Test-retest reliability of pressure pain threshold and heat pain threshold as test stimuli for evaluation of conditioned pain modulation

Objectives: There is growing interest in conditioned pain modulation (CPM) protocols for evaluating the function of the descending pain-modulatory system in clinical settings. The aim of this study was to evaluate test-retest reliability of a CPM protocol with contact heat as a conditioning stimulus (CS) and two test stimuli (pressure pain threshold (PPT) and heat pain threshold (HPT)), all applied within one session. In addition, gender and age differences were evaluated. Methods: The study included 87 healthy subjects (average age 37.95 +/- 12.02 years, 57.5% females). The magnitude of the results of the CPM test was calculated as the difference between subject-reported pain thresholds before and after application of the CS. To assess the reliability of the protocol, a subgroup of 66 subjects underwent re-test after 14 +/- 1 days. In order to investigate the influence of age on the CPM magnitude, subjects were divided into subgroups (20-29, 30-39, 40-49, 50-59 years). Results: The pain thresholds for both test stimuli (TS) were significantly higher following the application of the CS (p < 0.001). Values of the interclass correlation coefficient (ICC) for the CPM with PPT as the TS indicated good reliability (ICC=0.631, 95% CI:0.365-0.782), while those for the HPT indicated poor reliability (ICC=0.328, 95% CI:-0.067-0.582). Significant differences in CPM between genders were found for both TS. Significant CPM differences were not detected among the four age subgroups for either TS. Conclusions: CPM effects can be successfully induced with both PPT and HPT as a TS, but PPT showed significantly higher reliability. (C) 2021 Elsevier Masson SAS. All rights reserved.