Two-Point Discrimination Training for Chronic Pain

(TPD Trial)

Overseen By Eric Leon

Age: < 18

Sex: Any

Trial Phase: Phase < 1

Sponsor: Children's Hospital Medical Center, Cincinnati

Disqualifiers: Mental health disorders, Drug dependence, Developmental delays, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 10

Duration: 5 weeks

60 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment One-point discrimination training, Two-point discrimination training for chronic pain?

Research suggests that chronic pain patients have reduced sensitivity to touch, and two-point discrimination training might help improve this by retraining the brain's perception of touch. Additionally, sensory training could be more effective for certain patterns of sensory dissociation in chronic pain, indicating potential benefits for some patients. ^{1 2 3 4 5}

How does two-point discrimination training differ from other treatments for chronic pain?

Two-point discrimination training is unique because it focuses on retraining the brain's sensory perception by improving the ability to distinguish between two close points on the skin, which can help reorganize the sensory cortex and reduce pain. This approach is different from typical pain treatments that often focus on medication or physical therapy, as it directly targets the brain's processing of sensory information. ^{2 4 6 7 8}

What is the purpose of this trial?

SPECIFIC AIMS Pain in both youth and adults is a complex, subjective and personal experience, and remains poorly understood. One particularly perplexing dimension of some forms of pain is the tendency of pain to spread outside of an affected body site to adjacent location, and then to unaffected body sites. Such widespread pain may reflect an altered spatial tuning of somatosensory processing, such that lateral inhibition is diminished, thereby allowing pain to spread. To date, no therapies exist which are designed specifically to diminish or even reverse the spatial spread of pain. However, training in two-point discrimination holds the potential to retune spatial aspects of somatosensory processing and may represent a novel therapy for widespread pain. Thus, the present investigation will test the following aims: Aim 1. Do youth with chronic pain have disrupted spatial tuning of somatosensory processing? Deficits in two point tactile discrimination have long been noted in adults with chronic pain, but such deficits remain poorly documented in pediatric chronic pain patients. In order to determine if such deficits exist, youth with both chronic pain and healthy youth will undergo assessment of two point discrimination thresholds. Aim 2. Does two-point discrimination training result in diminished pain and disability in youth with somatic pain? After initial characterization of tactile discrimination thresholds, youth with chronic pain will participate in multiple sessions of either two-point discrimination training or a single-point spatially-directed attentional control condition. Training will involve up to 9 additional sessions. Efficacy of training will be assessed by 1) reductions in the spatial extent of pain, 2) reductions in pain intensity and unpleasantness, and 3) reductions in pain-related disability.

Research Team

Robert C Coghill, Ph.D.

Principal Investigator

Children's Hospital Medical Center, Cincinnati

Eligibility Criteria

This trial is for youths aged 10-17 with chronic pain conditions like fibromyalgia, complex regional pain syndrome, and other widespread musculoskeletal pains. Participants must be in good health overall and fluent in English. It's not for those with drug/alcohol dependence, primary migraine or visceral pain complaints, significant mental health disorders as per DSM V, or developmental impairments.

Inclusion Criteria

You experience pain in your lower back.

Control Participants: Youth in good general health

High fluency in written and oral English language

Exclusion Criteria

You have a dependence on alcohol or drugs.

You experience headaches or stomach pain without a clear physical cause.

You have a serious mental health condition like bipolar disorder, major depression, or psychosis as defined by DSM V.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Initial Assessment

Participants undergo assessments of two-point and single-point discrimination thresholds

1 session

1 visit (in-person)

Treatment

Participants with chronic pain undergo up to 9 sessions of two-point discrimination training or single-point spatially-directed attentional control

5 weeks

Up to 9 visits (in-person)

Follow-up

Participants are monitored for changes in pain ratings, spatial extent of pain, and pain-related disability

4 weeks

Treatment Details

Interventions

• One-point discrimination training
• Two-point discrimination training

Trial Overview The study tests if training in two-point discrimination can help reduce the spread of pain by retuning somatosensory processing. Youths will undergo assessments and then participate in multiple sessions of either two-point discrimination training or a control activity focusing on single-point attention.

Participant Groups

Group I: Two-point intervention Experimental Treatment 1 Intervention

Two point discrimination training.

Group II: Healthy Controls Active Control 1 Intervention

Observational component of differences in discrimination between chronic pain patients and healthy controls.

Group III: One-point intervention Active Control 1 Intervention

One point discrimination of size of probe

Who Is Running the Clinical Trial?

Children's Hospital Medical Center, Cincinnati

Lead Sponsor

Trials

844

Recruited

6,566,000+

References

1. United States pubmed.ncbi.nlm.nih.gov

Inter-Individual Differences in the Responses to Pain Neuroscience Education in Adults With Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. [2021]

2. England pubmed.ncbi.nlm.nih.gov

Sensory dissociation in chronic low back pain: Two case reports. [2018]

3. United States pubmed.ncbi.nlm.nih.gov

Effectiveness of training physical therapists in pain neuroscience education for patients with chronic spine pain: a cluster-randomized trial. [2023]

4. United States pubmed.ncbi.nlm.nih.gov

Tactual sensitivity of chronic pain patients to non-painful stimuli. [2021]

5. United States pubmed.ncbi.nlm.nih.gov

Validating the MPI-DLV using experience sampling data. [2019]

6. Germany pubmed.ncbi.nlm.nih.gov

[Two-point discrimination through electrical stimulation of receptive fields]. [2020]

7. Germany pubmed.ncbi.nlm.nih.gov

[Automated two-point discrimination (TPD) for phantom pain : Effect of a 3‑week automated therapy based on TPD for a transtibial amputee with phantom pain]. [2018]

8. Germany pubmed.ncbi.nlm.nih.gov

[Two-point discrimination for phantom pain: effect of a 4-week therapy in an upper arm amputee with phantom pain]. [2021]