Conditioned pain modulation-A comprehensive review

Conditioned pain modulation (CPM) is a centrally processed measure of the net effect of the descending pain pathway. This comprises both the facilitatory as well as the inhibitory effect. In the past, CPM or similar effects have been previously described using different terminologies such as diffuse noxious inhibitory control (DNIC), heterotopic noxious conditioning stimulation (HNCS) or endogenous analgesia (EA). A variety of patient-related factors such as age, gender, hormones, race, genetic and psychological factors have been thought to influence the CPM paradigms. CPM paradigms have also been associated with a wide range of methodological variables including the mode of application of the 'test' as well as the 'conditioning' stimuli. Despite all these variabilities, CPM seems to reliably lend itself to the pain modulation profile concept and could in future become one of the phenotypic biomarkers for pain and also a guide for mechanism-based treatment in chronic pain. Future research should focus on establishing consistent methodologies for measuring CPM and thereby enhancing the robustness of this emerging biomarker for pain. Crown Copyright (C) 2020 Published by Elsevier Masson SAS. All rights reserved.

Automated summary

Conditioned pain modulation (CPM) is a centrally processed measure of the net effect of the descending pain pathway, which could potentially serve as a biomarker for pain. Various factors influence CPM paradigms, including patient-related factors and methodological variables, highlighting the importance of establishing consistent methodologies for measuring CPM to enhance its robustness.