The effect of hydromorphone therapy on psychophysical measurements of the descending inhibitory pain systems in patients with chronic radicular pain

Objective: Conditioned pain modulation (CPM) and offset analgesia (OA) are considered to represent paradigms of descending inhibitory pain modulation in humans. This study tested the effects of hydromorphone therapy on descending inhibitory pain modulation, as measured by changes from baseline in the magnitudes of CPM and OA. Design: Prospective evaluation. Setting: Institute of Pain Medicine, Rambam Health Care Campus. Subjects: Patients with chronic radicular pain. Methods: Thirty patients received 4weeks of oral hydromorphone treatment at an individually titrated dose (mean±standard deviation dose of 11.6±4.8mg/day). CPM and OA were assessed before and after hydromorphone treatment. CPM was assessed by subtracting the response to a painful phasic heat stimulus administered simultaneously with a conditioning cold pain stimulus, from the response to the same heat stimulus administered alone. The OA paradigm consisted of a three-temperature stimuli train (T1=49°C [5seconds], T2=50°C [5seconds], and T3=49°C [20seconds]). The magnitude of OA was quantified by subtracting minimal pain scores obtained during T3 from the maximal pain scores obtained during T2. Results: CPM scores changed from a baseline of 17.7±20.6 to 21±20.4 following treatment, and OA scores changed from 7.8±20.5 to 9.7±14.6. Wilcoxon signed rank test indicated that these changes were not significant (CPM: P=0.22; OA: P=0.44). McNemar test revealed that the percentage of patients who exhibited a change in the direction of CPM or OA in response to hydromorphone treatment was not significant (CPM: P=0.37; OA: P=0.48). Conclusions: These results suggest that the descending inhibitory pain modulation, as manifested in humans by CPM and OA, is unlikely to be mediated by hydromorphone therapy.