Wednesday, September 21st
4:30pm-6:00pm EDT


Topical Workshop


Assessment, Diagnosis & Measurement of Pain


718 B

Offset Analgesia: At the Crossroads of Pain Modulation and Chronicity

Offset analgesia was first described in 2002 as a disproportionate decrease in perceived pain intensity following a slight incremental decrease in noxious stimulus intensity. Ever since, it has attracted much attention, both for the insights that it can provide into nociceptive processing mechanisms as well as for its clinical relevance to chronic pain. Together with conditioned pain modulation, assessment of offset analgesia has become a key psychophysical paradigm for the evaluation of endogenous pain modulation. Robert Coghill will first provide an overview of the mechanisms supporting offset analgesia and delineate its role in temporal filtering of nociceptive information. Second, Marieke Niesters will discuss the clinical relevance of offset analgesia, with particular focus on how offset analgesia is disrupted during neuropathic pain, and how offset analgesia can be pharmacologically modulated by a variety of analgesic drugs. Lastly, Jiro Kurata will address the involvement of offset analgesia in reward mechanisms as well as descending modulatory systems using evidence derived from neuroimaging studies of both healthy individuals and chronic pain patients. Together, all speakers will address the potential utility of offset analgesia in diagnosing/evaluating chronic pain and how it may serve as a marker for chronic pain.


4:30pm EDT6:00pm EDT

An Overview of Offset Analgesia: Mechanisms and Functional Significance

Tracks: Assessment, Diagnosis & Measurement Of Pain
Categories: Topical Workshop
Presented By: Robert C. Coghill

Nociceptive information undergoes substantial processing in both the temporal and spatial domains. Dr. Coghill will provide an overview of offset analgesia and its impact on nociceptive processing. He will discuss the role of offset analgesia in the temporal filtering of nociceptive input and will contrast it with the role of conditioned pain modulation in the spatial filtering of nociceptive input. Potential peripheral, spinal, descending, and supraspinal mechanisms will be delineated. Finally, the relationship between offset analgesia, conditioned pain modulation, individual differences in pain sensitivity will be described.

4:30pm EDT6:00pm EDT

Offset Analgesia Provides Diagnostic Modality and Mechanistic Insight into Chronic Pain

Tracks: Assessment, Diagnosis & Measurement Of Pain
Categories: Topical Workshop
Presented By: Dr. Jiro Kurata

One feels a relief when pain decreases or goes away. Offset analgesia gives such a relief in an exaggerated manner as if pain has totally gone. In addition to its role in temporal nociceptive filtering, it provides substantial reward on cessation of pain. It might be regarded as overexpectation for pain relief, possibly originating from innate predictive behaviors. What happens to patients with chronic pain in such predictive behavior? Chronic pain has been described as maladaptive response, i.e., adaptation to incurable state of pain. Patients with chronic pain tend to express their pain always as maximum and seldom feel any comfort even after strong therapeutic interventions or drugs. Attenuation of offset analgesia in patients with chronic pain might reflect such pessimistic, maladaptive behavior. Here Dr. Kurata will present recent data on psychophysiological properties of offset analgesia in health and chronic pain, under varied conditions of offset analgesia paradigms. He will further present functional MRI examination of offset analgesia that successfully delineated possible involvement of descending pain modulatory and reward systems.

4:30pm EDT6:00pm EDT

The Relevance of Offset Analgesia in Clinical Practice

Tracks: Assessment, Diagnosis & Measurement Of Pain
Categories: Topical Workshop
Presented By: Dr. Marieke Niesters

Offset analgesia is defined by a disproportionally decrease in pain perception after a small decrease of noxious stimulation. Many patients with chronic pain syndromes, such as painful polyneuropathy, display altered offset analgesia responses compared to healthy volunteers. In the proposed presentation an overview of the latest evidence on offset analgesia in chronic pain patients will be presented. New data on offset analgesia in patients with chronic low back pain will be shown with emphasis on segmental differences. The discriminative properties of offset analgesia to distinguish between health and disease will be presented, as well as the effect of several central and peripheral acting analgesic drugs on offset analgesia responses. Furthermore, the position of offset analgesia in clinical practice and future perspectives will be discussed.


Robert C. Coghill

Cincinnati Children’s Hospital

Dr. Jiro Kurata

Jikei University Graduate School of Medicine

Dr. Marieke Niesters

Anesthesiologist - Pain specialist
Leiden University Medical Center