Investigating the Feasibility of a Modified Quantitative Sensory Testing Approach to Profile Sensory Function and Predict Pain Outcomes Following Intrathecal Baclofen Implant Surgery in Cerebral Palsy.
Adolescent
Adult
Baclofen
/ administration & dosage
Cerebral Palsy
/ complications
Child
Feasibility Studies
Female
Humans
Infusion Pumps, Implantable
Injections, Spinal
Male
Muscle Relaxants, Central
/ administration & dosage
Muscle Spasticity
/ drug therapy
Pain
/ diagnosis
Physical Stimulation
/ instrumentation
Sensation
/ drug effects
Young Adult
Cerebral Palsy
Intrathecal Baclofen
Pain
Quantitative Sensory Testing
Journal
Pain medicine (Malden, Mass.)
ISSN: 1526-4637
Titre abrégé: Pain Med
Pays: England
ID NLM: 100894201
Informations de publication
Date de publication:
01 01 2020
01 01 2020
Historique:
pubmed:
4
7
2019
medline:
16
1
2021
entrez:
4
7
2019
Statut:
ppublish
Résumé
Intrathecal baclofen (ITB) pumps used to manage spasticity in children with cerebral palsy (CP) also improve pain outcomes for some but not all patients. The purpose of this clinical feasibility study was to explore whether a quantitative sensory testing approach could a) be modified and used to subgroup individuals into sensory profiles and b) test whether the profiles were related to postimplant pain outcomes (i.e., pain responsive or pain persistent). A purposeful clinical sample of nine children with CP (mean age = 12.5 years, male = 56%) and complex communication needs participated. A prospective within-subject design was used to measure proxy-reported pain before and after ITB implant. Pain response status was determined by proxy-reported pain intensity change (>50% change in maximum rated intensity). A modified quantitative sensory testing (mQST) procedure was used to assess behavioral responsivity to an array of calibrated sensory (tactile/acute nociceptive) stimuli before surgery. Seven individuals with presurgical pain had mQST differentiated sensory profiles in relation to ITB pain outcomes and relative to the two individuals with no pain. Presurgically, the ITB pain responsive subgroup (N = 3, maximum rated pain intensity decreased >50% after ITB implant) showed increased behavioral reactivity to an acute nociceptive stimulus and cold stimulus, whereas the ITB pain persistent subgroup (N = 4) showed reduced behavioral reactivity to cold and repeated von Frey stimulation relative to the no pain individuals. Implications for patient selection criteria and stratification to presurgically identify individuals with CP "at risk" for persistent postprocedure pain are discussed.
Identifiants
pubmed: 31268147
pii: 5527805
doi: 10.1093/pm/pnz114
pmc: PMC7999622
doi:
Substances chimiques
Muscle Relaxants, Central
0
Baclofen
H789N3FKE8
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
109-117Informations de copyright
© 2019 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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