Quantitative Sensory Testing Predicts Pregabalin Efficacy in Painful Chronic Pancreatitis

Abstract

BackgroundA major problem in pain medicine is the lack of knowledge about which treatment suits a specific patient. We tested the ability of quantitative sensory testing to predict the analgesic effect of pregabalin and placebo in patients with chronic pancreatitis.MethodsSixty-four patients with painful chronic pancreatitis received pregabalin (150–300 mg BID) or matching placebo for three consecutive weeks. Analgesic effect was documented in a pain diary based on a visual analogue scale. Responders were defined as patients with a reduction in clinical pain score of 30% or more after three weeks of study treatment compared to baseline recordings. Prior to study medication, pain thresholds to electric skin and pressure stimulation were measured in dermatomes T10 (pancreatic area) and C5 (control area). To eliminate inter-subject differences in absolute pain thresholds an index of sensitivity between stimulation areas was determined (ratio of pain detection thresholds in pancreatic versus control area, ePDT ratio). Pain modulation was recorded by a conditioned pain modulation paradigm. A support vector machine was used to screen sensory parameters for their predictive power of pregabalin efficacy.ResultsThe pregabalin responders group was hypersensitive to electric tetanic stimulation of the pancreatic area (ePDT ratio 1.2 (0.9–1.3)) compared to non-responders group (ePDT ratio: 1.6 (1.5–2.0)) (P = 0.001). The electrical pain detection ratio was predictive for pregabalin effect with a classification accuracy of 83.9% (P = 0.007). The corresponding sensitivity was 87.5% and specificity was 80.0%. No other parameters were predictive of pregabalin or placebo efficacy.ConclusionsThe present study provides first evidence that quantitative sensory testing predicts the analgesic effect of pregabalin in patients with painful chronic pancreatitis. The method can be used to tailor pain medication based on patient’s individual sensory profile and thus comprises a significant step towards personalized pain medicine.

Pain modulatory phenotypes differentiate subgroups with different clinical and experimental pain sensitivity

“…TSP assessed preoperatively was found to predict the pain intensity 12 months after total knee replacement [27]. Moreover, TSP predicted the efficacy of pregabalin, expected to reduce neuronal sensitization, in patients with chronic pancreatitis [24].…”

“…Protocols for assessment of pain facilitation and pain inhibition has demonstrated some promise in predicting future pain status [16,27,41,43] and the efficacy of analgesics [7,21,24,45].…”

Road map for pain management in pancreatic cancer: A review

“…Upstream transmission of neuropathic pain in the central nervous system and neuronal excitability are consecutively inhibited [39] . These molecules may have beneficial effects as adjuvants and opioids sparing for coeliac plexus pain [40,41] . Corticosteroids: Steroids have been proved particularly useful as adjuvant therapy for visceral pain [42] .…”

Pathogenesis and Treatment of Pain in Chronic Pancreatitis

“…A major problem in pain medicine is the lack of knowledge about which treatment suits a specific patient. In a recent study, we tested the ability of quantitative sensory testing to predict the analgesic effect of pregabalin and placebo in patients with chronic pancreatitis (48). A positive pregabalin effect was associated with pretreatment sensitivity to electric tetanic stimulation of the upper abdominal area (sharing spinal segmental innervation with the pancreatic gland).…”