Open Access Highly Accessed Research article

Association of anxiety with intracortical inhibition and descending pain modulation in chronic myofascial pain syndrome

Liliane Pinto Vidor14, Iraci LS Torres1234*, Liciane Fernandes Medeiros124, Jairo Alberto Dussán-Sarria14, Letizzia Dall’Agnol14, Alicia Deitos14, Aline Brietzke14, Gabriela Laste14, Joanna R Rozisky4, Felipe Fregni5 and Wolnei Caumo1346

Author Affiliations

1 Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

2 Post-Graduate Program in Biologic Sciences: Physiology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

3 Pharmacology Department, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Endereço: Rua Sarmento Leite, 500/202 – CEP, Porto Alegre 90050-170, Brazil

4 Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil

5 Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, United States of America

6 Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2350, Bairro Santa Cecilia, Porto Alegre, Rio Grande do Sul CEP 90035-903, Brazil

For all author emails, please log on.

BMC Neuroscience 2014, 15:42  doi:10.1186/1471-2202-15-42

Published: 19 March 2014



This study aimed to answer three questions related to chronic myofascial pain syndrome (MPS): 1) Is the motor cortex excitability, as assessed by transcranial magnetic stimulation parameters (TMS), related to state-trait anxiety? 2) Does anxiety modulate corticospinal excitability changes after evoked pain by Quantitative Sensory Testing (QST)? 3) Does the state-trait anxiety predict the response to pain evoked by QST if simultaneously receiving a heterotopic stimulus [Conditional Pain Modulation (CPM)]? We included females with chronic MPS (n = 47) and healthy controls (n = 11), aged 19 to 65 years. Motor cortex excitability was assessed by TMS, and anxiety was assessed based on the State-Trait Anxiety Inventory. The disability related to pain (DRP) was assessed by the Profile of Chronic Pain scale for the Brazilian population (B:PCP:S), and the psychophysical pain measurements were measured by the QST and CPM.


In patients, trait-anxiety was positively correlated to intracortical facilitation (ICF) at baseline and after QST evoked pain (β = 0.05 and β = 0.04, respectively) and negatively correlated to the cortical silent period (CSP) (β = -1.17 and β = -1.23, respectively) (P <0.05 for all comparisons). After QST evoked pain, the DRP was positively correlated to ICF (β = 0.02) (P < 0.05). Pain scores during CPM were positively correlated with trait-anxiety when it was concurrently with high DRP (β = 0.39; P = 0.02). Controls’ cortical excitability remained unchanged after QST.


These findings suggest that, in chronic MPS, the imbalance between excitatory and inhibitory descending systems of the corticospinal tract is associated with higher trait-anxiety concurrent with higher DRP.

Transcranial magnetic stimulation; Chronic pain; Noninvasive brain stimulation; Neuromodulation; Anxiety; Myofascial pain syndrome