The Association Between Conditioned Pain Modulation and Pain Catastrophizing in Chronic Low Back Pain

Study Overview
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Brief Summary
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This study evaluates the potential association between pain catastrophizing thoughts and the ability to dampen pain via endogenous descending inhibition. Half of the participants are persons with chronic low back pain and the other half are age and gender-matched controls

Detailed Description
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Pain catastrophizing is a cognitive feature commonly seen in various musculoskeletal pain population and is considered an important factor to account for in rehabilitation. The ability to dampen pain via endogenous pain modulatory mechanisms is likewise known to be reduced in musculoskeletal pain conditions. Studies utilizing functional magnetic resonance imaging (fMRI) have demonstrated that the supraspinal areas involved in pain-related cognitive processing to a great extent overlap with those involved in endogenous pain modulation. Therefore, it is plausible that factors such as pain catastrophizing thoughts may affect the nervous systems ability to dampen pain. Chronic low back pain is the single clinical problem with the biggest impact in the modern society. Previous studies have demonstrated that pain catastrophizing and reduced endogenous pain inhibition are part of the clinical picture. However, previous studies have never investigated a potential relationship between these two factors.

Official Title
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The Efficiency of Conditioned Pain Modulation is Associated With Levels of Pain Catastrophizing in Patients With Chronic Low Back Pain

Conditions
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Catastrophizing Pain, Pain, Somatic, Chronic Low Back Pain

Intervention / Treatment
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* Diagnostic Test: PPT measurement
* Diagnostic Test: Pain catastrophizing scale
* Procedure: Cold Pressor Test


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Low back pain group: chronic low back pain ( lasting more than 3 months) intensity of ≥ 3/10 on a numeric rating scale pain is located in the area between the gluteal folds below to the thoracolumbal junction above. Controls: No current or previous history of musculoskeletal pain of ongoing nature Exclusion Criteria: Applies for both groups: Signs of radicular pain or other specific medical conditions e.g. rheumatologic disease or diabetes Pregnancy

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: The study has a cross-sectional design and includes individuals (males and females) with and without chronic low back pain into two, equally large groups
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Chronic low back pain<br>Individuals with chronic low back pain. Baseline assessment of pain intensity, function, pain duration and pain catastrophizing thoughts is performed Pain sensitivity at the back and lower leg is measured at baseline and immediately after performing the cold pressor test | Diagnostic Test: PPT measurement<br>* The sensitivity to pressure which is gradually increased is assessed. The procedure is performed at the back and the lower leg<br>* Other names: Assessment of pain sensitivity;Diagnostic Test: Pain catastrophizing scale<br>* A validated questionnaire that measures three domains of pain-related catastrophizing thoughts: helplessness, rumination and excessive magnification<br>Procedure: Cold Pressor Test<br>* The participant submerges one hand into a tank of cold (5 deg C), circulating water. The procedure is commonly know to decrease the sensitivity to pressure (PPT procedure) so that a difference appears in pain sensitivity when comparing PPT values before and after the procedure<br>|
| Active Comparator: Healthy controls<br>Healthy, pain-free individuals who are age and gender matched to the low back pain group fill out the pain catastrophizing scale Pain sensitivity at the back and lower leg is measured at baseline and immediately after performing the cold pressor test | Diagnostic Test: PPT measurement<br>* The sensitivity to pressure which is gradually increased is assessed. The procedure is performed at the back and the lower leg<br>* Other names: Assessment of pain sensitivity;Diagnostic Test: Pain catastrophizing scale<br>* A validated questionnaire that measures three domains of pain-related catastrophizing thoughts: helplessness, rumination and excessive magnification<br>Procedure: Cold Pressor Test<br>* The participant submerges one hand into a tank of cold (5 deg C), circulating water. The procedure is commonly know to decrease the sensitivity to pressure (PPT procedure) so that a difference appears in pain sensitivity when comparing PPT values before and after the procedure<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Association between levels of pain catastrophizing thoughts and endogenous pain inhibition | The pain catastrophizing scale score is correlated with the changes in Pressure Pain Thresholds before and after the cold pressor test See descriptions of each assessment method below (outcome 2 and outcome 3, respectively) | One session (45 min) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in pressure pain thresholds (determined with pressure algometry) before and after the cold pressor test | Pressure Pain Thresholds (PPT) are assessed before and after the cold pressor test PPT measure the pressure needed to experience the first instance of pain. For this purpose, a pressure algometer (a pistol-like device with a 1cm2 contact surface) is used. Higher levels of pressure reflect lower pain sensitivity. In the cold pressor test, the subject is asked to submerge one hand into circulating water (constant temperature: 4 degrees C) for 2 minutes. When removing it from the water, the subject is asked to indicate the perceived pain using a numeric rating scale (see below). Before and after the cold pressor test, the PPT measurements are performed. The difference in PPT values before and after the cold pressor test is used in the correlation analysis described in outcome 1. The numeric rating scale is used to determine the perceived pain intensity from the cold water. The scale is runs from 0 - 10 where 0 is anchored with no pain and 10 reflects the worst pain imaginable | 30 minutes | 
| Catastrophizing thoughts measured with the Pain Catastrophizing Scale | The pain catastrophizing score by filling out the pain catastrophizing scale.The pain catastrophizing scale consists of 13 sentences describing pain-related thoughts or feelings. These are divided into 3 domains: rumination, magnification and helplessness. The subject is asked to indicate how how well each sentence applies for them: 0 = not at all, 1 = to a slight degree, 2 = to a moderate degree, 3 = to a great degree and 4 = all the time. The total score on the questionnaire can lie between 0 - 52 where a higher score indicates higher levels of pain catastrophizing thoughts. | 15 minutes |