title: Altered pain responses in abstinent (±)3,4-methylenedioxymethamphetamine (MDMA, "ecstasy") users.
abstract: BACKGROUND
  (±)3,4-Methylenedioxymethamphetamine (MDMA) is a popular recreational drug that has potential to damage brain serotonin (5-HT) neurons in humans. Brain 5-HT neurons play a role in pain modulation, yet little is known about long-term effects of MDMA on pain function. Notably, MDMA users have been shown to have altered sleep, a phenomenon that can lead to altered pain modulation.
  
  
  OBJECTIVE
  This study sought to assess pain processing in MDMA users using objective methods, and explore potential relationships between pain processing and sleep indices.
  
  
  METHODS
  Forty-two abstinent MDMA users and 43 age-matched controls participated in a 5-day inpatient study. Outcome measures included standardized measures of pain, sleep polysomnograms, and power spectral measures of the sleep EEG. When differences in psychophysiological measures of pain were found, the relationship between pain and sleep measures was explored.
  
  
  RESULTS
  MDMA users demonstrated lower pressure pain thresholds, increased cold pain ratings, increased pain ratings during testing of diffuse noxious inhibitory control, and decreased Stage 2 sleep. Numerous significant relationships between sleep and pain measures were identified, but differences in sleep between the two groups were not found to mediate altered pain perception in MDMA users.
  
  
  CONCLUSIONS
  Abstinent MDMA users have altered pain perception and sleep architecture. Although pain and sleep outcomes were related, differences in sleep architecture in MDMA users did not mediate altered pain responses. It remains to be determined whether alterations in pain perception in MDMA users are secondary to neurotoxicity of 5-HT-mediated pain pathways or alterations in other brain processes that modulate pain perception.
authors: Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, Room 5B71c, Baltimore, MD 21224, USA. umccann@jhmi.edu
authors: Una D
authors: UD
authors: McCann
authors: Robert R
authors: RR
authors: Edwards
authors: Michael T
authors: MT
authors: Smith
authors: Kristen
authors: K
authors: Kelley
authors: Michael
authors: M
authors: Wilson
authors: Francis
authors: F
authors: Sgambati
authors: George
authors: G
authors: Ricaurte
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