PMID- 30115262
OWN - NLM
STAT- MEDLINE
DCOM- 20190107
LR  - 20220129
IS  - 1471-6771 (Electronic)
IS  - 0007-0912 (Print)
IS  - 0007-0912 (Linking)
VI  - 121
IP  - 3
DP  - 2018 Sep
TI  - Conditioned pain modulation identifies altered sensitivity in extremely preterm 
      young adult males and females.
PG  - 636-646
LID - S0007-0912(18)30500-2 [pii]
LID - 10.1016/j.bja.2018.05.066 [doi]
AB  - BACKGROUND: Conditioned pain modulation is a potential biomarker for risk of 
      persistent pain. As early-life experience can alter subsequent somatosensory 
      processing and pain response, we evaluated conditioned pain modulation after 
      extremely preterm birth. METHODS: This observational study recruited extremely 
      preterm (<26 weeks gestation; n=98) and term-born control (n=48) young adults 
      (19-20 yr) from the longitudinal EPICure cohort. Pressure pain threshold (PPT; 
      variable test stimulus lower leg) was measured before, during, and after a 
      conditioning stimulus (contralateral hand immersion; 5 degrees C water; 30 s). 
      Questionnaires assessed current pain, medication use, anxiety, and pain 
      catastrophising. RESULTS: For participants tolerating conditioning, there were 
      significant main effects of extremely preterm status, sex, and time on PPT during 
      and after hand immersion. Inhibitory modulation was evoked in 64/98 extremely 
      preterm (3, no change) and 38/48 term-born control (3, facilitation) subjects. 
      The conditioned pain modulation effect (percentage change in PPT) did not differ 
      between the extremely preterm and term-born control groups 53% [95% confidence 
      interval (CI): 41-65] vs 57% [95% CI: 42-71]. Reduced cold tolerance (<20 s) 
      hampered conditioned pain modulation quantification in a higher proportion of 
      extremely preterm participants [extremely preterm vs term-born control: 31/98 
      (32%) vs 7/48 (15%); P=0.03]. One-third of extremely preterm females withdrew the 
      hand before parallel PPT (<15 s), and had lower baseline PPT than term-born 
      control females [4.9 (95% CI: 4.8-5.1) vs 5.3 (95% CI: 5.1-5.5) ln kPa; P=0.02]. 
      Higher anxiety, pain catastrophising, and medication use correlated with pain 
      intensity, but not conditioned pain modulation effect. CONCLUSIONS: Cold 
      conditioning evoked inhibitory modulation in the majority of young adults and 
      identified a subgroup of extremely preterm females with increased baseline 
      sensitivity. Early-life experience and sex/gender should be considered when 
      evaluating persistent pain risk with conditioned pain modulation.
CI  - Copyright (c) 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.
FAU - Walker, S M
AU  - Walker SM
AD  - Clinical Neurosciences (Pain Research), UCL Great Ormond Street Institute of 
      Child Health, London, UK; Department of Anaesthesia and Pain Medicine, Great 
      Ormond Street Hospital for Children NHS Foundation Trust, London, UK. Electronic 
      address: suellen.walker@ucl.ac.uk.
FAU - O'Reilly, H
AU  - O'Reilly H
AD  - Academic Neonatology, UCL EGA Institute for Women's Health, London, UK.
FAU - Beckmann, J
AU  - Beckmann J
AD  - Academic Neonatology, UCL EGA Institute for Women's Health, London, UK.
FAU - Marlow, N
AU  - Marlow N
AD  - Academic Neonatology, UCL EGA Institute for Women's Health, London, UK.
CN  - EPICure@19 Study Group
LA  - eng
GR  - MR/J01107X/1/MRC_/Medical Research Council/United Kingdom
PT  - Journal Article
PT  - Multicenter Study
DEP - 20180706
PL  - England
TA  - Br J Anaesth
JT  - British journal of anaesthesia
JID - 0372541
RN  - 0 (Analgesics)
SB  - IM
MH  - Analgesics/administration & dosage
MH  - Conditioning, Psychological/*physiology
MH  - Drug Utilization/statistics & numerical data
MH  - Female
MH  - Humans
MH  - Infant, Extremely Premature/*psychology
MH  - Infant, Newborn
MH  - Ireland/epidemiology
MH  - Longitudinal Studies
MH  - Male
MH  - Pain/epidemiology/*psychology
MH  - Pain Measurement/methods
MH  - Pain Perception/*physiology
MH  - Pain Threshold/*physiology
MH  - United Kingdom/epidemiology
MH  - Young Adult
PMC - PMC6200113
OTO - NOTNLM
OT  - conditioned pain modulation
OT  - extremely premature
OT  - infant
OT  - pain
EDAT- 2018/08/18 06:00
MHDA- 2019/01/08 06:00
PMCR- 2018/07/06
CRDT- 2018/08/18 06:00
PHST- 2018/01/31 00:00 [received]
PHST- 2018/04/28 00:00 [revised]
PHST- 2018/06/08 00:00 [accepted]
PHST- 2018/08/18 06:00 [entrez]
PHST- 2018/08/18 06:00 [pubmed]
PHST- 2019/01/08 06:00 [medline]
PHST- 2018/07/06 00:00 [pmc-release]
AID - S0007-0912(18)30500-2 [pii]
AID - 10.1016/j.bja.2018.05.066 [doi]
PST - ppublish
SO  - Br J Anaesth. 2018 Sep;121(3):636-646. doi: 10.1016/j.bja.2018.05.066. Epub 2018 
      Jul 6.