Patient and Disease Characteristics Associate With Sensory Testing Results in Chronic Pancreatitis.
Journal
The Clinical journal of pain
ISSN: 1536-5409
Titre abrégé: Clin J Pain
Pays: United States
ID NLM: 8507389
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
pubmed:
4
7
2019
medline:
21
10
2020
entrez:
4
7
2019
Statut:
ppublish
Résumé
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. 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. 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). 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.
Sections du résumé
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.
Identifiants
pubmed: 31268890
doi: 10.1097/AJP.0000000000000740
pmc: PMC6693925
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
786-793Références
Surg Clin North Am. 1999 Apr;79(2):231-52
pubmed: 10352653
Pain. 1999 Nov;83(2):157-62
pubmed: 10534586
Pancreatology. 2002;2(5):469-77
pubmed: 12378115
Am J Gastroenterol. 2005 Apr;100(4):918-26
pubmed: 15784041
Eur J Pain. 2006 May;10(4):363-70
pubmed: 16087373
Lancet. 2006 May 13;367(9522):1618-25
pubmed: 16698416
Eur J Gastroenterol Hepatol. 2006 Jul;18(7):755-64
pubmed: 16772833
J Diabetes Complications. 2006 Sep-Oct;20(5):308-16
pubmed: 16949518
Pancreas. 2007 Jul;35(1):22-9
pubmed: 17575541
Pain. 2008 Aug 15;138(1):22-8
pubmed: 18079062
Pain. 2009 Jul;144(1-2):16-9
pubmed: 19359095
Am J Gastroenterol. 2009 Nov;104(11):2797-805; quiz 2806
pubmed: 19603011
Clin Gastroenterol Hepatol. 2010 Aug;8(8):724-30
pubmed: 20304100
Br J Surg. 2010 Jul;97(7):1087-95
pubmed: 20632276
Pain. 2010 Dec;151(3):598-605
pubmed: 20965658
Gut. 2011 Jan;60(1):77-84
pubmed: 21148579
Pancreatology. 2010;10(6):742-51
pubmed: 21273802
Gastroenterology. 2011 Aug;141(2):536-43
pubmed: 21683078
Clin Neurophysiol. 2012 Apr;123(4):829-37
pubmed: 21925938
Reg Anesth Pain Med. 2011 Nov-Dec;36(6):531-6
pubmed: 22005656
Clin Gastroenterol Hepatol. 2012 Apr;10(4):434-8.e1
pubmed: 22155560
Reg Anesth Pain Med. 2012 Sep-Oct;37(5):530-6
pubmed: 22854397
PLoS One. 2012;7(8):e42096
pubmed: 22879908
J Pain. 2012 Sep;13(9):901-9
pubmed: 22958874
PLoS One. 2013;8(2):e55460
pubmed: 23405154
PLoS One. 2013;8(3):e57963
pubmed: 23469256
Neurogastroenterol Motil. 2013 Jul;25(7):623-e468
pubmed: 23551988
Eur J Pain. 2013 Nov;17(10):1491-501
pubmed: 23650124
Eur J Pain. 2013 Oct;17(9):1267-80
pubmed: 23658120
Pain Med. 2014 Jan;15(1):61-72
pubmed: 24010588
World J Gastroenterol. 2013 Nov 14;19(42):7292-301
pubmed: 24259960
Endocrinol Metab Clin North Am. 2013 Dec;42(4):747-87
pubmed: 24286949
Neurogastroenterol Motil. 2014 Apr;26(4):489-98
pubmed: 24351013
J Opioid Manag. 2013 Jul-Aug;9(4):239-54
pubmed: 24353017
Eur J Pain. 2014 Aug;18(7):968-77
pubmed: 24402765
Pain. 2014 Feb;155(2):367-76
pubmed: 24472518
Br J Anaesth. 2014 Jul;113(1):148-56
pubmed: 24713310
Curr Opin Obstet Gynecol. 2014 Aug;26(4):253-9
pubmed: 24921647
PM R. 2015 Jan;7(1):42-7
pubmed: 25043261
Eur J Pain. 2015 Nov;19(10):1406-17
pubmed: 25545011
Pain. 2015 Feb;156(2):260-72
pubmed: 25599447
J Pain Res. 2015 Jul 10;8:375-86
pubmed: 26203273
Pain. 2016 Mar;157(3):750-8
pubmed: 26630440
Pain. 2016 Jul;157(7):1480-8
pubmed: 26963852
Muscle Nerve. 2016 Jun;54(1):146-9
pubmed: 27104656
Pain. 2016 Sep;157(9):1851-71
pubmed: 27152687
Pain. 2016 Sep;157(9):1988-99
pubmed: 27152688
Pain Manag. 2016 Oct;6(5):469-86
pubmed: 27256577
Eur J Pain. 2017 Jan;21(1):3-19
pubmed: 27991730
Am J Gastroenterol. 2017 Apr;112(4):633-642
pubmed: 28244497
Pain. 2017 Jul;158(7):1217-1223
pubmed: 28328574
Scand J Gastroenterol. 2017 Aug;52(8):909-915
pubmed: 28471312
Pancreatology. 2017 Sep - Oct;17(5):720-731
pubmed: 28734722
Expert Rev Clin Pharmacol. 2019 Mar;12(3):249-258
pubmed: 30664364