Document Detail

Activation of the cortical pain network by soft tactile stimulation after injection of sumatriptan.
MedLine Citation:
PMID:  17449179     Owner:  NLM     Status:  MEDLINE    
The anti-migraine drug sumatriptan often induces unpleasant somatosensory side effects, including a dislike of being touched. With a double-blind cross-over design, we studied the effects of sumatriptan and saline on perception (visual analogue scale) and cortical processing (functional magnetic resonance imaging) of tactile stimulation in healthy subjects. Soft brush stroking on the calf (n=6) was less pleasant (p<0.04) and evoked less activation of posterior insular cortex in the sumatriptan compared to the saline condition. Soft brushing activated pain processing regions (anterior insular, lateral orbitofrontal, and anterior cingulate cortices, and medial thalamus) only in the sumatriptan condition, whereas activation of somatosensory cortices was similar in both conditions. Soft brush stroking on the palm (n=6) was equally pleasant in both conditions. One possible mechanism for the activation of pain processing regions by brush stroking is sensitization of nociceptors by sumatriptan. Another possibility is inhibition of a recently discovered system of low-threshold unmyelinated tactile (CT) afferents that are present in hairy skin only, project to posterior insular cortex, and serve affective aspects of tactile sensation. An inhibition of impulse transmission in the CT system by sumatriptan could disinhibit nociceptive signalling and make light touch less pleasant. This latter alternative is consistent with the observed reduction in posterior insular cortex activation and the selective effects of stimulation on hairy compared to glabrous skin, which are not explained by the nociceptor sensitization account.
Heidrun H Krämer; Linda Lundblad; Frank Birklein; Mattias Linde; Tomas Karlsson; Mikael Elam; Håkan Olausson
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2007-04-20
Journal Detail:
Title:  Pain     Volume:  133     ISSN:  1872-6623     ISO Abbreviation:  Pain     Publication Date:  2007 Dec 
Date Detail:
Created Date:  2007-11-27     Completed Date:  2008-01-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7508686     Medline TA:  Pain     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  72-8     Citation Subset:  IM    
Department of Neurology, Johannes Gutenberg University, Mainz, Germany.
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MeSH Terms
Brain Mapping
Cerebral Cortex* / blood supply,  drug effects,  physiopathology
Cross-Over Studies
Double-Blind Method
Image Processing, Computer-Assisted
Magnetic Resonance Imaging / methods
Oxygen / blood
Pain / drug therapy*,  etiology
Pain Measurement
Pain Threshold
Physical Stimulation / adverse effects
Serotonin Agonists / therapeutic use*
Skin / innervation
Sumatriptan / therapeutic use*
Touch / physiology*
Reg. No./Substance:
0/Serotonin Agonists; 103628-46-2/Sumatriptan; 7782-44-7/Oxygen

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