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Joseph L Riley III, PhD | Pain & Aging Pre-Conference Workshop.

Joseph L Riley III, PhD | Pain & Aging Pre-Conference Workshop. DISCLOSURE. I have no relevant commercial relationships to disclose. Assessing Pain Modulation in Older Adults. Topics. Pain modulation 101 Why older adults? Laboratory tests of pain modulation. Tissue damage

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Joseph L Riley III, PhD | Pain & Aging Pre-Conference Workshop.

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  1. Joseph L Riley III, PhD | Pain & Aging Pre-Conference Workshop.

  2. DISCLOSURE I have no relevant commercial relationships to disclose.

  3. Assessing Pain Modulation in Older Adults Topics • Pain modulation 101 • Why older adults? • Laboratory tests of pain modulation

  4. Tissue damage • Protective • Acute vs. Prolonged • Chronic pain (beyond normal healing?) Pain is adaptive

  5. Early models of pain

  6. Pain is modulated

  7. IOM Report: June 29, 2011 “Chronic pain ….. surpasses its underlying cause to become a disease in its own domains and dimensions.” “Changes in structure and function of the nervous system”

  8. How does modulation become dysfunctional? Central Sensitization • Increased sensitivity • Increased CNS excitability • Enlargement of receptive fields • CNS activity that outlast the trigger Loss of descending inhibition

  9. Pain psychophysics Laboratory (noxious stimuli) • Single end-points • Dynamic tests of pain modulation

  10. Chronic pain populations • Increased sensitivity • Enhanced facilitation • Reduced inhibition

  11. Temporal summation (facilitatory) Animal studies • Short rapid stimulation • C-fiber specific • Interval sensitive • Spinal mechanism

  12. Age differences in temporal summation Testing parameters: • SI: 0.8-sec • ISI: 2.5-, 3.5-, 4.5-sec • Individualized temperature Participants: • 88 Younger adults (ages 18-39) • 48 Middle-aged (40-59) • 62 Older adults (60-80)

  13. Rating the delayed sensation

  14. p=.04 p=.01 P<.001

  15. p=.04 p=.01 P<.001

  16. p=.04 p=.01 P<.001

  17. Rated the size percept of the pain Naugle KM, Cruz-Almeida Y, Fillingim RB, Staud R, Riley JL 3rd. Increased spatial dimensions of repetitive heat and cold stimuli in older women. Pain. 2017 May;158(5):973-979

  18. P<.001

  19. Response to prolonged stimuli Participants: • 36 Younger adults (18-36) • 28 Older adults (55-78) Thermal heat at individualized temperature (Pain40)

  20. Older group failed to inhibit in the first minute.

  21. Pain profile repeated for younger participants

  22. Additional sensitization for the older adults during trial 4

  23. Loss of inhibition/increased facilitation?

  24. Older adults show greater pain facilitation • Temporal summation - short acting • Spatial spreading of pain • Prolonged stimulation - over 60-min

  25. Pain-inhibits-pain model Conditioning stimulus Conditioned Pain Modulation (CPM)

  26. Pain-inhibits-pain model • Established in animal models • Heterotopic • Reduced with naloxone Test stimulus Conditioned Pain Modulation (CPM)

  27. Pain patients have reduced inhibition in tests of CPM

  28. Conditioned pain modulation Participants: • 27 Younger adults (20-44) • 24 Older adults (56-78) Riley JL 3rd, King CD, Mauderl AP, Wong F, Fillingim RB. Differences in pain sensitivity and modulation across the lifespan. Pain. 2010 Jul;150(1):153-160.

  29. Large effect for the younger sample, p. > .001

  30. 50% the inhibition of the younger group p. < .05

  31. 5

  32. Pain modulation becomes dysfunctional Central Sensitization • Increased sensitivity (120-s) • Increased CNS excitability (TS) • Enlargement of receptive fields (TS size) • CNS activity that outlast the trigger (After sensations) Loss of descending inhibition (CPM)

  33. Inhibition Is the balance tipped for older adults? Facilitation

  34. Restore loss of adaptive pain modulation Plasticity of the CNS • Changes in diet • Exercise • Reduction of stress • Positive thinking

  35. UF Pain Research and Intervention Center of Excellence (PRICE) Roger B. Fillingim, PhD Charles J. Vierck, PhD Roland Staud, MD Patrick Tighe, MD Andre P. Mauderli, DMD, PhD Yenisel Cruz-Almeida, MSPH, PhD Kelly M. Naugle, PhD Shannon M. Wallet, PhD Nathan Eckert, PhD Corey Simon, DPT, PhD and many UF students

  36. Future directions • Exercise restores cognitive functioning • Exercise programs reduce pain for many pain conditions

  37. THANK YOU!

  38. 14-week program of light cycling and stretching Preliminary data from 9 participants ages 55-74

  39. Following the exercise program Reduced summation

  40. Following the exercise program

  41. UF Pain Research and Intervention Center of Excellence (PRICE) Roger B. Fillingim, PhD Charles J. Vierck, PhD Roland Staud, MD Patrick Tighe, MD Andre P. Mauderli, DMD, PhD Yenisel Cruz-Almeida, MSPH, PhD Kelly M. Naugle, PhD Shannon M. Wallet, PhD Nathan Eckert, PhD Corey Simon, DPT, PhD and many UF students

  42. THANK YOU!

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