Mental pain and pain-proneness in patients with migraine: results from the PAINMIG cohort-study

Abstract

Background. Pain has been qualified under four categories: nociception, perception of pain, suffering, and pain behaviors. Most of the literature on migraine has devoted attention to the first two. The aim of the present cohort study was to investigate patients with migraine enrolled at a tertiary care unit to study suffering and mental pain and identify potential risk factors for migraine. Methods. An observational cross-sectional study was carried out on patients with chronic migraine (CM) and episodic migraine (EM), and healthy subjects (HS). The three groups were matched for age and sex. A comprehensive assessment of migraine disability, pain, psychiatric disorders, psychosomatic syndromes, depressive and anxious symptoms, euthymia, psychosocial variables, mental pain, and pain-proneness (PP) was performed. Results. Three hundred subjects were enrolled (100 CM, 100 EM, and 100 HS). Based on the multiple regression analyses, those presenting PP (social impairment: odds ratio [OR] = 3.59, 95% confidence interval [CI] = 1.14-11.29; depressive symptoms: OR = 3.82, 95% CI = 1.74-8.41) were more likely to be CM than HS. Those with higher levels of PP (social impairment: OR = 4.04, 95% CI = 1.60-10.22; depressive symptoms: OR = 2.02, 95% CI = 1.26-3.24) were more likely to be EM than HS. Those presenting higher levels of mental pain were more likely to be CM than EM (OR = 1.45, 95% CI = 1.02-2.07). Conclusion. Migraine is an unpleasant sensory and emotional experience associated with psychosocial manifestations that might contribute to the level of suffering of the individuals. Mental pain resulted to be the variable that most differentiated patients with CM from EM.

Clinimetric Perspectives in Clinical Psychology and Psychiatry

“…It may occur when an impending destruction of the person is perceived; it is at the core of the suicidal process. Mental pain also requires a clinimetric approach (e.g., the Mental Pain Questionnaire) [35][36][37][38] being complex and heterogeneous in addition to transdiagnostic.…”

Well-Being Therapy for Depressive Symptoms in Chronic Migraine: A Case Report

“…For instance, depression is present in 11% to 57% of cases (Dresler et al 2019) and represents a relevant problem worsening migraine prognosis, increasing migraine disability, and favoring a poorer response to treatment (Araki et al, 2019;Bigal & Lipton, 2009). Chronic migraine is also highly associated with mental pain, poor well-being and euthymia (Buse et al, 2010;Cosci et al, 2020;Manack et al, 2011). In addition, chronic migraine has a low response to treatments which are routinely provided to patients (e.g., medications such as triptans, non-invasive vagus nerve stimulation, pain management, stress management, biofeedback, cognitive behavioral therapy, relaxation techniques) (Becker, 2017;May & Schulte, 2016).…”

Mental pain as a global person-centered outcome measure

“…Subjects were derived from the PAINMIG cohort study, described in detail elsewhere. 13 Participants were outpatients with migraine enrolled from September 2016 to September 2019 at the Headache and Clinical Pharmacology Center of the University Hospital Careggi, Florence, Italy. Inclusion criteria were: (1) age from 18 to 64 years and (2) a diagnosis of episodic or chronic nonrefractory migraine according to the International Classification of Headache Disorders, 3rd edition (beta version).…”

“…12 People with chronic migraine were found to be more disabled than those with episodic migraine, and the former group had significantly higher MPQ scores than the latter. 13 The MPQ has been tested in a primary care sample. 14 People who had either a psychiatric disorder diagnosed according to the Diagnostic and Statistical Manual of mental disorders (DSM) 15 or a psychosomatic disorder diagnosed according to the Diagnostic Criteria for Psychosomatic Research-Revised (DCPR-R) 16 had significantly higher MPQ scores compared with those in the sample without psychiatric or psychosomatic diagnoses.…”

“…The present study aimed to test whether mental pain demonstrates these properties of a global outcome measure, in a secondary analysis of data from the migraine sample noted above. 13 The hypotheses tested were (a) that multiple measures of symptomatology and quality of life would each show modest but significant bivariate correlations with mental pain; and (b) that some of these measures would individually make unique contributions to overall mental pain.…”