Intact Conditioned Pain Modulation Despite Altered Pain Sensitivity in Migraine Across Phases and Sites

IF 3.8 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain Pub Date : 2026-10-26 DOI:10.1002/ejp.70433

Tibor M. Szikszay, Jakob Poehlmann, Waclaw M. Adamczyk, Kerstin Luedtke, Gabriela F. Carvalho

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引用次数: 0

Abstract

Objectives

Altered endogenous pain-inhibitory pathways have been proposed as a mechanistic contributor to migraine. However, results from conditioned pain modulation (CPM) paradigms are inconsistent, potentially reflecting limited assessment of trigeminal nociception and a paucity of data stratified by migraine phase. Accordingly, this study aimed to evaluate the site- and phase-dependence of CPM and somatosensory sensitivity in migraine.

Methods

In a cross-sectional study, 50 adults with migraine and 50 age-/sex- headache-free controls underwent assessor-blinded, standardized CPM and quantitative sensory testing (QST) at a trigeminal site (V1, forehead) and an extra-trigeminal site (C6, forearm). CPM was calculated as the change in heat pain thresholds measured during a heterotopic ischemic conditioning stimulus relative to baseline. QST captured thermal, pressure and mechanical pain measures, also including mechanical pain sensitivity and allodynia. Repeated-measures ANOVAs tested effects of CPM, site, diagnosis and migraine phase (peri-ictal vs. interictal).

Results

A robust inhibitory CPM effect was observed in both migraine and control groups, with no between-group or phase-specific differences across sites (all p > 0.05). Compared with controls and not considering the stimulated region, migraine was associated with lower pressure pain thresholds (p < 0.001) and higher mechanical pain sensitivity (p = 0.001), alongside elevated central sensitization and catastrophizing scores (p < 0.001). Across migraine phases, pain sensitivity measures were largely stable; however, trigeminal mechanical pain sensitivity was selectively higher during the peri-ictal phase (p = 0.017).

Conclusions

CPM appears preserved in migraine across phases and anatomical territories, whereas sensory alterations may be modality- and region-specific, supporting a pain sensitivity amplification phenotype rather than a generalized deficit in endogenous inhibition.

Significance Statement

Patients with migraine could inhibit pain similarly to controls, but they present in general lower pressure and mechanical pain thresholds in contrast to controls and increased mechanical sensitivity on the forehead during the peri-ictal phase. This suggests that migraine involves specific changes in pain processing rather than a general disruption of the descending inhibitory system.

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尽管偏头痛在不同阶段和部位的疼痛敏感性改变，但完整的条件疼痛调节

目的改变内源性疼痛抑制通路被认为是偏头痛的机制因素。然而，条件疼痛调节（CPM）范式的结果是不一致的，可能反映了三叉神经伤害感觉的有限评估和偏头痛阶段分层数据的缺乏。因此，本研究旨在评估CPM和躯体感觉敏感性在偏头痛中的位置和相位依赖性。方法在一项横断面研究中，50名患有偏头痛的成年人和50名无年龄/性别头痛的对照组接受了评估盲法、标准化CPM和三叉神经部位（V1，前额）和三叉神经外部位（C6，前臂）的定量感觉测试（QST）。CPM计算为在异位缺血条件刺激期间相对于基线测量的热痛阈值的变化。QST捕获热，压力和机械疼痛测量，也包括机械疼痛敏感性和异常性疼痛。重复测量ANOVAs测试了CPM、部位、诊断和偏头痛分期（周期与期间）的影响。结果在偏头痛组和对照组中均观察到强有力的CPM抑制作用，各组间或各部位的阶段特异性差异无统计学意义（均p >； 0.05）。与对照组相比，不考虑刺激区域，偏头痛与较低的压力疼痛阈值（p < 0.001）和较高的机械疼痛敏感性（p = 0.001）相关，同时中枢敏化和灾难化评分升高（p < 0.001）。在偏头痛的各个阶段，疼痛敏感性测量基本稳定；然而，三叉神经机械性疼痛敏感性在围周期选择性较高（p = 0.017）。结论：CPM似乎在偏头痛的各个阶段和解剖区域都有保留，而感觉改变可能是模态和区域特异性的，支持疼痛敏感性放大表型，而不是内源性抑制的普遍缺陷。与对照组相比，偏头痛患者可以抑制类似的疼痛，但与对照组相比，偏头痛患者通常表现为较低的压力和机械痛阈，并且在阴周期前额的机械敏感性增加。这表明偏头痛涉及疼痛处理的特定变化，而不是下行抑制系统的普遍破坏。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.