Improvement the Anti-migraine Treatment Efficacy by Tailoring the Drug to Individual's Pain Modulation Profile

Rambam Health Care Campus

Status

Completed

Conditions

Pain

Treatments

Drug: duloxetine

Study type

Interventional

Funder types

Other

Identifiers

NCT01470339

0462-10-RMB.CTIL

Details and patient eligibility

About

To delineate brain mechanisms that subserve endogenous analgesic (EA) in the healthy state.
To identify alterations in mechanisms supporting EA in chronic pain (migraine) and their therapeutic relevance.

Full description

The proposed research will use psychophysics and multiparametric MRI to (i) delineate the brain mechanisms that subserve and regulate endogenous analgesia (EA)in the healthy state and (ii) to identify alterations in mechanisms supporting EA in chronic pain and their therapeutic relevance. In both healthy subjects and chronic pain patients, EA will be probed using the DNIC (diffuse noxious inhibitory controls) and offset analgesia paradigms. Functional MRI will examine activation of brainstem mechanisms important in EA, while both functional and structural connectivity analyses will assess the regulation of these brainstem mechanisms by cerebral cortical regions involved in attention and affect. One pathological painful condition, migraine, will be examined since it allows changes in EA associated with chronic pain to be investigated between episodes of pain. Finally, EA and EA associated structural and functional parameters will be used to predict the efficacy of one compound, amitriptyline, to treat migraine in individual patients. Taken together, the proposed research will provide substantial insights into basic mechanisms supporting and regulating EA and can provide a foundation for mechanism-based individualized choice of therapy that may benefit all chronic pain patients.

Enrollment

200 patients

Sex

Female

Ages

18 to 50 years old

Volunteers

Accepts Healthy Volunteers

Inclusion criteria

healthy females
migaine females
ages 18-50
for migraineurs: >4 attacks/month

Exclusion criteria

any migraine preventive treatment received during last 3 months or prior treatment with amytriptiline
other chronic pain conditions
psychiatric, other neurological diseases, language barrier or cognitive dysfunction
Patients and controls will be asked to withdraw from any pain-relieving medications for 24 hours before the testing. The tests will be performed interictally atleast 2 days after the last attack.