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Papers of the Week

Papers: 21 Jan 2023 - 3 Feb 2023

2023 Jan 05


PAIN-related cognitions and emotional distress are not associated with conditioned pain modulation: an explorative analysis of 1142 participants with acute, subacute, and chronic pain.



Reduced conditioned pain modulation (CPM) and psychological distress co-occur frequently in many pain conditions. This study explored whether common negative pain cognitions and emotional factors were related to lower CPM in individuals across the spectrum from acute to chronic pain. Previously collected data on the CPM effect, pain-related cognitions (fear of movement, pain catastrophizing), and emotional distress (depression, anxiety) from questionnaires in 1142 individuals with acute, subacute, or chronic pain were used. The presence of negative psychological factors was dichotomized according to cut-off values for questionnaires. Associations between the presence of each negative psychological factor and the amplitude of pain reduction in the CPM paradigm was explored with Generalized Linear Models adjusted for sex, age, body mass index, and pain duration. A secondary analysis explored the cumulative effect of psychological factors on CPM. When dichotomized according to cut-off scores, 20% of participants were classified with anxiety, 19% with depression, 36% with pain catastrophizing, and 48% with fear of movement. The presence of any negative psychological factor nor the cumulative sum of negative psychological factors were associated with lower CPM (individual factor: β between -0.15 and 0.11, P≥0.08; Total: β between –0.27 and -0.12, P≥0.06). Despite the common observation of psychological factors and reduced CPM in musculoskeletal pain, these data challenge the assumption of a linear relationship between these variables across individuals with acute, subacute, and chronic pain. Arguably, there was a non-significant tendency for associations in non-expected directions, which should be studied in a more homogenous population.