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PhD Thesis
"Learned Control Over Spinal Nociception In Healthy Subjects And Patients With Chronic Back Pain"
Pain is vital for us. Pain is a warning signal that protects us from injuries or ensures that we treat injured body parts with care to promote healing. On the other hand, also suppression of nociception is essential to reduce pain. As a natural endogenous pain control mechanism, pain-inhibitory nerve tracts descend from the brainstem to the spinal cord where they suppress spinal nociceptive transmission, reducing ascending nociceptive input to the brain and thus diminishing pain sensation. Cognitive and emotional processes modulate this descending pain inhibition. In patients with chronic pain, descending pain inhibition often is impaired, possibly contributing to pain persistence. Therefore, improving descending pain inhibition in patients with chronic pain is a promising target for pain therapy. In this thesis, three studies present the development and implementation of a feedback training method in which subjects learn to apply cognitive-emotional strategies to reduce their spinal nociception, as quantified by the spinal nociceptive flexor reflex (RIII reflex), under visual feedback about their RIII reflex size, likely by activating their descending inhibition. The results showed that, under RIII feedback, healthy subjects as well as patients with chronic back pain could learn to deliberately suppress their RIII reflex, their concomitant experimental pain intensity, and, in parts, somatosensory evoked potentials, a measure of supraspinal nociception. Furthermore, patients significantly improved their descending pain inhibition, as quantified by the conditioned pain modulation effect, and significantly decreased their chronic back pain intensity and anxiety after the feedback training. In conclusion, the RIII feedback training enables subjects to deliberately activate their descending pain inhibition and reduce their spinal nociception. The RIII feedback training could potentially be an innovative drug-saving method to improve impaired descending pain inhibition in patients with chronic back pain and reduce their clinical pain.
Publications
Krafft S, Göhmann HD, Sommer J, Straube A, Ruscheweyh R ( 2017) Learned control over spinal nociception in patients with chronic back pain. Eur J Pain 21:1538-1549.
Bäumler M, Feller M, Krafft S, Schiffer M, Sommer J, Straube A, Weinges F, Ruscheweyh R (2017) Learned control over spinal nociception: Transfer and stability of training success in a long-term study. Clinical Neurophysiology 128:2462–2469
Ruscheweyh R, Bäumler M, Feller M, Krafft S, Sommer J, Straube A (2015) Learned control over spinal nociception reduces supraspinal nociception as quantified by late somatosensory evoked potentials. Pain, 156:2505-2513.
1st prize of the YoungScientistAward Pain 2016: http://www.janssen.com/germany/nachwuchsfoerderpreis-schmerz-2016-innovationen-gegen-schmerz