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A clinically feasible method for the assessment and characterization of pain in patients with chronic pancreatitis
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 qua...
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Published in: | Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2020-01, Vol.20 (1), p.25-34 |
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container_title | Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] |
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creator | Phillips, Anna Evans Faghih, Mahya Kuhlmann, Louise Larsen, Isabelle M. Drewes, Asbjørn Mohr Singh, Vikesh K. Yadav, Dhiraj Olesen, Søren Schou |
description | 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).
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).
Absolute pressure thresholds were subject to clinically relevant gender effects (all p |
doi_str_mv | 10.1016/j.pan.2019.11.007 |
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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).
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.
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.
NCT03434392.</description><identifier>ISSN: 1424-3903</identifier><identifier>EISSN: 1424-3911</identifier><identifier>DOI: 10.1016/j.pan.2019.11.007</identifier><identifier>PMID: 31787527</identifier><language>eng</language><publisher>Switzerland: Elsevier B.V</publisher><subject>Abdomen ; Age ; Algorithms ; Analgesics ; Central sensitization ; Chronic pancreatitis ; Enrollments ; Family medical history ; Lithotripsy ; Methods ; Narcotics ; Nociception ; Pain ; Pancreas ; Pancreatic diseases ; Pancreatitis ; Patients ; Pressure ; Questionnaires ; Spinal cord</subject><ispartof>Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.], 2020-01, Vol.20 (1), p.25-34</ispartof><rights>2019 IAP and EPC</rights><rights>Copyright © 2019 IAP and EPC. Published by Elsevier B.V. All rights reserved.</rights><rights>2019. IAP and EPC</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c311t-1c73106a1c1bd83dfa99fd349c341880e81138ff5a45a181ba61bc6f8294c0c13</citedby><cites>FETCH-LOGICAL-c311t-1c73106a1c1bd83dfa99fd349c341880e81138ff5a45a181ba61bc6f8294c0c13</cites><orcidid>0000-0002-4720-0718 ; 0000-0003-3916-3168 ; 0000-0001-7465-964X ; 0000-0001-6154-5651</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31787527$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Phillips, Anna Evans</creatorcontrib><creatorcontrib>Faghih, Mahya</creatorcontrib><creatorcontrib>Kuhlmann, Louise</creatorcontrib><creatorcontrib>Larsen, Isabelle M.</creatorcontrib><creatorcontrib>Drewes, Asbjørn Mohr</creatorcontrib><creatorcontrib>Singh, Vikesh K.</creatorcontrib><creatorcontrib>Yadav, Dhiraj</creatorcontrib><creatorcontrib>Olesen, Søren Schou</creatorcontrib><creatorcontrib>Pancreatic Quantitative Sensory Testing (P-QST) Consortium</creatorcontrib><title>A clinically feasible method for the assessment and characterization of pain in patients with chronic pancreatitis</title><title>Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]</title><addtitle>Pancreatology</addtitle><description>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).
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).
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.
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.
NCT03434392.</description><subject>Abdomen</subject><subject>Age</subject><subject>Algorithms</subject><subject>Analgesics</subject><subject>Central sensitization</subject><subject>Chronic pancreatitis</subject><subject>Enrollments</subject><subject>Family medical history</subject><subject>Lithotripsy</subject><subject>Methods</subject><subject>Narcotics</subject><subject>Nociception</subject><subject>Pain</subject><subject>Pancreas</subject><subject>Pancreatic diseases</subject><subject>Pancreatitis</subject><subject>Patients</subject><subject>Pressure</subject><subject>Questionnaires</subject><subject>Spinal cord</subject><issn>1424-3903</issn><issn>1424-3911</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kU1rVTEQhoNY7If-ADcScOPmnmaS3POBq1K0CgU3dR1ycibcXM5Jjkmu0v76Trm1CxdCIOHNMy8z8zL2HkQDAtrLfbPa2EgBQwPQCNG9Ymegpd6oAeD1y1uoU3Zeyl4IKQGGN-xUQdd3W9mdsXzF3RxicHae77lHW8I4I1-w7tLEfcq87pDbUrCUBWPlNk7c7Wy2rmIOD7aGFHnyfLUhcjorKcQV_ifUHZE5kTmp0WWkrxrKW3bi7Vzw3fN9wX5-_XJ3_W1z--Pm-_XV7cYpgLoB1ykQrQUH49Srydth8JPSg1Ma-l5gD6B677dWby30MNoWRtf6Xg7aCQfqgn06-q45_TpgqWYJxeE824jpUIxUUrQatBKEfvwH3adDjtQdUVrKQWxlSxQcKZdTKRm9WXNYbL43IMxTIGZvaFDzFIgBMBQI1Xx4dj6MC04vFX8TIODzEUBaxe-A2RRHC3Q4hYyumimF_9g_Ao10m_g</recordid><startdate>202001</startdate><enddate>202001</enddate><creator>Phillips, Anna Evans</creator><creator>Faghih, Mahya</creator><creator>Kuhlmann, Louise</creator><creator>Larsen, Isabelle M.</creator><creator>Drewes, Asbjørn Mohr</creator><creator>Singh, Vikesh K.</creator><creator>Yadav, Dhiraj</creator><creator>Olesen, Søren Schou</creator><general>Elsevier B.V</general><general>Elsevier Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4720-0718</orcidid><orcidid>https://orcid.org/0000-0003-3916-3168</orcidid><orcidid>https://orcid.org/0000-0001-7465-964X</orcidid><orcidid>https://orcid.org/0000-0001-6154-5651</orcidid></search><sort><creationdate>202001</creationdate><title>A clinically feasible method for the assessment and characterization of pain in patients with chronic pancreatitis</title><author>Phillips, Anna Evans ; Faghih, Mahya ; Kuhlmann, Louise ; Larsen, Isabelle M. ; Drewes, Asbjørn Mohr ; Singh, Vikesh K. ; Yadav, Dhiraj ; Olesen, Søren Schou</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c311t-1c73106a1c1bd83dfa99fd349c341880e81138ff5a45a181ba61bc6f8294c0c13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Abdomen</topic><topic>Age</topic><topic>Algorithms</topic><topic>Analgesics</topic><topic>Central sensitization</topic><topic>Chronic pancreatitis</topic><topic>Enrollments</topic><topic>Family medical history</topic><topic>Lithotripsy</topic><topic>Methods</topic><topic>Narcotics</topic><topic>Nociception</topic><topic>Pain</topic><topic>Pancreas</topic><topic>Pancreatic diseases</topic><topic>Pancreatitis</topic><topic>Patients</topic><topic>Pressure</topic><topic>Questionnaires</topic><topic>Spinal cord</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Phillips, Anna Evans</creatorcontrib><creatorcontrib>Faghih, Mahya</creatorcontrib><creatorcontrib>Kuhlmann, Louise</creatorcontrib><creatorcontrib>Larsen, Isabelle M.</creatorcontrib><creatorcontrib>Drewes, Asbjørn Mohr</creatorcontrib><creatorcontrib>Singh, Vikesh K.</creatorcontrib><creatorcontrib>Yadav, Dhiraj</creatorcontrib><creatorcontrib>Olesen, Søren Schou</creatorcontrib><creatorcontrib>Pancreatic Quantitative Sensory Testing (P-QST) Consortium</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Phillips, Anna Evans</au><au>Faghih, Mahya</au><au>Kuhlmann, Louise</au><au>Larsen, Isabelle M.</au><au>Drewes, Asbjørn Mohr</au><au>Singh, Vikesh K.</au><au>Yadav, Dhiraj</au><au>Olesen, Søren Schou</au><aucorp>Pancreatic Quantitative Sensory Testing (P-QST) Consortium</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A clinically feasible method for the assessment and characterization of pain in patients with chronic pancreatitis</atitle><jtitle>Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]</jtitle><addtitle>Pancreatology</addtitle><date>2020-01</date><risdate>2020</risdate><volume>20</volume><issue>1</issue><spage>25</spage><epage>34</epage><pages>25-34</pages><issn>1424-3903</issn><eissn>1424-3911</eissn><abstract>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).
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).
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.
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.
NCT03434392.</abstract><cop>Switzerland</cop><pub>Elsevier B.V</pub><pmid>31787527</pmid><doi>10.1016/j.pan.2019.11.007</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-4720-0718</orcidid><orcidid>https://orcid.org/0000-0003-3916-3168</orcidid><orcidid>https://orcid.org/0000-0001-7465-964X</orcidid><orcidid>https://orcid.org/0000-0001-6154-5651</orcidid></addata></record> |
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subjects | Abdomen Age Algorithms Analgesics Central sensitization Chronic pancreatitis Enrollments Family medical history Lithotripsy Methods Narcotics Nociception Pain Pancreas Pancreatic diseases Pancreatitis Patients Pressure Questionnaires Spinal cord |
title | A clinically feasible method for the assessment and characterization of pain in patients with chronic pancreatitis |
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