Clinical trial NCT00192790: Pain Perception is Attenuated in Patients With Painless Myocardial Infarction
Official title: Clinical and Experimental Pain Perception is Attenuated in Patients With Painless Myocardial Infarction
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Myocardial Infarction
Myocardial Ischemia
Keywords: Therma,pain, Silent myocardial ischemia, catastrophizing
Lead sponsor: Rambam Health Care Campus
Sponsor class: OTHER
First posted: 2005-09-19
Enrollment: 100
Sex: ALL
Minimum age (years): 18
Maximum age (years): 85
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: DEFINED_POPULATION
Time perspective: PROSPECTIVE

Brief summary: To explore whether reduced systemic pain perception in response to painful stimuli and personality pain related variables characterizes silent MI patients.

Detailed description: Objective: Silent myocardial infarction (MI) is an event of severe myocardial ischemia without pain experience. The lack of pain alarm leads to increased morbidity and mortality, because the patients do not sick timely medical treatment. This study aims to explore whether reduced systemic pain perception in response to painful stimuli and personality pain related variables characterizes silent MI patients.

Methods: Level of chest pain intensity was assessed by visual analogue scale (VAS), range from 0 (no pain) to 100 (maximal pain). Heat pain threshold, magnitude estimation of supra-threshold painful stimuli at 47ºC as well as pain catastrophizing scores were assessed in 90 acute MI patients (mean age 66±12.1, range 33-79) with chest pain (n=65) and without pain symptoms(n=25). All stimuli were performed by Thermal Sensory Analysis (TSA) and applied to the right forearm.

Results: The demographic variables, history of ischemic heart, risk factors for coronary artery disease, ST-T segment changes on ECG and troponin levels were similar in both groups. Greater intensity of chest pain VAS scores was inversely correlated with lower pain threshold (r= -0.417, p\<0.001), and directly associated with higher pain scores in response to the heat pain (r=0.354, p=0.002). Patients with painful MI demonstrated lower pain threshold (41.9±3.6 vs. 44.9±3.8, p=0.001), higher VAS scores in response to the supra-threshold painful stimuli (50.2 ±21.8 vs. 27.0±25.2, p=0.002), and higher catastrophizing level (10.6±12.0 vs. 5.4±8.8, p=0.032). Chest pain complaint was not related to ST-T changes as well as concomitant diseases.

Conclusions: This study suggests that reduced systemic pain perception as well as cognitive personality variables play an important role in the etiology of Silent MI.

Eligibility criteria: Inclusion Criteria:All patients with painless or painful myocardial infarction -

Exclusion Criteria:Patients who can't give informed concent or couldn't cooperate

-

Primary outcomes:
Secondary outcomes:
Other outcomes:
Locations:
city: Haifa
country: Israel
facility: RAMBAM Health Care Campus, Internal Medicine "B" & Cardiology
Study officials:
affiliation: Rambam Medical Center, The Ruth & Bruce Rappaport Faculty of Medicine Technion
name: Zaher S. Azzam, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Granot M, Khoury R, Berger G, Krivoy N, Braun E, Aronson D, Azzam ZS. Clinical and experimental pain perception is attenuated in patients with painless myocardial infarction. Pain. 2007 Dec 15;133(1-3):120-7. doi: 10.1016/j.pain.2007.03.017. Epub 2007 Apr 25.