'Pain inhibits pain' mechanisms: Is pain modulation simply due to distraction?

Ruth Moont, Dorit Pud, Elliot Sprecher, Gil Sharvit, David Yarnitsky

Research output: Contribution to journalArticlepeer-review


'Diffuse noxious inhibitory controls' (DNIC), a form of supraspinal descending endogenous analgesia, requires a noxious conditioning stimulus for pain attenuation. This may be partly dependent on a distraction effect. The term "conditioned pain modulation" (CPM) has recently been introduced to describe the psychophysical paradigm to test DNIC. The present study aimed to determine whether distraction and tonic heat stimulation inhibit pain through the same or different mechanisms by looking at whether there is a similar or even an additive effect on pain attenuation. Test pain was brief heat stimulation applied to the left volar of 34 healthy volunteers. For conditioning, the right hand was immersed in 46.5 °C water. Distraction was provided by three different difficulty levels of continuous cognitive visual tasks. Experimental blocks consisted of test pain: (1) alone; 'baseline', (2) with conditioning pain; 'CPM', (3) with distraction; 'distraction' and (4) with conditioning pain and distraction; 'combined'. They were randomized and repeated three times and pain intensity and unpleasantness rated. Results showed an overall effect of experimental block on test pain intensity (P = 0.0125). Post-hoc tests revealed a significant reduction in pain intensity ratings under Combined (21.2 ± 2.3; mean ± SEM) compared to CPM alone (16.0 ± 2.3) (P < 0.05). Furthermore, at all levels of distraction there were always a few subjects who were not distracted despite expressing CPM. Based on the additive effect of CPM and distraction on pain inhibition, and the cases of no distraction despite CPM, we suggest that CPM acts independently from distraction.

Original languageEnglish
Pages (from-to)113-120
Number of pages8
Issue number1
StatePublished - Jul 2010


  • Attention
  • Conditioned pain modulation (CPM)
  • Diffuse noxious inhibitory controls (DNIC)
  • Distraction
  • Endogenous analgesia

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Anesthesiology and Pain Medicine


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