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Effects of stress and relaxation on central pain modulation in chronic whiplash and fibromyalgia patients compared to healthy controls

Iris Coppieters (UGent) , Barbara Cagnie (UGent) , Jo Nijs, Jessica Van Oosterwijck (UGent) , Lieven Danneels (UGent) , Robby De Pauw (UGent) and Mira Meeus (UGent)
(2016) PAIN PHYSICIAN. 19(3). p.119-130
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Organization
Abstract
Background: Compelling evidence has demonstrated that impaired central pain modulation contributes to persistent pain in patients with chronic whiplash associated disorders (WAD) and fibromyalgia (FM). However, there is limited research concerning the influence of stress and relaxation on central pain modulation in patients with chronic WAD and FM. Objectives: The present study aims to investigate the effects of acute cognitive stress and relaxation on central pain modulation in chronic WAD and FM patients compared to healthy individuals. Study Design: A randomized crossover design was employed. Setting: The present study took place at the University of Brussels, the University Hospital Brussels, and the University of Antwerp. Methods: Fifty-nine participants (16 chronic WAD patients, 21 FM, 22 pain-free controls) were enrolled and subjected to various pain measurements. Temporal summation (TS) of pain and conditioned pain modulation (CPM) were evaluated. Subsequently, participants were randomly allocated to either a group that received progressive relaxation therapy or a group that performed a battery of cognitive tests (= cognitive stressor). Afterwards, all pain measurements were repeated. One week later participant groups were switched. Results: A significant difference was found between the groups in the change in TS in response to relaxation (P = 0.008) and cognitive stress (P = 0.003). TS decreased in response to relaxation and cognitive stress in chronic WAD patients and controls. In contrast, TS increased after both interventions in FM patients. CPM efficacy decreased in all 3 groups in response to relaxation (P = 0.002) and cognitive stress (P = 0.001). Limitations: The obtained results only apply for a single session of muscle relaxation therapy and cognitive stress, whereby no conclusions can be made for effects on pain perception and modulation of chronic cognitive stress and long-term relaxation therapies. Conclusions: A single relaxation session as well as cognitive stress may have negative acute effects on pain modulation in patients with FM, while cognitive stress and relaxation did not worsen bottom-up sensitization in chronic WAD patients and healthy persons. However, endogenous pain inhibition, assessed using a CPM paradigm, worsened in chronic WAD and FM patients, as well as in healthy people following both interventions.
Keywords
central sensitization, Chronic pain, endogenous pain inhibition, temporal summation of pain, cognitive stressor, relaxation, fibromyalgia, whiplash-associated disorders, CHRONIC-FATIGUE-SYNDROME, MUSCULAR-CONTRACTION TONUS, NOXIOUS INHIBITORY CONTROL, CENTRAL SENSITIZATION, TEMPORAL SUMMATION, COGNITIVE PERFORMANCE, WIDESPREAD PAIN, 2ND PAIN, ELECTRICAL MEASUREMENTS, RHEUMATOID-ARTHRITIS

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Please use this url to cite or link to this publication:

Chicago
Coppieters, Iris, Barbara Cagnie, Jo Nijs, Jessica Van Oosterwijck, Lieven Danneels, Robby De Pauw, and Mira Meeus. 2016. “Effects of Stress and Relaxation on Central Pain Modulation in Chronic Whiplash and Fibromyalgia Patients Compared to Healthy Controls.” Pain Physician 19 (3): 119–130.
APA
Coppieters, I., Cagnie, B., Nijs, J., Van Oosterwijck, J., Danneels, L., De Pauw, R., & Meeus, M. (2016). Effects of stress and relaxation on central pain modulation in chronic whiplash and fibromyalgia patients compared to healthy controls. PAIN PHYSICIAN, 19(3), 119–130.
Vancouver
1.
Coppieters I, Cagnie B, Nijs J, Van Oosterwijck J, Danneels L, De Pauw R, et al. Effects of stress and relaxation on central pain modulation in chronic whiplash and fibromyalgia patients compared to healthy controls. PAIN PHYSICIAN. 2016;19(3):119–30.
MLA
Coppieters, Iris, Barbara Cagnie, Jo Nijs, et al. “Effects of Stress and Relaxation on Central Pain Modulation in Chronic Whiplash and Fibromyalgia Patients Compared to Healthy Controls.” PAIN PHYSICIAN 19.3 (2016): 119–130. Print.
@article{7161849,
  abstract     = {Background: Compelling evidence has demonstrated that impaired central pain modulation contributes to persistent pain in patients with chronic whiplash associated disorders (WAD) and fibromyalgia (FM). However, there is limited research concerning the influence of stress and relaxation on central pain modulation in patients with chronic WAD and FM. 
Objectives: The present study aims to investigate the effects of acute cognitive stress and relaxation on central pain modulation in chronic WAD and FM patients compared to healthy individuals. 
Study Design: A randomized crossover design was employed. 
Setting: The present study took place at the University of Brussels, the University Hospital Brussels, and the University of Antwerp. 
Methods: Fifty-nine participants (16 chronic WAD patients, 21 FM, 22 pain-free controls) were enrolled and subjected to various pain measurements. Temporal summation (TS) of pain and conditioned pain modulation (CPM) were evaluated. Subsequently, participants were randomly allocated to either a group that received progressive relaxation therapy or a group that performed a battery of cognitive tests (= cognitive stressor). Afterwards, all pain measurements were repeated. One week later participant groups were switched. 
Results: A significant difference was found between the groups in the change in TS in response to relaxation (P = 0.008) and cognitive stress (P = 0.003). TS decreased in response to relaxation and cognitive stress in chronic WAD patients and controls. In contrast, TS increased after both interventions in FM patients. CPM efficacy decreased in all 3 groups in response to relaxation (P = 0.002) and cognitive stress (P = 0.001). 
Limitations: The obtained results only apply for a single session of muscle relaxation therapy and cognitive stress, whereby no conclusions can be made for effects on pain perception and modulation of chronic cognitive stress and long-term relaxation therapies. 
Conclusions: A single relaxation session as well as cognitive stress may have negative acute effects on pain modulation in patients with FM, while cognitive stress and relaxation did not worsen bottom-up sensitization in chronic WAD patients and healthy persons. However, endogenous pain inhibition, assessed using a CPM paradigm, worsened in chronic WAD and FM patients, as well as in healthy people following both interventions.},
  author       = {Coppieters, Iris and Cagnie, Barbara and Nijs, Jo and Van Oosterwijck, Jessica and Danneels, Lieven and De Pauw, Robby and Meeus, Mira},
  issn         = {1533-3159},
  journal      = {PAIN PHYSICIAN},
  keyword      = {central sensitization,Chronic pain,endogenous pain inhibition,temporal summation of pain,cognitive stressor,relaxation,fibromyalgia,whiplash-associated disorders,CHRONIC-FATIGUE-SYNDROME,MUSCULAR-CONTRACTION TONUS,NOXIOUS INHIBITORY CONTROL,CENTRAL SENSITIZATION,TEMPORAL SUMMATION,COGNITIVE PERFORMANCE,WIDESPREAD PAIN,2ND PAIN,ELECTRICAL MEASUREMENTS,RHEUMATOID-ARTHRITIS},
  language     = {eng},
  number       = {3},
  pages        = {119--130},
  title        = {Effects of stress and relaxation on central pain modulation in chronic whiplash and fibromyalgia patients compared to healthy controls},
  volume       = {19},
  year         = {2016},
}

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