Romero-Godoy Rosalinda, Romero-Godoy Sara Raquel, Romero-Acebal Manuel, Gutiérrez-Bedmar Mario
Department of Nursing and Physiotherapy, University of Balearic Islands, 07122 Palma, Spain.
Cognitive Affective Neuroscience & Clinical Psychology Research Group, Institute of Health Science Research (IUNICS-IdISBa), ECYCS Research Group, University of Balearic Islands, 07120 Palma, Spain.
J Clin Med. 2022 Mar 29;11(7):1905. doi: 10.3390/jcm11071905.
Chronic tension-type headache (CTTH) is a common disease with no fully defined pathophysiological processes. We designed a study to value electrophysiological responses in these patients and their correlation with possible psychopathological manifestations in order to deepen understanding of central and peripheral mechanisms of CTTH. In 40 patients with CTTH and 40 healthy controls, we used electrical stimulation to determine sensory threshold (SPT) and pain perception threshold (PPT) and the characteristics of the electrophysiological sensory nerve action potential (SNAP): initial sensory response (ISR) and supramaximal response (SMR). We then calculated the intensity differences between thresholds (IDT), namely SPT-PPT, ISR-SMR and SMR-PPT, and correlated these IDTs with psychological characteristics: trait and state anxiety, depression, and emotional regulation. The SPT, together with the ISR and SMR thresholds, were higher (p < 0.01) in CTTH patients. The SMR-PPT IDT was smaller and correlated with significantly higher indicators of depression, state and trait anxiety, and poorer cognitive reappraisal. CTTH patients have less capacity to recognize non-nociceptive sensory stimuli, greater tendency toward pain facilitation, and a poor central pain control requiring higher stimulation intensity thresholds to reach the start and the peak amplitude of the SNAP. This is consistent with relative hypoexcitability of the Aβ nerve fibers in distant regions from the site of pain, and therefore, it could be considered a generalized dysfunction with a focal expression. Pain facilitation is directly associated with psychological comorbidity.
慢性紧张型头痛（CTTH）是一种常见疾病，其病理生理过程尚未完全明确。我们设计了一项研究，以评估这些患者的电生理反应及其与可能的精神病理表现的相关性，从而加深对CTTH中枢和外周机制的理解。在40例CTTH患者和40名健康对照者中，我们使用电刺激来确定感觉阈值（SPT）和疼痛感知阈值（PPT）以及电生理感觉神经动作电位（SNAP）的特征：初始感觉反应（ISR）和超强反应（SMR）。然后，我们计算阈值之间的强度差异（IDT），即SPT-PPT、ISR-SMR和SMR-PPT，并将这些IDT与心理特征：特质和状态焦虑、抑郁及情绪调节进行关联。CTTH患者的SPT以及ISR和SMR阈值更高（p<0.01）。SMR-PPT IDT更小，且与抑郁、状态和特质焦虑的显著更高指标以及较差的认知重评相关。CTTH患者识别非伤害性感觉刺激的能力较弱，疼痛易化倾向更大，且中枢疼痛控制较差，需要更高的刺激强度阈值才能达到SNAP的起始和峰值幅度。这与远离疼痛部位的Aβ神经纤维相对兴奋性降低一致，因此，可以认为这是一种具有局灶性表现的全身性功能障碍。疼痛易化与心理共病直接相关。
