IntroductionConditioned pain modulation (CPM) is a validated measure of the function of endogenous pain inhibitory pathways (Kennedy et al., ) and has a well‐documented analgesic effect in both animals (Le Bars et al., ,b) and humans (Willer et al., ; De Broucker et al., ). CPM is assessed via ‘pain inhibits pain’ paradigms that test whether central inhibition of a painful stimulus can be induced by applying a second painful stimulus to a remote body region (i.e. counter‐irritation) (Le Bars et al., ; Pud et al., ; Lewis et al., ). With a normally functioning endogenous pain modulatory system, the intensity of the primary test stimulus is reduced after the conditioning pain stimulus (Le Bars et al., ; Willer et al., ). CPM reflects bottom‐up activation of endogenous pain modulatory mechanisms (Pud et al., ) and has been related to neurotransmitter systems such as the endogenous opioid system (Willer et al., ; King et al., ). Yet, studies have shown that the pain relief related to CPM paradigms may also be influenced by cognitive factors such as expectations (Lariviere et al., ; Bjorkedal and Flaten, ; Nir et al., ; Cormier et al., ; France et al., ), which suggest that CPM is not exclusively an expression of bottom‐up activation of endogenous pain modulation.Placebo effects
European Journal of Pain – Wiley
Published: Jan 1, 2018
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