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

NCT ID: NCT03644810

Last Updated: 2018-12-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

44 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-05-01

Study Completion Date

2018-11-08

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.

Conditions

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Catastrophizing Pain Pain, Somatic Chronic Low Back Pain

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

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
Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

SINGLE

Participants
The participants are blind to the study hypothesis and therefore the expected outcome of the tests performed

Study Groups

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Chronic low back pain

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

Group Type ACTIVE_COMPARATOR

PPT measurement

Intervention Type DIAGNOSTIC_TEST

The sensitivity to pressure which is gradually increased is assessed. The procedure is performed at the back and the lower leg

Pain catastrophizing scale

Intervention Type DIAGNOSTIC_TEST

A validated questionnaire that measures three domains of pain-related catastrophizing thoughts: helplessness, rumination and excessive magnification

Cold Pressor Test

Intervention Type PROCEDURE

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

Healthy controls

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

Group Type ACTIVE_COMPARATOR

PPT measurement

Intervention Type DIAGNOSTIC_TEST

The sensitivity to pressure which is gradually increased is assessed. The procedure is performed at the back and the lower leg

Pain catastrophizing scale

Intervention Type DIAGNOSTIC_TEST

A validated questionnaire that measures three domains of pain-related catastrophizing thoughts: helplessness, rumination and excessive magnification

Cold Pressor Test

Intervention Type PROCEDURE

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

Interventions

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PPT measurement

The sensitivity to pressure which is gradually increased is assessed. The procedure is performed at the back and the lower leg

Intervention Type DIAGNOSTIC_TEST

Pain catastrophizing scale

A validated questionnaire that measures three domains of pain-related catastrophizing thoughts: helplessness, rumination and excessive magnification

Intervention Type DIAGNOSTIC_TEST

Cold Pressor Test

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

Intervention Type PROCEDURE

Other Intervention Names

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Assessment of pain sensitivity

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
Minimum Eligible Age

18 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Spine Centre of Southern Denmark

OTHER

Sponsor Role collaborator

Aalborg University

OTHER

Sponsor Role lead

Responsible Party

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Thorvaldur Skuli Palsson

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Thorvaldur S Palsson, PhD

Role: PRINCIPAL_INVESTIGATOR

Aalborg University

Locations

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Spine Centre of Southern Denmark

Middelfart, Southern Denmark, Denmark

Site Status

Countries

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Denmark

References

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Edwards RR, Smith MT, Stonerock G, Haythornthwaite JA. Pain-related catastrophizing in healthy women is associated with greater temporal summation of and reduced habituation to thermal pain. Clin J Pain. 2006 Oct;22(8):730-7. doi: 10.1097/01.ajp.0000210914.72794.bc.

Reference Type BACKGROUND
PMID: 16988570 (View on PubMed)

Vaegter HB, Palsson TS, Graven-Nielsen T. Facilitated Pronociceptive Pain Mechanisms in Radiating Back Pain Compared With Localized Back Pain. J Pain. 2017 Aug;18(8):973-983. doi: 10.1016/j.jpain.2017.03.002. Epub 2017 Mar 24.

Reference Type RESULT
PMID: 28344100 (View on PubMed)

Meints SM, Wang V, Edwards RR. Sex and Race Differences in Pain Sensitization among Patients with Chronic Low Back Pain. J Pain. 2018 Dec;19(12):1461-1470. doi: 10.1016/j.jpain.2018.07.001. Epub 2018 Jul 17.

Reference Type RESULT
PMID: 30025944 (View on PubMed)

Mlekusch S, Neziri AY, Limacher A, Juni P, Arendt-Nielsen L, Curatolo M. Conditioned Pain Modulation in Patients With Acute and Chronic Low Back Pain. Clin J Pain. 2016 Feb;32(2):116-21. doi: 10.1097/AJP.0000000000000238.

Reference Type RESULT
PMID: 26741741 (View on PubMed)

Correa JB, Costa LO, de Oliveira NT, Sluka KA, Liebano RE. Central sensitization and changes in conditioned pain modulation in people with chronic nonspecific low back pain: a case-control study. Exp Brain Res. 2015 Aug;233(8):2391-9. doi: 10.1007/s00221-015-4309-6. Epub 2015 May 12.

Reference Type RESULT
PMID: 25963754 (View on PubMed)

Other Identifiers

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S-20170021

Identifier Type: -

Identifier Source: org_study_id