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Are headaches common due to lacking conditioned pain modulation (CPM)?

Headaches and conditioned pain modulation
Headaches and conditioned pain modulation

This question motivated Levy et al. to investigate the endogenous inhibition efficiency of the trigeminal and extra-trigeminal areas of the face, neck, and arm in healthy volunteers.

The use of two thermodes to test CPM

Two TSA devices were used to allow thermal test and conditioning stimulation within these areas. CPM was tested in three different zones; 1) forehead (V1) and cheek (V3), 2) cheek and neck (C4), and 3) neck and arm (C7). Additionally, spatial summation of pain (SSP) and temporal summation (TS) of pain were tested on all four areas. Interestingly, the forehead was found to be least sensitive to heat pain, requiring the highest temperature to reach a VAS 5-6 pain rating.

Variability of CPM between body sites

The only configuration that yielded a significant CPM response, was the neck and arm set-up, which did not involve any of the trigeminal sites. Spatial summation of pain was elicited in all four sites, and post-hoc analysis showed less spatial summation of pain in the forehead as compared to the other regions. Temporal summation of pain did not differ significantly between sites.

Trigeminal and extra-trigeminal pain modulation

This study showed inefficient pain modulation in trigeminal, as compared to extra-trigeminal areas. These findings could point to a possible factor in the etiology of pain syndromes involving the trigeminal area.

To study CPM with two thermodes, you no longer need two TSAs, Our new TSA2 comes with standard dual-thermode abilities, allowing for advanced thermal stimulation protocols, with one portable device!


Levy, D., Abdian, L., Dekel-Steinkeller, M., & Defrin, R. (2018). Experimental evidence for weaker endogenous inhibition of trigeminal pain than extra-trigeminal pain in healthy individuals. Cephalalgia, 38(7), 1307-1315.‏


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