Investigation of the Effects of Sleep Deprivation on Itch and Pain Sensitivity

Sponsor

Aalborg University (Other)

Overall Status

Not yet recruiting

CT.gov ID

NCT06081998

Collaborator

(none)

Enrollment

Arm

Anticipated Duration (Months)

Study Details

Study Description

Brief Summary

In This experiment, the investigators would like to test following hypotheses regarding the influence of sleep deprivation on itch:

To investigate similarity and differences between itch and pain by comparing the effect of sleep deprivation in them.
To evaluate the inflammatory state induced by sleep fragmentation via the analysis of C-reactive protein (CRP) levels from blood samples.
To correlate the anxiety and depression scores (evaluated through questionnaires) with itch and pain sensitivity and evaluate how they are affected by sleep. In This experiment, the investigators would like to test following hypotheses regarding the influence of sleep fragmentation on itch:
To investigate similarity and differences between itch and pain by comparing the effect of sleep deprivation in them.
To evaluate the inflammatory state induced by sleep fragmentation via the analysis of C-reactive protein (CRP) levels from blood samples.
To correlate the anxiety and depression scores (evaluated through questionnaires) with itch and pain sensitivity and evaluate how they are affected by sleep deprivation.

Condition or Disease	Intervention/Treatment	Phase
Histamine Cowhage Sleep Deprivation	Other: Histamine Other: Cowhage	N/A

Detailed Description

Chronic itch affects approximately a fifth of the global population and is associated with substantial negative consequences for the affected individuals. Furthermore, there is a lack of efficient treatment options for chronic itch. Poor sleep is a common companion of itch and is often reported by patients with chronic itch. Poor sleep is often characterized by nightly awakenings and troubles falling asleep. This is a significant problem as poor sleep in general is associated with lowered quality of life. While previous research has already established the negative impact of itch on sleep, it is yet to be studied whether the opposite tendency might be true as well. Knowledge about patients with chronic pain has shown that poor sleep can increase the sensitivity to pain and inflammation, and this tendency can also be observed in healthy participants after experimental sleep provocations. Therefore, the investigators wish to investigate how sleep provocations affect markers of itch in healthy participants.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

30 participants

Allocation:

N/A

Intervention Model:

Single Group Assignment

Intervention Model Description:

The participants will be instructed to stay awake for 24 hours following the baseline session of this subproject.The participants will be instructed to stay awake for 24 hours following the baseline session of this subproject.

Masking:

None (Open Label)

Masking Description:

Participant will be blinded about application of pruritogens.

Primary Purpose:

Basic Science

Official Title:

Investigation of the Effects of Sleep Provocations on Itch and Pain Sensitivity

Anticipated Study Start Date :

Nov 1, 2023

Anticipated Primary Completion Date :

Dec 30, 2024

Anticipated Study Completion Date :

Dec 31, 2026

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Sleep deprivation This subproject will be conducted in two sessions separated by three nights of sleep deprivation. Each session will last approximately 2 hours. At the beginning of the first visit and after the last visit, 9 ml of blood will be drawn, and plasma will be isolated. After plasma isolation, the CRP concentration will be analyzed. In each forearm of the participant, a 4x4 cm area will be selected as Area of Interest (AOI). In these selected areas, itch will be induced in both sessions using histamine and cowhage and several tests will be conducted.	Other: Histamine Histaminergic itch will be evoked by a 1% histamine solution. A droplet of histamine solution will be placed on the predetermined area on the forearm, and the SPT lancet will be pierced through the histamine with 120 g of pressure for 1-2 seconds Other: Cowhage 25 spicules will be inserted in the centre of the predefined skin area on the mandibular area. The spicules will be gently rubbed for 15-20 seconds in circular motion to facilitate epidermal penetration

Arm

Intervention/Treatment

Experimental: Sleep deprivation

This subproject will be conducted in two sessions separated by three nights of sleep deprivation. Each session will last approximately 2 hours. At the beginning of the first visit and after the last visit, 9 ml of blood will be drawn, and plasma will be isolated. After plasma isolation, the CRP concentration will be analyzed. In each forearm of the participant, a 4x4 cm area will be selected as Area of Interest (AOI). In these selected areas, itch will be induced in both sessions using histamine and cowhage and several tests will be conducted.

Other: Histamine

Histaminergic itch will be evoked by a 1% histamine solution. A droplet of histamine solution will be placed on the predetermined area on the forearm, and the SPT lancet will be pierced through the histamine with 120 g of pressure for 1-2 seconds

Other: Cowhage

25 spicules will be inserted in the centre of the predefined skin area on the mandibular area. The spicules will be gently rubbed for 15-20 seconds in circular motion to facilitate epidermal penetration

Outcome Measures

Primary Outcome Measures

Assessment of itch [Day 1: 1 minute after every itch inductions]
Immediately following the itch provocations, participants will be instructed to rate the itch intensity for 10 minutes using a digital visual analogue scale (VAS; eVAS Software: Aalborg, University, Denmark), on a tablet. The scale will be measured from 0 to 100, where 0 represents 'no itch' and 100 'worst itch imaginable'
Assessment of itch [Day 2: 1 minute after every itch inductions]
Immediately following the itch provocations, participants will be instructed to rate the itch intensity for 10 minutes using a digital visual analogue scale (VAS; eVAS Software: Aalborg, University, Denmark), on a tablet. The scale will be measured from 0 to 100, where 0 represents 'no itch' and 100 'worst itch imaginable'
Assessment of pain [Day 1: 1 minute after every itch inductions]
Immediately following the itch provocations, participants will be instructed to rate the pain intensity for 10 minutes using a digital visual analogue scale (VAS; eVAS Software: Aalborg, University, Denmark), on a tablet. The scale will be measured from 0 to 100, where 0 represents 'no pain' and 100 'worst pain imaginable'.
Assessment of pain [Day 2: 1 minute after every itch inductions]
Immediately following the itch provocations, participants will be instructed to rate the pain intensity for 10 minutes using a digital visual analogue scale (VAS; eVAS Software: Aalborg, University, Denmark), on a tablet. The scale will be measured from 0 to 100, where 0 represents 'no pain' and 100 'worst pain imaginable'.

Secondary Outcome Measures

Microvascular reactivity [Day 1: 10 minutes after every itch inductions]
Microvascular reactivity The evoked cutaneous inflammation (quantified by superficial blood perfusion) will be measured by full-field laser perfusion imaging
Microvascular reactivity [Day 2: 10 minutes after every itch inductions]
Microvascular reactivity The evoked cutaneous inflammation (quantified by superficial blood perfusion) will be measured by full-field laser perfusion imaging
Touch Pleasantness (TP) [Day 1: 10 minutes after every itch inductions]
Pleasant touch sensation measured using a standardized sensory brush (SENSELab Brush-05, Somedic AB, Hörby, Sweden) exerting a force of 200 to 400 mN.The stimulation consists of three strokes (2 cm in length) over the treated/control areas. The strokes will be applied perpendicularly to the skin and the subject will rate the sensation induced by the brush on a NRS scale labeled "very unpleasant" and "very pleasant" at the extremity and "neutral" at the center.
Touch Pleasantness (TP) [Day 2: 10 minutes after every itch inductions]
Pleasant touch sensation measured using a standardized sensory brush (SENSELab Brush-05, Somedic AB, Hörby, Sweden) exerting a force of 200 to 400 mN. The stimulation consists of three strokes (2 cm in length) over the treated/control areas. The strokes will be applied perpendicularly to the skin and the subject will rate the sensation induced by the brush on a NRS scale labeled "very unpleasant" and "very pleasant" at the extremity and "neutral" at the center.
Mechanically evoked itch (MEI), intensity approach [Day 1: 10 minutes after every itch inductions]
MEI is measured by using mildly pruritic, non-painful von Frey nylon filaments of a predetermined intensity (generally 5-30 miliNewton of force). This stimulator is moved in intervals of 0.5 cm outside the area of itch provocation. The subjects will report a score on a NRS scale ranging 0-10.
Mechanically evoked itch (MEI), intensity approach [Day 2: 10 minutes after every itch inductions]
MEI is measured by using mildly pruritic, non-painful von Frey nylon filaments of a predetermined intensity (generally 5-30 miliNewton of force). This stimulator is moved in intervals of 0.5 cm outside the area of itch provocation. The subjects will report a score on a NRS scale ranging 0-10.
Mechanically evoked itch, spatial approach [Day 1: 10 minutes after every itch inductions]
The von-Frey filament that better evokes the itch sensation during the assessment of mechanically evoked itch as well as a template of soft plastic are used to map the area of hyperkinesis in the test areas (forearms). The subjects will report a score on a NRS scale ranging 0-10.
Mechanically evoked itch, spatial approach [Day 2: 10 minutes after every itch inductions]
The von-Frey filament that better evokes the itch sensation during the assessment of mechanically evoked itch as well as a template of soft plastic are used to map the area of hyperkinesis in the test areas (forearms). The subjects will report a score on a NRS scale ranging 0-10.
Mechanical Pain Thresholds (MPT) [Day 1: 10 minutes after every itch inductions]
This test is conducted using a pinprick set (Aalborg University, Aalborg). The set consists of 7 needles each with a diameter of 0.6 mm and different force applications: 8, 16, 32, 64, 128, 256, and 512 mN. The subjects will report a score on a NRS scale ranging 0-10.
Mechanical Pain Thresholds (MPT) [Day 2: 10 minutes after every itch inductions]
This test is conducted using a pinprick set (Aalborg University, Aalborg). The set consists of 7 needles each with a diameter of 0.6 mm and different force applications: 8, 16, 32, 64, 128, 256, and 512 mN. The subjects will report a score on a NRS scale ranging 0-10.
Mechanical Pain Sensitivity (MPS), intensity approach [Day 1: 10 minutes after every itch inductions]
This test is conducted with the same pinprick set used to test the MPT. Starting with the lightest, each stimulator is applied at a rate of 2 s on, 2 s off in an ascending order, and the subject will be asked to give a pain rating for each stimulus on a scale from 0-10 (where 0 indicates ''no pain'', and 10 indicates the ''worst imaginable pain'') on a NRS.
Mechanical Pain Sensitivity (MPS), intensity approach [Day 2: 10 minutes after every itch inductions]
This test is conducted with the same pinprick set used to test the MPT. Starting with the lightest, each stimulator is applied at a rate of 2 s on, 2 s off in an ascending order, and the subject will be asked to give a pain rating for each stimulus on a scale from 0-10 (where 0 indicates ''no pain'', and 10 indicates the ''worst imaginable pain'') on a NRS.
Cold Detection Thresholds (CDT) and heat (HPT) detection [Day 1: 10 minutes after every itch inductions]
Thermal cold and heat stimuli will be applied by a contact heat-evoked potential stimulator (PATHWAYS; Medoc Ltd, Ramat Yishai, Israel), placed 5 cm distal to the elbow on the right dorsal forearm
Cold Detection Thresholds (CDT) and heat (HPT) detection [Day 2: 10 minutes after every itch inductions]
Thermal cold and heat stimuli will be applied by a contact heat-evoked potential stimulator (PATHWAYS; Medoc Ltd, Ramat Yishai, Israel), placed 5 cm distal to the elbow on the right dorsal forearm
Cold Detection Thresholds (CDT) and heat (HPT) pain thresholds [Day 1: 10 minutes after every itch inductions]
Thermal cold and heat stimuli will be applied by a contact heat-evoked potential stimulator (PATHWAYS; Medoc Ltd, Ramat Yishai, Israel), placed 5 cm distal to the elbow on the right dorsal forearm
Cold Detection Thresholds (CDT) and heat (HPT) pain thresholds [Day 2: 10 minutes after every itch inductions]
Thermal cold and heat stimuli will be applied by a contact heat-evoked potential stimulator (PATHWAYS; Medoc Ltd, Ramat Yishai, Israel), placed 5 cm distal to the elbow on the right dorsal forearm
Pain to Supra-threshold Heat Stimuli (STHS) [Day 1: 10 minutes after every itch inductions]
The tests will be conducted by using a PATHWAY ATS (Medoc Ltd, Israel) thermal sensory testing device. A thermode stimulator of 3x3 cm will be placed on the treated/placebo areas and kept in place by means of Velcro tape. The subjects will rate the pain to three suprathreshold heat pain stimuli (starting and ending at 32°C with an increase and decrease of 5°C and 3 s plateau at 50°C).
Pain to Supra-threshold Heat Stimuli (STHS) [Day 2: 10 minutes after every itch inductions]
The tests will be conducted by using a PATHWAY ATS (Medoc Ltd, Israel) thermal sensory testing device. A thermode stimulator of 3x3 cm will be placed on the treated/placebo areas and kept in place by means of Velcro tape. The subjects will rate the pain to three suprathreshold heat pain stimuli (starting and ending at 32°C with an increase and decrease of 5°C and 3 s plateau at 50°C).
Deep-tissue Pain Sensitivity Measurements [Day 1: 10 minutes after every itch inductions]
Deep-tissue pain sensitivity will be evaluated by cuff pressure stimuli using a computer-controlled cuff algometer (Cortex Technology and Aalborg University, Denmark) including a 13-cm wide tourniquet cuff (VBM, Sulz, Germany) and an electronic visual analog scale (VAS) (Aalborg University, Denmark) for recording of the pain intensity.
Deep-tissue Pain Sensitivity Measurements [Day 2: 10 minutes after every itch inductions]
Deep-tissue pain sensitivity will be evaluated by cuff pressure stimuli using a computer-controlled cuff algometer (Cortex Technology and Aalborg University, Denmark) including a 13-cm wide tourniquet cuff (VBM, Sulz, Germany) and an electronic visual analog scale (VAS) (Aalborg University, Denmark) for recording of the pain intensity.
Pressure Detection and Tolerance Threshold [Day 1: 10 minutes after every itch inductions]
The pressure will be increased by 1 kPa/s and the subject will be instructed to rate the pain intensity continuously on the electronic VAS until the tolerance level is reached.
Pressure Detection and Tolerance Threshold [Day 2: 10 minutes after every itch inductions]
The pressure will be increased by 1 kPa/s and the subject will be instructed to rate the pain intensity continuously on the electronic VAS until the tolerance level is reached.
Temporal Summation of Pain - TSP [Day 1: 10 minutes after every itch inductions]
A total of 10 repeated mechanical pressure stimuli at the PTT level will be delivered at 0.5 Hz (1 s stimulus duration and 1 s interval between stimuli) to the lower leg. A constant pressure of 5 kPa will be applied between the individual pressure stimuli to avoid movement of the cuff. During the 10 repeated stimuli, the subject will continuously rate the pain intensity on a 10 cm continuous VAS.
Temporal Summation of Pain - TSP [Day 2: 10 minutes after every itch inductions]
A total of 10 repeated mechanical pressure stimuli at the PTT level will be delivered at 0.5 Hz (1 s stimulus duration and 1 s interval between stimuli) to the lower leg. A constant pressure of 5 kPa will be applied between the individual pressure stimuli to avoid movement of the cuff. During the 10 repeated stimuli, the subject will continuously rate the pain intensity on a 10 cm continuous VAS.
Conditioned Pain Modulation - CPM [Day 1: 10 minutes after every itch inductions]
The concept of CPM is that a tonic painful stimulus (conditioning stimulus) will inhibit pain evoked simultaneously from another site (test stimulus). The painful conditioned stimulus will be applied simultaneously with the assessment - Page 4 of 6 [DRAFT] - stimulus. The conditioned stimulus will be terminated right after the subject presses the stop button. CPM will be defined as the difference between stimulus during and before the conditioned pain (i.e., "during" minus "before").
Conditioned Pain Modulation - CPM [Day 2: 10 minutes after every itch inductions]
The concept of CPM is that a tonic painful stimulus (conditioning stimulus) will inhibit pain evoked simultaneously from another site (test stimulus). The painful conditioned stimulus will be applied simultaneously with the assessment - Page 4 of 6 [DRAFT] - stimulus. The conditioned stimulus will be terminated right after the subject presses the stop button. CPM will be defined as the difference between stimulus during and before the conditioned pain (i.e., "during" minus "before").
The Itch Catastrophizing Scale [Day 1]
The itch catastrophizing scale is a modified version of the pain catastrophizing scale (PCS), which is a validated questionnaire measuring pain-related thoughts and feelings
The Itch Catastrophizing Scale [Day 2]
The itch catastrophizing scale is a modified version of the pain catastrophizing scale (PCS), which is a validated questionnaire measuring pain-related thoughts and feelings
The Pittsburg Sleep Quality Index (PSQI) [Day 1]
The PSQI consists of 19 items generating seven component scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction.
The Pittsburg Sleep Quality Index (PSQI) [Day 2]
The PSQI consists of 19 items generating seven component scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction.
The Hospital Anxiety and Depression Scale (HADS) [Day 1]
The HADS consists of 14 items with two 7-item subscales measuring anxiety and depression symptoms, respectively
The Hospital Anxiety and Depression Scale (HADS) [Day 2]
The HADS consists of 14 items with two 7-item subscales measuring anxiety and depression symptoms, respectively
Positive and Negative Affective Schedule [Day 1]
This 20-item instrument is a psychometric self-report test to assess affect (10 items for positive affect and 10 items for negative affect) and validated for the use in adolescents and adults
Positive and Negative Affective Schedule [Day 2]
This 20-item instrument is a psychometric self-report test to assess affect (10 items for positive affect and 10 items for negative affect) and validated for the use in adolescents and adults
Blood Sampling for C-Reactive Protein Analysis [Day 1]
Whole blood samples will be collected from the antecubital vein using a vacutainer blood collection device (SMonovette, Sarstedt) with a 21-gauge needle.
Blood Sampling for C-Reactive Protein Analysis [Day 2]
Whole blood samples will be collected from the antecubital vein using a vacutainer blood collection device (SMonovette, Sarstedt) with a 21-gauge needle.

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years to 60 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Yes

Inclusion Criteria:

Healthy men and women
18-60 years
Speak and understand English
Access to a smartphone during the experimental nights

Exclusion Criteria:

Pregnancy or lactation
Drug addiction defined as any use of cannabis, opioids, or other drugs
Previous or current history of neurological, dermatological, immunological musculoskeletal, cardiac disorder or mental illnesses (psychiatric diagnosis) that may affect the results (e.g., neuropathy, muscular pain in the upper extremities, anxiety, depression, schizophrenia etc.)
Moles, wounds, scars, or tattoos in the area to be treated or tested
Current use of medications that may affect the trial such as antihistamines and pain killers.
Skin diseases
Consumption of alcohol or painkillers 24 hours before the study days and between these
Acute or chronic pain and itch
Participation in other trials within 1 week of study entry (4 weeks in the case of pharmaceutical studies)
Lack of ability to cooperate

Contacts and Locations

Locations

No locations specified.

Sponsors and Collaborators

Aalborg University

Investigators

None specified.

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.

Responsible Party:

Silvia Lo Vecchio, Assistant Professor, Aalborg University

ClinicalTrials.gov Identifier:

NCT06081998

Other Study ID Numbers:

N-20230028 2nd Experiment

First Posted:

Oct 13, 2023

Last Update Posted:

Oct 13, 2023

Last Verified:

Oct 1, 2023

Studies a U.S. FDA-regulated Drug Product:

Studies a U.S. FDA-regulated Device Product:

Additional relevant MeSH terms:

Sleep Deprivation

Histamine

Study Results

No Results Posted as of Oct 13, 2023