Conditioned Pain Modulation
Conditioned Pain Modulation (CPM): A Conversation with Prof. David Yarnitsky, Head of the Neurology department, Rambam Medical Center, Haifa, Israel
Professor Yarnitsky is a director at the neurology department, Rambam Health Care Campus. He is also the head the clinical neurophysiology laboratory at the Technion (Haifa, Israel). His research focuses on pain, in the aspects of measurement, mechanism and therapy, migraine, autonomic disorders and cerebrovascular disorders]
Q: What is Conditioned Pain Modulation / CPM?
A: CPM is a paradigm used in the lab where we use a conditioning stimulus to influence a test stimulus. The context is “pain inhibits pain”. CPM is a way to study the endogenous pain inhibition ability of the subject. The purpose is not to
inhibit pain per se by applying another pain, but to learn about the inhibition ability.
Q: What is CPM used for?
A: The first question that leads all pain researchers is why does the same disease or injury cause different pain levels in different people. One way to explain this is pain modulation: how does the nervous system of different individuals handle painful stimuli? The process of pain-
Q: What are the major applications for CPM?
A: The most significant area is pain treatment – deciding on the most suitable drug according to the defective pain inhibition mechanism as tested with CPM. Until now, treating neuropathic pain is through trial and error. The physician would recommend one type of drug and it would take weeks or even months until one could decide whether the drug is efficient or not. Meanwhile, the patient continues to suffer…
The second possible application is predicting future pain; for instance, post-
The third possible application is prophylaxis. For example, in migraines there is no way of knowing which drug would prevent the migraine. If you can test the patient’s pain modulation, you can identify the defective mechanism and therefore prescribe a drug that would treat this specific mechanism. This way the patient would benefit from an individualized tailored treatment. Another example would be proper preparation for an operation. If we know a specific operation is considered of high pain level, and we know the pain modulation profile of the patient, we can treat him with the suitable drug and provide maximum defense against the post -
Q: What is the potential role of CPM in pharmaceutical / clinical trials?
A: A major problem of pharmacologic clinical trials is that often, very few people respond to the tested drug and when the results are analyzed, the conclusion is that the drug is not effective. The potential role of CPM here is in “enriched enrolment”. If we know the mechanism of action of a new potential drug, we can hypothesize which pain modulation mechanism would be affected by it. Potential enrolled subjects can be tested, looking for those individuals in which this specific mechanism is defected. If the pharmaceutical company would enroll only this population in their trial, they are bound to have better results. This area is still very new and additional research is still required.
Q: Could you share your clinical research plans with CPM?
A: We are planning a study on post-
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Pain Research applications: