Q-Sense CPM

1. Q-Sense CPM Dual-Thermode System for Dynamic QST

2. Conditioned Pain Modulation • Descending pathways from the brain can modulate the perception of a noxious stimulus • A painful stimulus in one area of the body can inhibit a painful stimulus in another area • This effect is called Conditioned Pain Modulation (CPM). Also known as DNIC-like effect • DNIC = Diffuse Noxious Inhibitory Control

3. Q-Sense CPM • Range: 16°C – 50°C • Rates: 0.1°C/sec - 2°C/sec • Modalities: R&H, CPM, Limits, Levels, TSL • Smart sync between Thermodes • Thermodesize: • Approx. 10 Kg, Portable Tabletop Unit 30x30 mm

4. Q-Sense CPM Software • Intuitive step-by-step workflow • Features are easily personalized and managed • Pre-programmed test algorithms, including dual-thermode protocols • Comprehensive statistics • Report generator • (built in + custom) • Easy data export to Excel • SQL data base

5. Movie

6. CPM pain rating graph

7. CPM pain rating with CoVAS

8. CPM pain rating with Heat Pain Threshold as a test stimulus Medoc Ltd. 2010 - 8

9. CPM Application Medoc Ltd. 2019 - 9

10. CPM Application – Individual Pain Profile • CPM protocol (pain inhibition) and/or Temporal Summation protocol (pain facilitation) can be used to characterize the individual pain profile and place the individual on the spectrum between pro and antinociception • The individual pain profile can be useful to predict various clinical pain characteristics, such as future pain development or treatment efficacy

11. CPM Application – Pathophysiology of Pain CPM test can be used to assess the changes in pain inhibition and to contribute to pain profile understanding in various chronic pain conditions (Teles et al., 2018; Chalaye et al., 2014)

12. CPM Application – Post Operative Pain CPM test can be used for identification of patients tend to develop post-operative pain – less efficient CPM is associated with higher risk to develop acute and chronic post-operative pain (Yarnitsky et al., 2008; Landau et al., 2010)

13. CPM Application – Treatment Efficacy CPM test can used to predict the efficacy of analgesic treatment based on pain mechanism. It can also be used as an efficacy measure for different pain treatments (Yarnitsky et al., 2012; Niester et al., 2014)

14. Recently Published – 2-thermode CPM Dual-thermode CPM: both test and conditioning stimuli are performed with 30x30 thermode • Defrin et al., (2010). The interactions between spatial summation and DNIC: Effect of the distance between two painful stimuli and attentional factors on pain perception • Nahman-Averbuch el al., (2012). The role of stimulation parameters on the conditioned pain modulation response • Razavi et al., (2013). The influence of intensity and duration of a painful conditioning stimulation on conditioned pain modulation in volunteers • Geva et al., (2014). Acute psychosocial stress reduces pain modulation capabilities in healthy men • Granovsky et al., (2015). CPM Test–Retest Reliability: “Standard” vs “Single Test-Stimulus” Protocols • Da Silva et al., (2018). Not just a matter of pain intensity: Effects of three different conditioning stimuli on conditioned pain modulation effects

15. Benefits of using 2 Thermode CPM • Computer controlled synchronization of test and conditioning stimuli • Easy to use & portable • Compared to water bath: • Suitable for all body sites • Time saving • Easy disinfection

16. Q-Sense CPM Device – Other Capabilities

17. Offset Analgesia • A profound decrease in the sensation of pain following a temporary increase in stimulus intensity • Completes the battery of dynamic QST

18. Thermal Grill • Simultaneous warm and cool stimuli can cause an illusion of heat and pain => burning sensation

19. Thank you!