A clinically feasible method for the assessment and characterization of pain in patients with chronic pancreatitis

A E Phillips, M Faghih, L Kuhlmann, I M Larsen, A M Drewes, V K Singh, D Yadav, S S Olesen, Pancreatic Quantitative Sensory Testing (P-QST) Working Group

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

BACKGROUND AND AIMS: Pain is the primary symptom of chronic pancreatitis (CP), but methods for sensory testing and pain characterization have not previously been validated for clinical use. We present a clinically feasible method for the assessment and characterization of pain mechanisms in patients with CP based on quantitative sensory testing (QST).

METHODS: This was a cross-sectional, multicenter study of 122 control subjects without pancreatic disease and another 60 patients with painful CP. All subjects underwent standardized QST assessments including a cold pressor test, a conditioned pain modulation paradigm, repetitive pin-prick stimuli (temporal summation) and pressure stimulation of the upper abdominal (pancreatic) and control dermatomes. The effects of age and gender on QST assessment parameters were investigated and normative reference values based on quartile regression were derived and implemented in algorithms to categorize patients according to their patterns of central pain processing (normal vs. segmental sensitization vs. widespread sensitization).

RESULTS: Absolute pressure thresholds were subject to clinically relevant gender effects (all p < 0.001), while the remainder of QST parameters were unaffected by age and gender. The algorithm with the best discriminatory capacity showed good separation between patients and controls (p < 0.001); 50% of patients had normal central pain processing, 23% had evidence of segmental sensitization and 27% had evidence of widespread sensitization.

CONCLUSION: We show normative reference values for a clinically feasible method for assessment and characterization of pain mechanisms in patients with CP. Application of this method streamlines the evaluation of pancreatic pain and may be used to inform treatment. CLINICALTRIALS.

GOV ID: NCT03434392.

Original languageEnglish
JournalPancreatology
Volume20
Issue number1
Pages (from-to)25-34
ISSN1424-3903
DOIs
Publication statusPublished - Jan 2020

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Chronic Pancreatitis
Pain Measurement
Pain
Reference Values
Pressure
Pancreatic Diseases
Multicenter Studies
Cross-Sectional Studies

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Phillips, A E ; Faghih, M ; Kuhlmann, L ; Larsen, I M ; Drewes, A M ; Singh, V K ; Yadav, D ; Olesen, S S ; Pancreatic Quantitative Sensory Testing (P-QST) Working Group. / A clinically feasible method for the assessment and characterization of pain in patients with chronic pancreatitis. In: Pancreatology. 2020 ; Vol. 20, No. 1. pp. 25-34.
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title = "A clinically feasible method for the assessment and characterization of pain in patients with chronic pancreatitis",
abstract = "BACKGROUND AND AIMS: Pain is the primary symptom of chronic pancreatitis (CP), but methods for sensory testing and pain characterization have not previously been validated for clinical use. We present a clinically feasible method for the assessment and characterization of pain mechanisms in patients with CP based on quantitative sensory testing (QST).METHODS: This was a cross-sectional, multicenter study of 122 control subjects without pancreatic disease and another 60 patients with painful CP. All subjects underwent standardized QST assessments including a cold pressor test, a conditioned pain modulation paradigm, repetitive pin-prick stimuli (temporal summation) and pressure stimulation of the upper abdominal (pancreatic) and control dermatomes. The effects of age and gender on QST assessment parameters were investigated and normative reference values based on quartile regression were derived and implemented in algorithms to categorize patients according to their patterns of central pain processing (normal vs. segmental sensitization vs. widespread sensitization).RESULTS: Absolute pressure thresholds were subject to clinically relevant gender effects (all p < 0.001), while the remainder of QST parameters were unaffected by age and gender. The algorithm with the best discriminatory capacity showed good separation between patients and controls (p < 0.001); 50{\%} of patients had normal central pain processing, 23{\%} had evidence of segmental sensitization and 27{\%} had evidence of widespread sensitization.CONCLUSION: We show normative reference values for a clinically feasible method for assessment and characterization of pain mechanisms in patients with CP. Application of this method streamlines the evaluation of pancreatic pain and may be used to inform treatment. CLINICALTRIALS.GOV ID: NCT03434392.",
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Phillips, AE, Faghih, M, Kuhlmann, L, Larsen, IM, Drewes, AM, Singh, VK, Yadav, D, Olesen, SS & Pancreatic Quantitative Sensory Testing (P-QST) Working Group 2020, 'A clinically feasible method for the assessment and characterization of pain in patients with chronic pancreatitis', Pancreatology, vol. 20, no. 1, pp. 25-34. https://doi.org/10.1016/j.pan.2019.11.007

A clinically feasible method for the assessment and characterization of pain in patients with chronic pancreatitis. / Phillips, A E; Faghih, M; Kuhlmann, L; Larsen, I M; Drewes, A M; Singh, V K; Yadav, D; Olesen, S S; Pancreatic Quantitative Sensory Testing (P-QST) Working Group.

In: Pancreatology, Vol. 20, No. 1, 01.2020, p. 25-34.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - A clinically feasible method for the assessment and characterization of pain in patients with chronic pancreatitis

AU - Phillips, A E

AU - Faghih, M

AU - Kuhlmann, L

AU - Larsen, I M

AU - Drewes, A M

AU - Singh, V K

AU - Yadav, D

AU - Olesen, S S

AU - Pancreatic Quantitative Sensory Testing (P-QST) Working Group

PY - 2020/1

Y1 - 2020/1

N2 - BACKGROUND AND AIMS: Pain is the primary symptom of chronic pancreatitis (CP), but methods for sensory testing and pain characterization have not previously been validated for clinical use. We present a clinically feasible method for the assessment and characterization of pain mechanisms in patients with CP based on quantitative sensory testing (QST).METHODS: This was a cross-sectional, multicenter study of 122 control subjects without pancreatic disease and another 60 patients with painful CP. All subjects underwent standardized QST assessments including a cold pressor test, a conditioned pain modulation paradigm, repetitive pin-prick stimuli (temporal summation) and pressure stimulation of the upper abdominal (pancreatic) and control dermatomes. The effects of age and gender on QST assessment parameters were investigated and normative reference values based on quartile regression were derived and implemented in algorithms to categorize patients according to their patterns of central pain processing (normal vs. segmental sensitization vs. widespread sensitization).RESULTS: Absolute pressure thresholds were subject to clinically relevant gender effects (all p < 0.001), while the remainder of QST parameters were unaffected by age and gender. The algorithm with the best discriminatory capacity showed good separation between patients and controls (p < 0.001); 50% of patients had normal central pain processing, 23% had evidence of segmental sensitization and 27% had evidence of widespread sensitization.CONCLUSION: We show normative reference values for a clinically feasible method for assessment and characterization of pain mechanisms in patients with CP. Application of this method streamlines the evaluation of pancreatic pain and may be used to inform treatment. CLINICALTRIALS.GOV ID: NCT03434392.

AB - BACKGROUND AND AIMS: Pain is the primary symptom of chronic pancreatitis (CP), but methods for sensory testing and pain characterization have not previously been validated for clinical use. We present a clinically feasible method for the assessment and characterization of pain mechanisms in patients with CP based on quantitative sensory testing (QST).METHODS: This was a cross-sectional, multicenter study of 122 control subjects without pancreatic disease and another 60 patients with painful CP. All subjects underwent standardized QST assessments including a cold pressor test, a conditioned pain modulation paradigm, repetitive pin-prick stimuli (temporal summation) and pressure stimulation of the upper abdominal (pancreatic) and control dermatomes. The effects of age and gender on QST assessment parameters were investigated and normative reference values based on quartile regression were derived and implemented in algorithms to categorize patients according to their patterns of central pain processing (normal vs. segmental sensitization vs. widespread sensitization).RESULTS: Absolute pressure thresholds were subject to clinically relevant gender effects (all p < 0.001), while the remainder of QST parameters were unaffected by age and gender. The algorithm with the best discriminatory capacity showed good separation between patients and controls (p < 0.001); 50% of patients had normal central pain processing, 23% had evidence of segmental sensitization and 27% had evidence of widespread sensitization.CONCLUSION: We show normative reference values for a clinically feasible method for assessment and characterization of pain mechanisms in patients with CP. Application of this method streamlines the evaluation of pancreatic pain and may be used to inform treatment. CLINICALTRIALS.GOV ID: NCT03434392.

U2 - 10.1016/j.pan.2019.11.007

DO - 10.1016/j.pan.2019.11.007

M3 - Journal article

C2 - 31787527

VL - 20

SP - 25

EP - 34

JO - Pancreatology

JF - Pancreatology

SN - 1424-3903

IS - 1

ER -