Pain perception is altered in patients with medication-overuse headache but can improve after detoxification

Abstract Background Previously, central sensitization has been found in chronic, primary headaches but pain perception in MOH patients has only scarcely been studied. Aim To investigate pain perception before and during detoxification in patients with medication overuse headache (MOH). Methods 35 patients with MOH following structured detoxification programmes were tested before and 2, 6 and 12 months after withdrawal and 40 age and sex matched, healthy volunteers were tested for comparison. We measured cephalic and extra cephalic pressure pain thresholds (PPT) and supra-threshold pressure pain (STPP) as well as extra cephalic pain thresholds, supra-threshold pain and wind-up for electrical stimulation. Results At baseline, cephalic and extra cephalic PPTs were significantly lower in patients with MOH compared with healthy volunteers. Cephalic STPP was significantly higher in MOH patients compared with healthy volunteers but decreased significantly from baseline to the 6-month and 12-month follow-up. Supra-threshold pain for a single electrical stimulus was significantly higher in MOH patients compared with healthy volunteers. In contrast to healthy volunteers, patients with MOH did not exhibit wind-up before withdrawal. After 2 months, MOH patients had regained ability to wind-up and this persisted at 6-month and 12-month follow-up. Conclusions Patients with MOH have altered pain sensation and exhibit both allodynia and hyperalgesia indicating central sensitization. Withdrawal from medication overuse causes significant decrease in central sensitization. The ability to wind-up is altered in MOH patients, probably as a consequence of medication overuse, but it can be regained after withdrawal. These findings emphasize the need for detoxification in MOH.

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Modulation of central sensitisation by detoxification in MOH: Results of a 12-month detoxification study

Cephalalgia ◽

10.1177/0333102412475235 ◽

2013 ◽

Vol 33 (7) ◽

pp. 444-453 ◽

Cited By ~ 26

Author(s):

Signe B Munksgaard ◽

Lars Bendtsen ◽

Rigmor H Jensen

Keyword(s):

Temporal Summation ◽

Pain Perception ◽

Threshold Pressure ◽

Healthy Controls ◽

Central Sensitisation ◽

Pain Thresholds ◽

Pressure Pain ◽

Pain Scores ◽

Pressure Pain Thresholds

Background Human and animal models suggest that central sensitisation plays a role in medication-overuse headache (MOH). We aimed to study pain perception in MOH patients before and a year after withdrawal. Methods We examined pain perception in 35 MOH patients before and two, six and 12 months after detoxification. For baseline comparison, we tested 40 healthy controls. We measured cephalic and extra-cephalic pressure-pain thresholds and supra-threshold pressure-pain scores and extra-cephalic pain thresholds, supra-threshold pain scores and temporal summation for electrical stimulation. Results Of the 35 patients, 21 patients completed the entire study and remained cured of MOH. Statistically significant differences between patients and healthy controls were found in cephalic pressure-pain thresholds (137.3 kPa vs. 170 kPa, p < 0.05), extra-cephalic pressure pain thresholds (213.3 vs. 274.3 kPa, p < 0.05), in cephalic supra-threshold pressure-pain scores measured on a 100 mm visual analogue scale (61 vs. 27 mm, p < 0.05) and extra-cephalic supra-threshold pain scores for electrical stimulation (19.0 vs. 10.0 mm, p < 0.05). Cephalic supra-threshold pain scores decreased statistically significantly from 50.3 mm at baseline to 28.0 mm at the 12-month follow-up. In contrast to controls, temporal summation was not found in MOH patients before withdrawal, but after detoxification temporal summation normalised. Conclusion The central nervous system is sensitised in patients with MOH. For the first time we demonstrate that the pain perception continues to normalise up to a year after detoxification. This emphasises the importance of detoxification and follow-up to prevent relapse.

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Pressure pain thresholds in children before and after surgery: a prospective study

Scandinavian Journal of Pain ◽

10.1515/sjpain-2019-0130 ◽

2020 ◽

Vol 20 (2) ◽

pp. 339-344

Author(s):

Line Kjeldgaard Pedersen ◽

Polina Martinkevich ◽

Ole Rahbek ◽

Lone Nikolajsen ◽

Bjarne Møller-Madsen

Keyword(s):

Prospective Study ◽

Orthopaedic Surgery ◽

Rating Scale ◽

Pain Thresholds ◽

Pressure Pain ◽

Bonferroni Adjustment ◽

Pressure Pain Thresholds ◽

Significant Difference ◽

Baseline Values

AbstractBackground and aimsThis prospective study aimed to assess pressure pain thresholds (PPTs) by pressure algometry and the correlation to postoperative pain in children undergoing orthopaedic surgery. We hypothesized, that the PPTs would decline immediately after elective orthopaedic surgery and return to baseline values at follow-up.MethodsThirty children aged 6–16 years were included. PPTs and intensity of pain (Numerical Rating Scale, NRS) were assessed 3–6 weeks before surgery (baseline), 1–2 h before surgery (Day 0), the first postoperative day (Day 1) and 6–12 weeks after surgery (Follow-up).ResultsA significant difference of PPTs between the four assessments was seen using the Friedman test for detecting differences across multiple tests and Wilcoxon signed-rank test with a Bonferroni adjustment. The changes in PPTs between baseline (PPTcrus = 248 kPa, PPTthenar = 195 kPa) and day 1 (PPTcrus = 146 kPa, PPTthenar = 161 kPa) showed a decline of PPTs as hypothesized (Zcrus = 2.373, p = 0.018; Zthenar = 0.55, p = 0.581). More surprisingly, a significant decrease in PPTs between baseline and day 0, just before surgery (PPTcrus = 171 kPa, PPTthenar = 179 kPa), was also measured (Zcrus = 2.475, p = 0.013; Zthenar = 2.414, p = 0.016). PPTs were positively correlated to higher age, weight and height; but not to NRS or opioid equivalent use.ConclusionsChildren undergoing orthopaedic surgery demonstrate significant changes in PPTs over time. The PPTs decrease significantly between baseline and day 0, further decreases the first day postoperatively and returns to baseline values at follow-up. This suggests that other factors than surgery modulate the threshold for pain.ImplicationsAwareness of pressure pain thresholds may help identify children with affected pain perception and hence improve future pain management in children undergoing orthopaedic surgery. Factors as for example anticipatory anxiety, psychological habitus, expected pain, catastrophizing, distraction, physical activity, patient education and preoperative pain medication might play a role in the perception of pain and need further investigation.

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Tests for central sensitization in general practice: a Delphi study

BMC Family Practice ◽

10.1186/s12875-021-01539-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Carine den Boer ◽

Berend Terluin ◽

Johannes C. van der Wouden ◽

Annette H. Blankenstein ◽

Henriëtte E. van der Horst

Keyword(s):

Systematic Review ◽

Chronic Pain ◽

General Practice ◽

Delphi Study ◽

Central Sensitization ◽

Added Value ◽

Pain Thresholds ◽

Pressure Pain ◽

Pressure Pain Thresholds ◽

Central Sensitization Inventory

Abstract Introduction Central sensitization (CS) may explain the persistence of symptoms in patients with chronic pain and persistent physical symptoms (PPS). There is a need for assessing CS in the consultation room. In a recently published systematic review, we made an inventory of tests for CS. In this study we aimed to assess which tests might have added value, might be feasible and thus be suitable for use in general practice. Methods We conducted a Delphi study consisting of two e-mail rounds to reach consensus among experts in chronic pain and PPS. We invited 40 national and international experts on chronic pain and PPS, 27 agreed to participate. We selected 12 tests from our systematic review and additional searches; panellists added three more tests in the first round. We asked the panellists, both clinicians and researchers, to rate these 15 tests on technical feasibility for use in general practice, added value and to provide an overall judgement for suitability in general practice. Results In two rounds the panellists reached consensus on 14 of the 15 tests: three were included, eleven excluded. Included were the Central Sensitization Inventory (CSI), pressure pain thresholds (PPTs) and monofilaments. No consensus was reached on the Sensory Hypersensitivity Scale. Conclusion In a Delphi study among an international panel of experts, three tests for measuring CS were considered to be suitable for use in general practice: the Central Sensitization Inventory (CSI), pressure pain thresholds (PPTs) and monofilaments.

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Acupuncture for Frequent Migraine: A Randomized, Patient/Assessor Blinded, Controlled Trial with One-Year Follow-Up

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2015/920353 ◽

2015 ◽

Vol 2015 ◽

pp. 1-14 ◽

Cited By ~ 6

Author(s):

Yanyi Wang ◽

Charlie Changli Xue ◽

Robert Helme ◽

Cliff Da Costa ◽

Zhen Zheng

Keyword(s):

Controlled Trial ◽

Sham Acupuncture ◽

Manual Acupuncture ◽

Pain Thresholds ◽

Pressure Pain ◽

Pressure Pain Thresholds ◽

One Year ◽

The One

Objectives. This study aimed to evaluate the efficacy and safety of manual acupuncture as a prophylaxis for frequent migraine.Methods. Fifty frequent migraineurs were randomly allocated to receive 16 sessions of either real acupuncture (RA = 26) or sham acupuncture (SA = 24) during 20 weeks. The primary outcomes were days with migraine over four weeks, duration, and intensity of migraine and the number of responders with more than 50% reduction of migraine days. The secondary outcomes were the relief medication, quality of migraine, quality of life, and pressure pain thresholds.Results. The two groups were comparable at baseline. At the end of the treatment, when compared with the SA group, the RA group reported significant less migraine days (RA: 5.2 ± 5.0; SA: 10.1 ± 7.1;P=0.008), less severe migraine (RA: 2.18 ± 1.05; SA: 2.93 ± 0.61;P=0.004), more responders (RA: 19 versus SA: 7), and increased pressure pain thresholds. No other group difference was found. Group differences were maintained at the end of the three-month follow-up, but not at the one-year follow-up. No severe adverse event was reported. Blinding was successful.Discussion. Manual acupuncture was an effective and safe treatment for short-term relief of frequent migraine in adults. Larger trials are warranted.

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Role of educational programs in management of patients with medication-overuse headache

Neurology neuropsychiatry Psychosomatics ◽

10.14412/2074-2711-2021-3-27-33 ◽

2021 ◽

Vol 13 (3) ◽

pp. 27-33

Author(s):

A. E. Shagbazyan ◽

N. A. Kovalchuk ◽

G. R. Tabeeva

Keyword(s):

Medication Overuse ◽

Medication Overuse Headache ◽

Primary Headache ◽

Fold Increase ◽

Educational Programs ◽

Primary Headaches ◽

Effective Strategies ◽

Group I ◽

Headache Diary

Patients with primary headaches are prone to frequent uncontrolled use of analgesics, leading to medication-overuse headache (MOH). One of the most accessible and effective strategies for its prevention is informing patients about the potential danger of its development. For this, training programs («schools») are conducted.Objective: to evaluate the effectiveness of educational programs in management of patients with MOH and its prevention.Patients and methods. We included 120 patients (12 men and 108 women, mean age: men – 46.3±3.54 years, women – 41.3±9.5 years) with primary headache and MOH. The follow-up period was 12 months. First, patients were divided into two groups depending on the clinical diagnosis: group I (n=44) – patients with chronic primary headaches without MOH, group II (n=76) – patients with chronic primary headaches and MOH. Then, patients in each group were randomized into subgroups depending on the prescribed therapy. All participants underwent repeated clinical examinations and questionnaires assessment at 1-, 3- and 12-months follow-ups. In addition, all patients kept a headache diary. An educational «school» developed for this study was held in those subgroups where educational programs were specified.Results and discussion. We observed a significant decrease in mean Headache-Attributed Lost Time (HALT) and Headache Impact Test (HIT-6) scores (р<0,05) at 12-months follow-up in subgroups where headache educational programs were combined with drug therapy, compared to the subgroups without educational programs. At the end of follow-up, we found a mean 1.75-fold increase in patients' treatment satisfaction (compared to baseline) in the subgroups where the «school» was held. Financial costs during the 12-month follow-up period for patients decreased by seven times because most patients stopped taking medications to relieve headaches.Conclusion. Information and educational programs are an integral part of the management of patients with MOH.

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Exploring the pain in patellofemoral pain: A systematic review and meta-analysis examining signs of central sensitization

Journal of Athletic Training ◽

10.4085/1062-6050-0190.20 ◽

2020 ◽

Author(s):

Kemery J. Sigmund ◽

Marie K. Hoeger Bement ◽

Jennifer E. Earl-Boehm

Keyword(s):

Systematic Review ◽

Central Sensitization ◽

Temporal Summation ◽

Meta Analysis ◽

Pain Modulation ◽

Conditioned Pain Modulation ◽

Pain Thresholds ◽

Pressure Pain ◽

Pressure Pain Thresholds ◽

Pain Mapping

Objective: Patellofemoral pain has high recurrence rates and minimal long-term treatment success. Central sensitization refers to dysfunctional pain modulation that occurs when nociceptive neurons become hyper responsive. Research in this area in PFP has been increasingly productive in the past decade. The aim of this review is to determine whether evidence supports manifestations of central sensitization in individuals with PFP. Data sources: MeSH terms for quantitative sensory testing (QST) pressure pain thresholds, conditioned pain modulation, temporal summation, sensitization, hyperalgesia, and anterior knee pain or PFP were searched in PubMed, SportDiscus, CINAHL, Academic Search Complete, and Ebscohost. Study Selection: Peer reviewed studies written in English, published between 2005–2020 which investigated QST and/or pain mapping in a sample with PFP were included in this review. Data Extraction: The initial search yielded 140 articles. After duplicates were removed, 78 article abstracts were reviewed. Full-text review of 21 studies occurred, with 11 studies included in the meta-analysis and eight studies included in the systematic review. Data Synthesis: A random-effects meta-analysis was conducted for four QST variables (local pressure pain thresholds, remote pressure pain thresholds, conditioned pain modulation, temporal summation). Strong evidence supports lower local and remote pressure pain thresholds, impaired conditioned pain modulation, and facilitated temporal summation in individuals with PFP compared to pain-free individuals. Conflicting evidence is presented for heat and cold pain thresholds. Pain mapping demonstrated expanding pain patterns associated with long PFP symptom duration. Conclusions: Signs of central sensitization are present in individuals with PFP, indicating altered pain modulation. PFP etiological and treatment models should reflect the current body of evidence regarding central sensitization. Signs of central sensitization should be monitored clinically and treatments with central effects should be considered as part of a multi-modal plan of care. Registration Number: This review is registered with Prospero (CRD42019127548) Registration URL: https://www.crd.york.ac.uk/PROSPERO Key Points:

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Assessment of Pressure-Pain Thresholds and Central Sensitization of Pain in Lateral Epicondylalgia

Pain Medicine ◽

10.1111/pme.12021 ◽

2013 ◽

Vol 14 (2) ◽

pp. 297-304 ◽

Cited By ~ 36

Author(s):

Anders Jespersen ◽

Kirstine Amris ◽

Thomas Graven-Nielsen ◽

Lars Arendt-Nielsen ◽

Else Marie Bartels ◽

...

Keyword(s):

Central Sensitization ◽

Pain Thresholds ◽

Pressure Pain ◽

Pressure Pain Thresholds ◽

Lateral Epicondylalgia

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High concurrent validity between digital and analogue algometers to measure pressure pain thresholds in healthy participants and people with migraine: a cross-sectional study

The Journal of Headache and Pain ◽

10.1186/s10194-021-01278-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

René F. Castien ◽

Michel W. Coppieters ◽

Tom S. C. Durge ◽

Gwendolyne G. M. Scholten-Peeters

Keyword(s):

Concurrent Validity ◽

Tibialis Anterior Muscle ◽

Intraclass Correlation ◽

Cephalic Region ◽

Limits Of Agreement ◽

Temporal Muscle ◽

Pain Thresholds ◽

Pressure Pain ◽

Pressure Pain Thresholds ◽

Healthy Participants

Abstract Background Pressure pain thresholds (PPTs) are commonly assessed to quantify mechanical sensitivity in various conditions, including migraine. Digital and analogue algometers are used, but the concurrent validity between these algometers is unknown. Therefore, we assessed the concurrent validity between a digital and analogue algometer to determine PPTs in healthy participants and people with migraine. Methods Twenty-six healthy participants and twenty-nine people with migraine participated in the study. PPTs were measured interictally and bilaterally at the cephalic region (temporal muscle, C1 paraspinal muscles, and trapezius muscle) and extra-cephalic region (extensor carpi radialis muscle and tibialis anterior muscle). PPTs were first determined with a digital algometer, followed by an analogue algometer. Intraclass correlation coefficients (ICC3.1) and limits of agreement were calculated to quantify concurrent validity. Results The concurrent validity between algometers in both groups was moderate to excellent (ICC3.1 ranged from 0.82 to 0.99, with 95%CI: 0.65 to 0.99). Although PPTs measured with the analogue algometer were higher at most locations in both groups (p < 0.05), the mean differences between both devices were less than 18.3 kPa. The variation in methods, such as a hand-held switch (digital algometer) versus verbal commands (analogue algometer) to indicate when the threshold was reached, may explain these differences in scores. The limits of agreement varied per location and between healthy participants and people with migraine. Conclusion The concurrent validity between the digital and analogue algometer is excellent in healthy participants and moderate in people with migraine. Both types of algometer are well-suited for research and clinical practice but are not exchangeable within a study or patient follow-up.

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The tolerance to stretch is linked with endogenous modulation of pain

Scandinavian Journal of Pain ◽

10.1515/sjpain-2020-0010 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Morten Pallisgaard Støve ◽

Rogerio Pessoto Hirata ◽

Thorvaldur Skuli Palsson

Keyword(s):

Range Of Motion ◽

Pain Sensitivity ◽

Cold Pressor Test ◽

Cold Pressor ◽

Static Stretch ◽

Pain Thresholds ◽

Pressure Pain ◽

Pressor Test ◽

Pressure Pain Thresholds ◽

Exercise Induced

Abstract Objectives The effect of stretching on joint range of motion is well documented, and although sensory perception has significance for changes in the tolerance to stretch following stretching the underlining mechanisms responsible for these changes is insufficiently understood. The aim of this study was to examine the influence of endogenous pain inhibitory mechanisms on stretch tolerance and to investigate the relationship between range of motion and changes in pain sensitivity. Methods Nineteen healthy males participated in this randomized, repeated-measures crossover study, conducted on 2 separate days. Knee extension range of motion, passive resistive torque, and pressure pain thresholds were recorded before, after, and 10 min after each of four experimental conditions; (i) Exercise-induced hypoalgesia, (ii) two bouts of static stretching, (iii) resting, and (iv) a remote, painful stimulus induced by the cold pressor test. Results Exercise-induced hypoalgesia and cold pressor test caused an increase in range of motion (p<0.034) and pressure pain thresholds (p<0.027). Moderate correlations in pressure pain thresholds were found between exercise-induced hypoalgesia and static stretch (Rho>0.507, p=0.01) and exercise-induced hypoalgesia and the cold pressor test (Rho=0.562, p=0.01). A weak correlation in pressure pain thresholds and changes in range of motion were found following the cold pressor test (Rho=0.460, p=0.047). However, a potential carryover hypoalgesic effect may have affected the results of the static stretch. Conclusions These results suggest that stretch tolerance may be linked with endogenous modulation of pain. Present results suggest, that stretch tolerance may merely be a marker for pain sensitivity which may have clinical significance given that stretching is often prescribed in the rehabilitation of different musculoskeletal pain conditions where reduced endogenous pain inhibition is frequently seen.

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