Open Access Open Badges Research article

Stability of conditioned pain modulation in two musculoskeletal pain models: investigating the influence of shoulder pain intensity and gender

Carolina Valencia1, Lindsay L Kindler2, Roger B Fillingim3 and Steven Z George45*

Author Affiliations

1 Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN, USA

2 School of Nursing, University of Portland, Portland, OR, USA

3 Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA

4 Department of Physical Therapy, University of Florida, UFHSC, Box 100154, Gainesville, FL 32610 - 0154, USA

5 Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA

For all author emails, please log on.

BMC Musculoskeletal Disorders 2013, 14:182  doi:10.1186/1471-2474-14-182

Published: 10 June 2013



Several chronic pain populations have demonstrated decreased conditioned pain modulation (CPM). However there is still a need to investigate the stability of CPM paradigms before the measure can be recommended for implementation. The purpose of the present study was to assess whether shoulder pain intensity and gender influence CPM stability within and between sessions.


This study examined two different musculoskeletal pain models, clinical shoulder pain and an experimental model of shoulder pain induced with eccentric exercise in healthy participants. Patients in the clinical cohort (Nā€‰=ā€‰134) were tested before surgery and reassessed 3 months post-surgery. The healthy cohort (Nā€‰=ā€‰190) was examined before inducing pain at the shoulder, and 48 and 96 hours later.


Our results provide evidence that 1) stability of inhibition is not related to changes in pain intensity, and 2) there are sex differences for CPM stability within and between days.


Fluctuation of pain intensity did not significantly influence CPM stability. Overall, the more stable situations for CPM were females from the clinical cohort and males from the healthy cohort.

Conditioned pain modulation; Stability; Shoulder pain