Clinical trial NCT01470339: Improvement the Anti-migraine Treatment Efficacy by Tailoring the Drug to Individual's Pain Modulation Profile
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Pain
Keywords: endogenous pain modulation
migraine
fMRI
duloxetine
preventive migraine treatment
Lead sponsor: Rambam Health Care Campus
Sponsor class: OTHER
First posted: 2011-11-11
Enrollment: 200
Sex: FEMALE
Minimum age (years): 18
Maximum age (years): 50
Standard ages: ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL

Brief summary: * 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.

Detailed 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.

Eligibility criteria: 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.

Primary outcomes:
measure: Distinguish between two endogenous pain modulation mechanisms
timeFrame: 2 year
Secondary outcomes:
measure: To charcterize functional and structural neuroanatomical correlates of pain modulation profile and it's relevance for predicting the duloxetine efficacy in migraine
timeFrame: 3 years
Other outcomes:
Locations:
city: Haifa
country: Israel
facility: MRI center
Study officials:
affiliation: Rambam Health Care Campus
name: David Yarnitsky, professor
role: PRINCIPAL_INVESTIGATOR
References: