Chronic Pain Clinical Trial
Diffuse noxious inhibitory control In order to quantify central sensitization in chronic
pain patients, the Diffuse Noxious Inhibitory Control (DNIC) model has been used frequently.
DNIC relies on painful conditioning stimulation of one part of the body to inhibit pain in
another part, to remove the "noise" and to focus on relevant stimuli.
Earlier studies provided evidence for malfunctioning of DNIC in Fibromyalgia (FM) patients.
However, the cause of this impairment is not yet elucidated, and further study is required
to unravel the pathophysiology of DNIC in FM.
Hypothalamus-Pituitary-Adrenal (HPA) axis Besides neural mechanisms, also hormonal
abnormalities could cause altered pain processing. Cortisol is released in answer to pain to
suppress the pain. Given the evidence for hypofunction of the hypothalamic-pituitary-adrenal
axis and the lower cortisol release in response to stressors in a proportion of FM patients
and in chronic whiplash associated disorders (WAD) patients, the relation between pain and
cortisol in these patients may be an interesting topic to consider.
Neurocognitive performance Besides chronic pain, people with chronic WAD and FM suffer from
severe concentration difficulties and decreased neurocognitive capabilities (reduced
reaction time, short term memory deficits etc. The decreased neurocognitive performance is
known to be related to pain severity in various chronic pain populations. It is hypothesized
that malfunctioning of descending inhibitory pathways and subsequent chronic pain experience
precludes optimal neurocognitive performance.
Objectives The present investigation addresses the (patho)physiological mechanisms of DNIC
in chronic pain populations.
1. Firstly, patients with FM, chronic WAD and healthy controls are compared regarding
functioning of DNIC, cortisol levels and response and neurocognitive performance
(case-control).
2. Secondly, the possible interaction between the functioning of DNIC, cortisol and
neurocognitive performance is studied in patients with FM, WAD and healthy control
subjects (cross-sectional).
3. Thirdly, to examine whether a fatiguing neurocognitive stressor changes DNIC and
cortisol levels in patients with FM, chronic WAD or healthy sedentary control subjects.
n/a
Observational Model: Case-Crossover, Time Perspective: Cross-Sectional
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