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

Phillips, Anna E.; Faghih, Mahya; Kuhlmann, Louise; Larsen, Isabelle M.; Drewes, Asbjørn Mohr; Singh, Vikesh K.; Yadav, Dhiraj; Olesen, Søren Schou

doi:10.1016/j.pan.2019.11.007

Cited by 40 publications

(59 citation statements)

References 49 publications

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“…A collaboration of researchers has developed and tested a pancreas-specific quantitative sensory testing protocol (P-QST) that can separate patients into three phenotypes suggestive of normal nociception, altered nociception at the level of the pancreatic viscerotome, and widespread hyperalgesia suggestive of systemic central sensitization. 13 Although this method does not test pain per se, it can assess alterations in neural signaling. Widespread hyperalgesia in CP patients has been associated with higher pain intensity, constant pain, lower QOL, and lower physical functioning.…”

Section: Quantitative Sensory Testingmentioning

confidence: 99%

“…[8][9][10][11] Currently, pain management in RAP and CP is based on questionnaire-based measurements of pain severity 12 and analgesic therapy is based on general recommendations from the World Health Organization on the treatment of chronic pain. 13 Treatment options in CP focus on symptom relief with most CP patients being prescribed opioids for the treatment of their pain. 13 In some patients, ductobstructing pancreatic duct stones or strictures can be treated with invasive treatments (endotherapy, extracorporeal shockwave lithotripsy [ESWL] or surgery) to relieve suspected intraductal hypertension, although these interventions are effective in only a subset of patients.…”

Section: Introductionmentioning

confidence: 99%

“…13 Treatment options in CP focus on symptom relief with most CP patients being prescribed opioids for the treatment of their pain. 13 In some patients, ductobstructing pancreatic duct stones or strictures can be treated with invasive treatments (endotherapy, extracorporeal shockwave lithotripsy [ESWL] or surgery) to relieve suspected intraductal hypertension, although these interventions are effective in only a subset of patients. 9,[14][15][16][17] Total pancreatectomy with islet cell auto-transplantation (TPIAT) has been offered as radical treatment and the last resort to patients with severe, unmanageable pain.…”

Section: Introductionmentioning

confidence: 99%

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Severe Pain in Chronic Pancreatitis Patients: Considering Mental Health and Associated Genetic Factors

Dunbar¹,

Saloman²,

Phillips³

et al. 2021

JPR

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Pain is the most distressing and disruptive feature of recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) resulting in low quality of life (QOL) and disabilities. There is no single, characteristic pain pattern in patients with RAP and CP. Abdominal imaging features of CP accurately reflect morphologic features but they do not correlate with pain. Pain is the major driver of poor quality of life (QOL) and it is the constant pain, rather than intermittent pain that drives poor QOL. Furthermore, the most severe constant pain experience in CP is also a complex condition. The ability to target the etiopathogenesis of severe pain requires new methods to detect the exact pain mechanisms in an individual at cellular, tissue, system and psychiatric levels. In patients with complex and severe disease, it is likely that multiple overlapping mechanisms are simultaneously driving pain, anxiety and depression. Quantitative sensory testing (QST) shows promise in detecting alterations in central processing of pain signals and to classify patients for mechanistic and therapeutic studies. New genetic research suggests that genetic loci for severe pain in CP overlap with genetic loci for depression and other psychiatric disorders, providing additional insights and therapeutic targets for individual patients with severe CP pain. Well-designed clinical trials that integrate clinical features, QST, genetics and psychological assessments with targeted treatment and assessment of responses are required for a quantum leap forward. A better understanding of the context and mechanisms contributing to severe pain experiences in individual patients is predicted to lead to better therapies and quality of life.

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Section: Quantitative Sensory Testingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Severe Pain in Chronic Pancreatitis Patients: Considering Mental Health and Associated Genetic Factors

Dunbar¹,

Saloman²,

Phillips³

et al. 2021

JPR

Self Cite

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“…The Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials has recently called for improved phenotyping of pain in an effort to deliver the most appropriate therapy based on an individual patient’s pain characteristics[ 36 ]. In line with this, pancreatic quantitative sensory testing (QST) represents a novel method of characterizing sensory processing in the peripheral and central pain pathways[ 37 ]. While data has demonstrated how QST can be used to predict the efficacy of pregabalin in CP patients, much work is needed to determine if QST can help predict a priori which patients will respond to PET[ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of pancreatic endotherapy on quality of life in chronic pancreatitis patients: A systematic review

Han

Papachristou

Conwell

2021

WJGE

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BACKGROUND Pancreatic endotherapy provides treatment options for the management of chronic pancreatitis-related structural complications such as pancreatic duct stones, strictures, and pancreatic fluid collections. Most studies detailing endotherapy, however, have focused on technical success outcomes such as stone clearance or stricture resolution. AIM To review the effect of pancreatic endotherapy on patient-centered outcomes. METHODS Systematic review of studies examining pancreatic endotherapy. RESULTS A total of 13 studies including 3 randomized clinical trials were included. The majority of studies found an improvement in quality of life with pancreatic endotherapy. CONCLUSION While pancreatic endotherapy does appear to improve quality of life, there are clear gaps in knowledge regarding many pancreatic endotherapy modalities. Furthermore, qualitative analysis is lacking in these studies and further work is needed to elucidate the patient experience with pancreatic endotherapy.

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“…We originally developed a specialized QST-protocol for chronic pancreatitis, which reliably characterizes peripheral and central pain mechanisms [ 19 , 20 ]. The protocol includes validated specific phasic pressure tests, repetitive tests to assess temporal summation (TS), tonic cold pain (summated pain response to the immersion of the hand into cold water), and capacity of conditioned pain modulation (CPM).…”

Section: Introductionmentioning

confidence: 99%

Simple Quantitative Sensory Testing Reveals Paradoxical Co-existence of Hypoesthesia and Hyperalgesia in Diabetes

et al. 2021

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Background: Diabetic neuropathy is characterized by the paradoxical co-existence of hypo- and hyperalgesia to sensory stimuli. The literature shows consistently sensory differences between healthy and participants with diabetes. We hypothesized that due to differences in pathophysiology, advanced quantitative sensory testing (QST) might reveal sensory discrepancies between type 1 (T1D) and type 2 diabetes (T2D). Furthermore, we investigated whether vibration detection thresholds (VDT) were associated with sensory response.Method: Fifty-six adults with T1D [43 years (28–58)], 99 adults with T2D [65 years (57–71)], and 122 healthy individuals [51 years (34–64)] were included. VDT, pressure pain detection thresholds (pPDT) and tolerance (pPTT), tonic cold pain (hand-immersion in iced water), and central pain mechanisms (temporal summation and conditioned pain modulation) were tested and compared between T1D and T2D. VDT was categorized into normal (< 18 V), intermediary (18–25 V), or high (> 25 V).Results: In comparison to healthy, analysis adjusted for age, BMI, and gender revealed hypoalgesia to tibial (pPDT): p = 0.01, hyperalgesia to tonic cold pain: p < 0.01, and diminished temporal summation (arm: p < 0.01; abdomen: p < 0.01). In comparison to participants with T2D, participants with T1D were hypoalgesic to tibial pPDT: p < 0.01 and pPTT: p < 0.01, and lower VDT: p = 0.02. VDT was not associated with QST responses.Conclusion: Participants with T1D were more hypoalgesic to bone pPDT and pPTT independent of lower VDT, indicating neuronal health toward normalization. Improved understanding of differentiated sensory profiles in T1D and T2D may identify improved clinical endpoints in future trials.

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

Cited by 40 publications

References 49 publications

Severe Pain in Chronic Pancreatitis Patients: Considering Mental Health and Associated Genetic Factors

Severe Pain in Chronic Pancreatitis Patients: Considering Mental Health and Associated Genetic Factors

Effect of pancreatic endotherapy on quality of life in chronic pancreatitis patients: A systematic review

Simple Quantitative Sensory Testing Reveals Paradoxical Co-existence of Hypoesthesia and Hyperalgesia in Diabetes

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