Sedentary behaviour facilitates conditioned pain modulation in middle-aged and older adults with persistent musculoskeletal pain: a cross-sectional investigation

Ramakrishnan Mani; Divya Bharatkumar Adhia; Sook Ling Leong; Sven Vanneste; Dirk De Ridder

doi:10.1097/PR9.0000000000000773

Sedentary behaviour facilitates conditioned pain modulation in middle-aged and older adults with persistent musculoskeletal pain: a cross-sectional investigation

Pain Rep. 2019 Aug 2;4(5):e773. doi: 10.1097/PR9.0000000000000773. eCollection 2019 Sep-Oct.

Authors

Ramakrishnan Mani¹, Divya Bharatkumar Adhia^{1

2}, Sook Ling Leong^{2

3}, Sven Vanneste^{4

3}, Dirk De Ridder²

Affiliations

¹ Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand.
² Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
³ Global Brain Health Institute, Trinity College Dublin, Institute of Neuroscience, Ireland, Dublin.
⁴ School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA.

Abstract

Introduction: Higher physical activity (PA) and lower sedentary behaviour (SB) levels have demonstrated beneficial effects on temporal summation (TS) and conditioned pain modulation (CPM) in healthy adults. This cross-sectional study investigated the relationships between PA and SB and TS/CPM responses in individuals with chronic musculoskeletal pain.

Methods: Sixty-seven middle-aged and older adults with chronic musculoskeletal pain were recruited from the community. Questionnaires measuring demographics, pain, and psychological measures were completed. Physical activity/SB levels were measured using the International Physical Activity Questionnaire-short form and Sedentary Behaviour Questionnaire, respectively. Semmes monofilament was used to assess mechanical TS (MTS) at the most symptomatic (MTS-S) and a reference region (MTS-R); change in the pain scores (baseline-10th application) was used for analysis. Conditioned pain modulation procedure involved suprathreshold pressure pain threshold (PPT-pain4) administered before and after (CPM30sec, CPM60sec, and CPM90sec) conditioning stimulus (2 minutes; ∼12°C cold bath immersion). For analysis, PPT-pain4 (%) change scores were used.

Results: PPT-pain4 (%) change scores at CPM30sec and CPM60sec demonstrated significant weak positive correlations with SB levels and weak negative correlations with PA measures. After adjusting for confounding variables, a significant positive association was found between SB (h/d) and PPT-pain4 (%) change scores at CPM30sec and CPM60sec. No significant associations between MTS and PA/SB measures.

Conclusion: Sedentariness is associated with higher pain inhibitory capacity in people with chronic musculoskeletal pain. The observed relationship may be characteristic of a protective (sedentary) behaviour to enhance pain modulatory mechanism. Prospective longitudinal studies using objective PA/SB measures are required to validate the observed relationship in a larger sample size.

Keywords: Boom-bust pain cycle; Conditioned pain modulation; Older adults; Pain mechanisms; Pain modulation; Physical activity; Sedentary behavior; Temporal summation.