Department of Psychology, University of Jaén, 23071, Jaén, Spain.
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
Sci Rep. 2021 Feb 25;11(1):4582. doi: 10.1038/s41598-021-84157-1.
Migraine headache is a pain condition characterized by severe and recurrent unilateral head pain. Among other mechanisms, central pain sensitization processes seem to be involved in the disorder. An experimental protocol based on slowly repeated evoked pain (SREP) has been shown to indicate pain sensitization in fibromyalgia patients and differentiate these patients from healthy individuals and rheumatoid arthritis patients. This study examined SREP sensitization in migraine patients and explored its potential usefulness as a central sensitization marker. The SREP protocol was administered to 40 episodic migraine (EM) patients not currently experiencing a headache and 40 healthy controls. SREP consisted of a series of 9 suprathreshold painful pressure stimuli of 5 s duration and a 30 s interstimulus interval. SREP sensitization was indexed by the increase in pain ratings across the stimuli. Pain threshold, pain tolerance and temporal summation of pain were also assessed. SREP sensitization was observed in EM, but not in healthy individuals (p < .001). SREP differentiated between EM and healthy individuals with up to 75% diagnostic accuracy. Pain threshold, pain tolerance and temporal summation of pain did not show significant discriminative ability. An SREP index value of 0.5 was the most sensitive cut-off for detecting central pain sensitization when prioritizing diagnostic sensitivity (0.88). Results provide evidence for SREP as a possible central sensitization marker with potential clinical utility in migraine patients. Inclusion of SREP in Quantitative Sensory Testing protocols may enhance the assessment of altered pain modulation in different pain conditions.
偏头痛是一种以严重且反复发作的单侧头痛为特征的疼痛疾病。在其他机制中，中枢疼痛敏化过程似乎与该疾病有关。基于缓慢重复诱发疼痛（SREP）的实验方案已被证明可指示纤维肌痛患者的疼痛敏化，并将这些患者与健康个体和类风湿关节炎患者区分开来。本研究检查了偏头痛患者的 SREP 敏化，并探讨了其作为中枢敏化标志物的潜在用途。该 SREP 方案应用于 40 名未出现头痛的发作性偏头痛（EM）患者和 40 名健康对照者。SREP 由 9 个超阈值疼痛压力刺激组成，每个刺激持续 5 秒，刺激间隔 30 秒。SREP 敏化通过刺激过程中疼痛评分的增加来衡量。还评估了疼痛阈值、疼痛耐量和疼痛的时间总和。在 EM 中观察到 SREP 敏化，但在健康个体中未观察到（p<0.001）。SREP 可区分 EM 和健康个体，诊断准确性高达 75%。疼痛阈值、疼痛耐量和疼痛的时间总和没有表现出显著的区分能力。当优先考虑诊断敏感性（0.88）时，SREP 指数值为 0.5 是检测中枢疼痛敏化的最敏感截止值。结果为 SREP 作为一种可能的中枢敏化标志物提供了证据，在偏头痛患者中具有潜在的临床应用价值。在定量感觉测试方案中纳入 SREP 可能会增强对不同疼痛状况下疼痛调节改变的评估。
