Dissertation
The characterization of multisensory sensitivity in people with and without chronic pain
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Autumn 2020
DOI: 10.17077/etd.005682
Abstract
Chronic pain is challenging to treat clinically. The mechanism-based classification approach has been proposed and thought to provide promising effects on pain management. Several markers, including psychosocial factors, pain sensitivity, or neuronal network connectivity, have been targeted to indirectly infer the underlying pathophysiology of chronic pain. Unfortunately, many patients still do not get enough pain relief, which may be partially due to the limited markers. However, multisensory sensitivity (MSS) may serve as an additional marker that may help stratify patients. Elevated MSS appears to be more prevalent in chronic pain patients than pain-free adults and particularly occurs in centrally meditated pain conditions. The aim of this thesis is to characterize MSS in people with and without chronic pain. We found that MSS seemed to be inherently linked to mechanical pain sensitivity in normal pain-free state, which did not require the priming of chronic pain. Moreover, MSS was increasingly higher in pain conditions thought to involve larger central components. Compared to those with average MSS, those with higher MSS were more likely to have multiple numbers of pain comorbidities whereas those with lower MSS were less likely. Additionally, in order to better quantify MSS, we evaluated and modified an improved tool that could be clinically applicable for assessing MSS. The body of research indicates MSS could serve as an additional marker to characterize and stratify pain phenotypes driven by varying degrees of central sensitivity. Additionally, lower MSS or higher MSS could respectively serve as a resilient or a risk factor for the presence of centrally mediated pain conditions. The enhanced identification of markers would help better sort out pain subtypes for improved stratified personalized treatments and direct the implementation of appropriate therapeutic approaches to each subgroup of patients, for instance, desensitization intervention for pain patients characterized with elevated MSS.
Details
- Title: Subtitle
- The characterization of multisensory sensitivity in people with and without chronic pain
- Creators
- Dan Wang
- Contributors
- Laura A Frey Law (Advisor)Jason M Wilken (Committee Member)Donna L. Hammond (Committee Member)Kathleen A. Sluka (Committee Member)Richard K. Shields (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Physical Rehabilitation Science
- Date degree season
- Autumn 2020
- DOI
- 10.17077/etd.005682
- Publisher
- University of Iowa
- Number of pages
- xii, 151 pages
- Copyright
- Copyright 2020 Dan Wang
- Language
- English
- Description illustrations
- color illustrations
- Description bibliographic
- Includes bibliographical references (pages 139-151).
- Public Abstract (ETD)
Chronic pain is a disease that negatively affects people’s quality of life. Unfortunately, chronic pain is challenging to treat clinically in part due to the lack of enough identified markers that can be directly measured to efficiently infer the underlying pathophysiology. For example, markers currently often measured in clinical practice include pain sensitivity and psychological factors yet provide limited success on pain management. Recently, a newly factor of multisensory sensitivity seems to serve as an additional maker to characterize pain profiles. A very few studies have shown that several chronic pain patients, particularly those with centrally mediated pain, frequently report heightened multisensory sensitivity (MSS) (e.g., being easily aversive to bright lights or noises) compared to healthy individuals. However, MSS has far well been characterized given the limited evidence and mixed methodologies utilized across current studies. This dissertation aims to better characterize MSS in people with and without chronic pain. We have found that MSS is fundamentally linked to deep-tissue pain sensitivity in a pain-free state of chronic pain, suggesting the relationship inherently exists and does not need the priming of chronic pain. In order to better quantify MSS, the mod-SSAS was developed as a clinically feasible, brief and valid tool to optimally measure MSS across all five sense systems. Last, we applied the newly developed tool to characterized MSS across a chronic pain continuum thought to involve varying degrees of central mechanisms. We have found MSS appears to be increasingly higher across pain patients driven by from less to more central mechanisms. In practice, MSS could serve as an additional marker that is clinically feasible to access and test, to help differentiate pain phenotypes characterized by a central sensitivity spectrum. Future studies may investigate whether sensory therapeutic intervention targeting MSS could relieve pain for the improvement of personized treatment.
- Academic Unit
- Physical Therapy and Rehabilitation Science
- Record Identifier
- 9984036085902771
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