• Dawn Wong Lit Wan, Lars Arendt-Nielsen, Kelun Wang, Charlie Changli Xue, Yanyi Wang, and Zhen Zheng.
• School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia.
• J Pain. 2018 Aug 1; 19 (8): 897-909.

AbstractHealthy humans can be divided into the pain adaptive (PA) and the pain nonadaptive (PNA) groups; PA showed a greater decrease in pain rating to a cold pressor test (CPT) than PNA. This study examined if the dichotomy of pain adaptability existed in individuals with chronic musculoskeletal pain. CPTs at 2°C and 7°C were used to assess the status of pain adaptability in participants with either chronic nonspecific low back pain or knee osteoarthritis. The participants' potency of conditioned pain modulation (CPM) and local inhibition were measured. The strengths of pain adaptability at both CPTs were highly correlated. PA and PNA did not differ in their demographic characteristics, pain thresholds from thermal and pressure stimuli, or potency of local inhibition or CPM. PA reached their maximum pain faster than PNA (t41 = -2.76, P < .01), and had a gradual reduction of pain unpleasantness over 7 days whereas PNA did not (F6,246 = 3.01, P = .01). The dichotomy of pain adaptability exists in musculoskeletal pain patients. Consistent with the healthy human study, the strength of pain adaptability and potency of CPM are not related. Pain adaptability could be another form of endogenous pain inhibition of which clinical implication is yet to be understood.Copyright © 2018 The American Pain Society. Published by Elsevier Inc. All rights reserved.

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