Patient and Disease Characteristics Associate with Sensory Testing Results in Chronic Pancreatitis

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BACKGROUND: Abdominal pain is the most common symptom in chronic pancreatitis (CP) and has an extensive impact on patients' lives. Quantitative sensory testing (QST) provides information on sensitivity to pain and mechanisms that can help quantify pain and guide treatment. The aims of this study were (1) to explore sensitivity to pain in patients with CP using QST and (2) to associate patient and disease characteristics with QST results.

METHODS: Ninety-one patients with painful CP and 28 healthy control participants completed a QST paradigm using static tests (muscle pressure stimulation and electrical skin stimulations) to unravel segmental and widespread hyperalgesia as a consequence of visceral pain. A dynamic conditioned pain modulation (CPM) paradigm was used as a proxy of pain modulation from the brainstem to inhibit incoming nociceptive barrage, and questionnaires were used to gather information on pain experience and quality of life.

RESULTS: Patients had impaired CPM compared with controls (18.0±29.3% vs. 30.9±29.3%, P=0.04) and were hypersensitive to pressure stimulation, specifically in the pancreatic (Th10) dermatome (P<0.001). The capacity of CPM was associated with clinical pain intensity (P=0.01) and (in the univariate analysis only) the use of opioids was associated with hyperalgesia to pressure stimulation (P<0.05).

CONCLUSIONS: Sensitivity to pain in CP patients can be characterized by a simple bedside QST. Severe clinical pain in CP was associated with reduced CPM function and should be targeted in management.

OriginalsprogEngelsk
TidsskriftThe Clinical Journal of Pain
Vol/bind35
Udgave nummer9
Sider (fra-til)786-793
Antal sider8
ISSN0749-8047
DOI
StatusUdgivet - sep. 2019

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Chronic Pancreatitis
Pain
Hyperalgesia
Pressure
Visceral Pain
Proxy
Abdominal Pain
Opioid Analgesics
Electric Stimulation
Brain Stem
Healthy Volunteers
Quality of Life

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title = "Patient and Disease Characteristics Associate with Sensory Testing Results in Chronic Pancreatitis",
abstract = "BACKGROUND: Abdominal pain is the most common symptom in chronic pancreatitis (CP) and has an extensive impact on patients' lives. Quantitative sensory testing (QST) provides information on sensitivity to pain and mechanisms that can help quantify pain and guide treatment. The aims of this study were (1) to explore sensitivity to pain in patients with CP using QST and (2) to associate patient and disease characteristics with QST results.METHODS: Ninety-one patients with painful CP and 28 healthy control participants completed a QST paradigm using static tests (muscle pressure stimulation and electrical skin stimulations) to unravel segmental and widespread hyperalgesia as a consequence of visceral pain. A dynamic conditioned pain modulation (CPM) paradigm was used as a proxy of pain modulation from the brainstem to inhibit incoming nociceptive barrage, and questionnaires were used to gather information on pain experience and quality of life.RESULTS: Patients had impaired CPM compared with controls (18.0±29.3{\%} vs. 30.9±29.3{\%}, P=0.04) and were hypersensitive to pressure stimulation, specifically in the pancreatic (Th10) dermatome (P<0.001). The capacity of CPM was associated with clinical pain intensity (P=0.01) and (in the univariate analysis only) the use of opioids was associated with hyperalgesia to pressure stimulation (P<0.05).CONCLUSIONS: Sensitivity to pain in CP patients can be characterized by a simple bedside QST. Severe clinical pain in CP was associated with reduced CPM function and should be targeted in management.",
keywords = "chronic pancreatitis, hyperalgesia, pain, pain measurement",
author = "Louise Kuhlmann and Olesen, {S{\o}ren Schou} and Debbie Gr{\o}nlund and Olesen, {Anne Estrup} and Phillips, {Anna Evans} and Mahya Faghih and Drewes, {Asbj{\o}rn Mohr}",
year = "2019",
month = "9",
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language = "English",
volume = "35",
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Patient and Disease Characteristics Associate with Sensory Testing Results in Chronic Pancreatitis. / Kuhlmann, Louise; Olesen, Søren Schou; Grønlund, Debbie; Olesen, Anne Estrup; Phillips, Anna Evans; Faghih, Mahya; Drewes, Asbjørn Mohr.

I: The Clinical Journal of Pain, Bind 35, Nr. 9, 09.2019, s. 786-793.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Patient and Disease Characteristics Associate with Sensory Testing Results in Chronic Pancreatitis

AU - Kuhlmann, Louise

AU - Olesen, Søren Schou

AU - Grønlund, Debbie

AU - Olesen, Anne Estrup

AU - Phillips, Anna Evans

AU - Faghih, Mahya

AU - Drewes, Asbjørn Mohr

PY - 2019/9

Y1 - 2019/9

N2 - BACKGROUND: Abdominal pain is the most common symptom in chronic pancreatitis (CP) and has an extensive impact on patients' lives. Quantitative sensory testing (QST) provides information on sensitivity to pain and mechanisms that can help quantify pain and guide treatment. The aims of this study were (1) to explore sensitivity to pain in patients with CP using QST and (2) to associate patient and disease characteristics with QST results.METHODS: Ninety-one patients with painful CP and 28 healthy control participants completed a QST paradigm using static tests (muscle pressure stimulation and electrical skin stimulations) to unravel segmental and widespread hyperalgesia as a consequence of visceral pain. A dynamic conditioned pain modulation (CPM) paradigm was used as a proxy of pain modulation from the brainstem to inhibit incoming nociceptive barrage, and questionnaires were used to gather information on pain experience and quality of life.RESULTS: Patients had impaired CPM compared with controls (18.0±29.3% vs. 30.9±29.3%, P=0.04) and were hypersensitive to pressure stimulation, specifically in the pancreatic (Th10) dermatome (P<0.001). The capacity of CPM was associated with clinical pain intensity (P=0.01) and (in the univariate analysis only) the use of opioids was associated with hyperalgesia to pressure stimulation (P<0.05).CONCLUSIONS: Sensitivity to pain in CP patients can be characterized by a simple bedside QST. Severe clinical pain in CP was associated with reduced CPM function and should be targeted in management.

AB - BACKGROUND: Abdominal pain is the most common symptom in chronic pancreatitis (CP) and has an extensive impact on patients' lives. Quantitative sensory testing (QST) provides information on sensitivity to pain and mechanisms that can help quantify pain and guide treatment. The aims of this study were (1) to explore sensitivity to pain in patients with CP using QST and (2) to associate patient and disease characteristics with QST results.METHODS: Ninety-one patients with painful CP and 28 healthy control participants completed a QST paradigm using static tests (muscle pressure stimulation and electrical skin stimulations) to unravel segmental and widespread hyperalgesia as a consequence of visceral pain. A dynamic conditioned pain modulation (CPM) paradigm was used as a proxy of pain modulation from the brainstem to inhibit incoming nociceptive barrage, and questionnaires were used to gather information on pain experience and quality of life.RESULTS: Patients had impaired CPM compared with controls (18.0±29.3% vs. 30.9±29.3%, P=0.04) and were hypersensitive to pressure stimulation, specifically in the pancreatic (Th10) dermatome (P<0.001). The capacity of CPM was associated with clinical pain intensity (P=0.01) and (in the univariate analysis only) the use of opioids was associated with hyperalgesia to pressure stimulation (P<0.05).CONCLUSIONS: Sensitivity to pain in CP patients can be characterized by a simple bedside QST. Severe clinical pain in CP was associated with reduced CPM function and should be targeted in management.

KW - chronic pancreatitis

KW - hyperalgesia

KW - pain

KW - pain measurement

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U2 - 10.1097/AJP.0000000000000740

DO - 10.1097/AJP.0000000000000740

M3 - Journal article

VL - 35

SP - 786

EP - 793

JO - The Clinical Journal of Pain

JF - The Clinical Journal of Pain

SN - 0749-8047

IS - 9

ER -