Aberrant pain modulation in trigeminal neuralgia patients

Ila Joshi; Bhawna Mattoo; Virender K. Mohan; Renu Bhatia

doi:10.1515/jbcpp-2019-0274

Article

Aberrant pain modulation in trigeminal neuralgia patients

Ila Joshi , Bhawna Mattoo , Virender K. Mohan and Renu Bhatia

Published/Copyright: July 10, 2020

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From the journal Journal of Basic and Clinical Physiology and Pharmacology Volume 32 Issue 1

Abstract

Objectives

The present study attempts to understand the role of supraspinal nociceptive pain modulation in typical trigeminal neuralgia (TN) patients by using a conditioned pain modulation paradigm and estimation of plasma levels of two important neuromodulators; Calcitonin Gene-Related Peptide and β-endorphin.

Methods

Twenty TN patients and 20 healthy, age and gender-matched subjects participated in the study. The participants' hot pain thresholds (HPT) were measured over their affected side on the face. Testing sites were matched for healthy controls. For the conditioned pain modulation their contralateral foot was immersed in noxious cold (5 °C) water bath (conditioning stimuli) for 30 s and HPT (testing stimuli) was determined before, during and till 5 min after the immersion. Plasma Calcitonin Gene-Related Peptide and β-endorphin levels were estimated to understand their role in disease pathogenesis and pain modulation.

Results

Change in HPT during foot immersion was significantly higher in healthy controls compared to TN patients (p<0.0001). The changes recorded in HPT in patients, were significant only in 2nd and 3rd minute post immersion. While in healthy controls, the effect lasted till the 4th minute. The concentration of beta-endorphin was significantly lower in TN patients (p=0.003) when compared to healthy controls.

Conclusions

The results suggest that there is an impairment in supraspinal pain modulation also known as Diffuse Noxious Inhibitory Controls in typical TN and that the reduced levels of β-endorphin may contribute to the chronic pain state experienced by patients.

Keywords: β-endorphin; conditioned pain modulation; diffuse noxious inhibitory control; endogenous pain modulation; facial pain

Corresponding author: Dr. Renu Bhatia, M.D., Additional Professor, Pain Research and TMS Lab, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India, Phone: +91 11 26549310, E-mail: renuaiims28@gmail.com

Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: The study was approved by the Institute Ethics Committee (Ref. No. IECPG-7/16.02.2017, RT-15/22.03.2017).

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Received: 2019-02-20

Accepted: 2019-11-06

Published Online: 2020-07-10

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Articles in the same Issue

https://doi.org/10.1515/jbcpp-2019-0274

Keywords for this article

β-endorphin; conditioned pain modulation; diffuse noxious inhibitory control; endogenous pain modulation; facial pain