Influence of ketamine and morphine on descending pain modulation in chronic pain patients: a randomized placebo-controlled cross-over proof-of-concept.

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Influence of ketamine and morphine on descending pain modulation in chronic pain patients: a randomized placebo-controlled cross-over proof-of-concept study M. Niesters, L. Aarts, E. Sarton, A. Dahan British Journal of Anaesthesia Volume 110, Issue 6, Pages 1010-1016 (June 2013) DOI: 10.1093/bja/aes578 Copyright © 2013 The Author(s) Terms and Conditions

Fig 1 Quantitative sensory testing. The test site was the site most affected by pain (either hand or foot; blue symbols), the control site was the face (green symbols). Data are the population mean z-scores (sem). z-scores were calculated in relation to a population of healthy subjects as determined by Rolke and colleagues.39 The horizontal broken lines indicate the +2 and −2 z-score boundaries. A specific QST test is considered abnormal if the test-value lies above the upper or below the lower boundary. CDT, cold detection threshold; WDT, warm detection threshold; TSL, thermal sensory limen; PHS, paradoxal heat sensation; CPT, cold pain threshold; HPT, heat pain threshold; MDT, mechanical detection threshold; MPT, mechanical pain threshold; MPS, mechanical pain sensitivity; ALL, dynamic mechanical allodynia; WUR, windup ratio; VDT, vibration detection threshold; PPT, pressure pain threshold. British Journal of Anaesthesia 2013 110, 1010-1016DOI: (10.1093/bja/aes578) Copyright © 2013 The Author(s) Terms and Conditions

Fig 2 (a) AUC values of the eVAS-time responses without conditioning stimulus (–) and with conditioning stimulus (+). The conditioning stimulus had no effect on baseline responses, but decreased eVAS responses after treatment with placebo, morphine, and ketamine. *P<0.001 vs AUC of eVAS-time responses without conditioning stimulus. AUCs of responses without conditioning stimuli were similar for baseline, placebo, morphine, and ketamine. NS, not significant. (b) Magnitude of conditioning pain modulation (CPM%) responses after treatment with placebo (PLCB), morphine (MOR), and ketamine (KET). The magnitude of CPM% responses did not differ among treatments. British Journal of Anaesthesia 2013 110, 1010-1016DOI: (10.1093/bja/aes578) Copyright © 2013 The Author(s) Terms and Conditions

Fig 3 Conditioning pain modulation (CPM% responses) compared with spontaneous pain ratings in chronic pain patients. Data are mean (sem). British Journal of Anaesthesia 2013 110, 1010-1016DOI: (10.1093/bja/aes578) Copyright © 2013 The Author(s) Terms and Conditions