Augmented Cerebral Pain Processing in Chronic, Unexplained Pain: a fMRI Study

• ClinicalTrials.gov Identifier: NCT00463177
• Recruitment Status: Completed
• First Posted: April 20, 2007
• Last Update Posted: September 4, 2008
• Sponsor: UMC Utrecht
• Collaborators: K.F. Hein Foundation; Fonds Psychische Gezondheid
• Information provided by: UMC Utrecht

Study Description

Brief Summary:

Chronic, unexplained pain symptoms are very common in all layers of the population, but it is largely unknown what causes them. This study examines the hypothesis that patients with these pain symptoms process pain abnormally in their brain. TO this aim, we compare patients and healthy people: they receive mild pain at their painful body region and at another location. Concurrently, we measure brain activity with brain scans (functional MRI scans). With our study results, we want to increase understanding of what causes chronic, unexplained pain symptoms, in order to find better methods of diagnosing and treating them.

Condition or disease
Pain

Detailed Description:

Background

Chronic, unexplained pain is a heterogeneously defined, but common and recurring clinical problem, in general medical practice as well as in specialist care. Chronic, unexplained pain causes considerable loss of quality of life, frequent absence from work and it is a common reason for health care visits. From a pathophysiological point of view, an augmented and self-amplifying sensitivity for physical signals such as pain (as well as for other signals) seems to be important. This is referred to as 'generalised hypervigilance', a specific type of sensitisation. Central sensitisation mechanisms have been implied in several pain syndromes. In our own psychophysical pilot study, we confirmed the existence of amplified pain perception in chronic, unexplained pain, as well as the disturbed influence of attentional processes. Our study results probably reflect a general disturbance of perception, not associated with a specific body location. This general perceptual disturbance is expressed in a stronger fashion in the clinically affected body region. Abnormal pattern of cerebral pain processing have been found in functional MRI studies in other syndromes of unknown origin, such as fibromyalgia, somatoform pain disorder and irritable bowel syndrome. However, the role of several neurobiological factors in chronic, unexplained pain remain to be elucidated and to be placed in the context of the biopsychosocial model.

Work plan:

A 3T rapid event-related, Functional MRI-experiment into the cerebral processing of experimental pain stimuli in chronic, unexplained pain-patients versus healthy controls. Twelve chronic, unexplained pain-patients with unilateral limb pain and twelve healthy control subjects experience painful and non-painful electrical stimuli on the painful limb, whilst the attentional state of the subject is controlled. With functional MRI, we record the pain-related cerebral activations and compare them between groups, in order to characterise the cerebral correlates of altered pain processing in chronic, unexplained pain.

Study Design

• Study Type: Observational
• Actual Enrollment: 24 participants
• Time Perspective: Cross-Sectional
• Official Title: Augmented Cerebral Pain Processing in Chronic, Unexplained Pain: a 3T Event-Related Functional MRI Study
• Study Start Date: March 2007
• Actual Primary Completion Date: June 2008
• Actual Study Completion Date: June 2008

Groups and Cohorts

Outcome Measures

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No
• Sampling Method: Non-Probability Sample

Study Population

Chronic unexplained pain patients

Criteria

Inclusion Criteria:

• Chronic limb pain > 6 months
• No known somatic cause

Exclusion Criteria:

• Chronic benzodiazepine use
• Axis-I psychiatric co-morbidity
• Contra-indications for MRI scanning (e.g. implanted pacemaker)

Contacts and Locations

Locations

Netherlands

UMC Utrecht

Utrecht, Netherlands, 3584 CX

Sponsors and Collaborators

UMC Utrecht

K.F. Hein Foundation

Fonds Psychische Gezondheid

Investigators

• Principal Investigator: Tom Snijders, MD; UMC Utrecht
• Study Chair: Jan van Gijn, MD; UMC Utrecht
• Study Director: Nick Ramsey, PhD; UMC Utrecht

More Information

• Responsible Party: UMC Utrecht
• ClinicalTrials.gov Identifier: NCT00463177
• Other Study ID Numbers: NFGV5503-02
• First Posted: April 20, 2007
• Last Update Posted: September 4, 2008
• Last Verified: September 2008

Keywords provided by UMC Utrecht:

Pain; Chronic pain; Pain disorder; Functional MRI; Sensitization