693: Effects of Affective Manipulation and Distraction on Pain Modulation

Topic: Experimental (Non-clinical) Human Studies
Subtopic: Non -specific to any diagnosis, Psychology, Pain mechanisms (e.g. descending inhibitory control, placebo, inflammation), Quantitative Sensory testing (static and dynamic, e.g., HPT, PPT, CPM, TSP, offset analgesia)

Background and Aims: The intrinsic endogenous capacity to modulate pain has been suggested to be linked with better treatment outcomes and less vulnerability to persistent pain. Examples of ways in which pain perception adapts are Conditioned Pain Modulation (CPM), Offset analgesia (OA), and analgesia driven by cognitive and affective engagement. However, the interaction between the different methods of modulating pain is uncertain. This study examines whether OA and CPM are altered following affective or cognitive tasks.

Methods: OA, CPM, pressure pain detection threshold (PDT), and perceived pain during a predetermined heat stimulus eliciting 50/100 on a visual analogue scale (VAS) were assessed in two sessions. Each session included baseline, post, and two manipulation trials. One session involved easy and difficult Stroop tasks, the other positive and negative affective images; order was randomized and counterbalanced. PDT and CPM were the cuff pressures evoking 10/100 VAS with and without a secondary painful stimulus. OA was the difference between peak and nadir ratings during a predetermined temperature → +1 °C → return sequence, relative to constant stimulation.

Results: Thirty participants (15 male, 15 female at birth; mean age 26.9 ± 3.3) were studied. No mean differences between manipulations were observed for OA, CPM, PDT, or the constant heat stimulus. A main effect of time emerged for CPM (p = 0.002) and PDT (p < .001) across baseline, manipulation, and post measurements. Negative and positive images differed in valence (p < 0.01) but not arousal (p = .902). Negative images decreased PANAS positive (p = 0.025), whereas positive images had no effect. The difficult Stroop task produced longer reaction times than the easy task (p = 0.012).

Conclusions: OA and CPM were not significantly changed by affective or cognitive manipulations. However, CPM was impacted by time, whereas OA was not. Indicating that CPM is potentially more influenced by repeated painful stimuli, and OA is a stable measure of endogenous pain modulation. Future studies may benefit from focusing on individual variability, as subgroup-specific responses could be masked in group-level analyses.

References: McPhee, M. E., & Graven-Nielsen, T. (2022). Positive affect and distraction enhance whereas negative affect impairs pain modulation in patients with recurrent low back pain and matched controls. Pain, 163(5), 887–896. 10.1097/j.pain.0000000000002442
Graven-Nielsen, T. (2022). Mechanisms and manifestations in musculoskeletal pain: from experimental to clinical pain settings. Pain, 163(S1), S29–S45. 10.1097/j.pain.0000000000002690
Szikszay, T. M., Adamczyk, W. M., & Luedtke, K. (2019). The Magnitude of Offset Analgesia as a Measure of Endogenous Pain Modulation in Healthy Participants and Patients With Chronic Pain: A Systematic Review and Meta-Analysis. The Clinical Journal of Pain, 35(2), 189–204. 10.1097/AJP.0000000000000657
Mikkelsen, M. B., Neumann, H., Buskbjerg, C. R., Johannsen, M., O'Toole, M. S., Arendt-Nielsen, L., & Zachariae, R. (2024). The effect of experimental emotion induction on experimental pain: a systematic review and meta-analysis. Pain (Amsterdam), 165(4), e17–e38. 10.1097/j.pain.0000000000003073

Presenting Author: Jens Frøjk Axel Dixen
Submitting Author: Jens Frøjk Axel Dixen

Senior Author: Thomas Graven-Nielsen

IASP 2026 Global Year theme of Neuropathic Pain: No