?
  21. Clinical pain research
  22. Mandatory documentation of pain in the emergency department increases analgesic administration but does not improve patients’ satisfaction of pain management
  23. Editorial comment
  24. Pain relief during childbirth: Efficacy and safety of prolonging labour-analgesia with morphine directly into the lumbar cerebro-spinal-fluid (CSF)
  25. Systematic review
  26. Prolonging the duration of single-shot intrathecal labour analgesia with morphine: A systematic review
  27. Editorial comment
  28. The intricate relationship amongst pain intensity, fear and avoidance
  29. Systematic review
  30. A meta-analysis of fear-avoidance and pain intensity: The paradox of chronic pain
  31. Editorial comment
  32. Local infiltration analgesia(LIA), risk of local anaesthetic systemic toxicity (LAST) and kidney failure from NSAID in elderly patients
  33. Topical review
  34. Local infiltration analgesia in knee and hip arthroplasty efficacy and safety
  35. Editorial comment
  36. Analysis of pain-intensity measurements
  37. Topical review
  38. How to analyze the Visual Analogue Scale: Myths, truths and clinical relevance
  39. Editorial comment
  40. The relationship between chronic pain and cardiovascular disease: Squaring the circle?
  41. Systematic review
  42. Assessing the relationship between chronic pain and cardiovasculardisease: A systematic review and meta-analysis
  43. Editorial comment
  44. Optimists fare better when chronic pain strikes – Or does pain related disability make us pessimists?
  45. Observational study
  46. Constructs of health belief and disabling distal upper limb pain
  47. Editorial comment
  48. Attitude and belief of pain-therapists are important when trying to help chronic pain patients: The Norwegian version of the Pain Attitudes and Beliefs Scale (PABS) improved by Rasch analysis
  49. Observational study
  50. Rasch analysis resulted in an improved Norwegian version of the Pain Attitudes and Beliefs Scale(PABS)
  51. Editorial comment
  52. Anxiety could play a larger role than depression in migraine headache
  53. Clinical pain research
  54. The relative importance of anxiety and depression in pain impact in individuals with migraine headaches
  55. Editorial comment
  56. Bringing the lab to the people: Experimental pain testing in the general population
  57. Clinical pain research
  58. Pressure and cold pain threshold reference values in a large, young adult, pain-free population
  59. Editorial comment
  60. Improving pain treatment in children
  61. Clinical pain research
  62. A randomized controlled trial of amitriptyline versus gabapentin for complex regional pain syndrome type I and neuropathic pain in children
  63. Editorial comment
  64. Gut gateway to generalized pain
  65. Original experimental
  66. A low fermentable oligo-di-mono saccharides and polyols(FODMAP) diet reduced pain and improve ddaily life in fibromyalgia patients
  67. Editorial comment
  68. Measuring outcomes of pain management
  69. Clinical pain research
  70. Osteoarthritis patients with pain improvement are highly likely to also have improved quality of life and functioning. A post hoc analysis of a clinical trial
  71. Clinical pain research
  72. Construct validity and reliability of Finnish version of Örebro Musculoskeletal Pain Screening Questionnaire
  73. Observational study
  74. Total sleep deprivation and pain perception during cold noxious stimuli in humans
  75. Corrigendum
  76. Corrigendum to ‘Reliability of pressure pain threshold testing in healthy pain free young adults’ [Scand. J. Pain 9 (2015) 38–41]
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