Limits...
Effects of pregabalin on central sensitization in patients with chronic pancreatitis in a randomized, controlled trial.

Bouwense SA, Olesen SS, Drewes AM, Poley JW, van Goor H, Wilder-Smith OH - PLoS ONE (2012)

Bottom Line: During the disease changes in central pain processing, e.g. central sensitization manifest as spreading hyperalgesia, can result from ongoing nociceptive input.The main effect parameter was the change in the sum of all body pain threshold values after three weeks of study treatment versus baseline values between both treatment groups. 64 patients were analyzed.For individual dermatomes, change vs. baseline pain thresholds was significantly greater in pregabalin vs. placebo patients for electric pain detection threshold in C5 (P = 0.005), electric pain tolerance threshold in C5 (P = 0.04) and L1 (P = 0.05), and pressure pain tolerance threshold in T4 (P = 0.004).

View Article: PubMed Central - PubMed

Affiliation: Pain and Nociception Neuroscience Research Group, Department of Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.

ABSTRACT

Background: Intense abdominal pain is the dominant feature of chronic pancreatitis. During the disease changes in central pain processing, e.g. central sensitization manifest as spreading hyperalgesia, can result from ongoing nociceptive input. The aim of the present study is to evaluate the effect of pregabalin on pain processing in chronic pancreatitis as assessed by quantitative sensory testing (QST).

Methods: This randomized, double-blind, placebo-controlled trial evaluated effects of pregabalin on pain processing. QST was used to quantify pain processing by measuring thresholds to painful electrical and pressure stimulation in six body dermatomes. Descending endogenous pain modulation was quantified using the conditioned pain modulation (CPM) paradigm to elicit a DNIC (diffuse noxious inhibitory controls) response. The main effect parameter was the change in the sum of all body pain threshold values after three weeks of study treatment versus baseline values between both treatment groups.

Results: 64 patients were analyzed. No differences in change in sum of pain thresholds were present for pregabalin vs. placebo after three weeks of treatment. For individual dermatomes, change vs. baseline pain thresholds was significantly greater in pregabalin vs. placebo patients for electric pain detection threshold in C5 (P = 0.005), electric pain tolerance threshold in C5 (P = 0.04) and L1 (P = 0.05), and pressure pain tolerance threshold in T4 (P = 0.004). No differences were observed between pregabalin and placebo regarding conditioned pain modulation.

Conclusion: Our study provides first evidence that pregabalin has moderate inhibitory effects on central sensitization manifest as spreading hyperalgesia in chronic pancreatitis patients. These findings suggest that QST can be of clinical use for monitoring pain treatments in the context of chronic pain.

Trial registration: ClinicalTrials.gov NCT00755573.

Show MeSH

Related in: MedlinePlus

Dermatomes of measurement for quantitative sensory testing.Quantitative sensory testing was performed on the following sites on the dominant body side (black dots): clavicle (C5 dermatome), sternum (T4 dermatome), pancreatic site (dorsal and ventral T10 dermatome), hip region (L1 dermatome) and knee (L4 dermatome).
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3412837&req=5

pone-0042096-g001: Dermatomes of measurement for quantitative sensory testing.Quantitative sensory testing was performed on the following sites on the dominant body side (black dots): clavicle (C5 dermatome), sternum (T4 dermatome), pancreatic site (dorsal and ventral T10 dermatome), hip region (L1 dermatome) and knee (L4 dermatome).

Mentions: After initial QST training per participating subject, pressure pain thresholds were obtained for muscles overlying bone using a pressure algometer with a 1.0 cm2 probe (Somedic Sales AB, Horby, Sweden), at each of the following sites on the dominant body side: clavicle (C5 dermatome), sternum (T4 dermatome), pancreatic site (dorsal and ventral T10 dermatome), hip region (L1 dermatome) and knee (L4 dermatome) (Figure 1). The pancreas and more distant dermatomes were chosen to observe segmental and spreading hyperalgesia respectively. Two thresholds were measured: pressure pain detection threshold (pPDT) and pressure pain tolerance threshold (pPTT). As the primary endpoint, the sum of all the thresholds across dermatomes was calculated. [17].


Effects of pregabalin on central sensitization in patients with chronic pancreatitis in a randomized, controlled trial.

Bouwense SA, Olesen SS, Drewes AM, Poley JW, van Goor H, Wilder-Smith OH - PLoS ONE (2012)

Dermatomes of measurement for quantitative sensory testing.Quantitative sensory testing was performed on the following sites on the dominant body side (black dots): clavicle (C5 dermatome), sternum (T4 dermatome), pancreatic site (dorsal and ventral T10 dermatome), hip region (L1 dermatome) and knee (L4 dermatome).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3412837&req=5

pone-0042096-g001: Dermatomes of measurement for quantitative sensory testing.Quantitative sensory testing was performed on the following sites on the dominant body side (black dots): clavicle (C5 dermatome), sternum (T4 dermatome), pancreatic site (dorsal and ventral T10 dermatome), hip region (L1 dermatome) and knee (L4 dermatome).
Mentions: After initial QST training per participating subject, pressure pain thresholds were obtained for muscles overlying bone using a pressure algometer with a 1.0 cm2 probe (Somedic Sales AB, Horby, Sweden), at each of the following sites on the dominant body side: clavicle (C5 dermatome), sternum (T4 dermatome), pancreatic site (dorsal and ventral T10 dermatome), hip region (L1 dermatome) and knee (L4 dermatome) (Figure 1). The pancreas and more distant dermatomes were chosen to observe segmental and spreading hyperalgesia respectively. Two thresholds were measured: pressure pain detection threshold (pPDT) and pressure pain tolerance threshold (pPTT). As the primary endpoint, the sum of all the thresholds across dermatomes was calculated. [17].

Bottom Line: During the disease changes in central pain processing, e.g. central sensitization manifest as spreading hyperalgesia, can result from ongoing nociceptive input.The main effect parameter was the change in the sum of all body pain threshold values after three weeks of study treatment versus baseline values between both treatment groups. 64 patients were analyzed.For individual dermatomes, change vs. baseline pain thresholds was significantly greater in pregabalin vs. placebo patients for electric pain detection threshold in C5 (P = 0.005), electric pain tolerance threshold in C5 (P = 0.04) and L1 (P = 0.05), and pressure pain tolerance threshold in T4 (P = 0.004).

View Article: PubMed Central - PubMed

Affiliation: Pain and Nociception Neuroscience Research Group, Department of Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.

ABSTRACT

Background: Intense abdominal pain is the dominant feature of chronic pancreatitis. During the disease changes in central pain processing, e.g. central sensitization manifest as spreading hyperalgesia, can result from ongoing nociceptive input. The aim of the present study is to evaluate the effect of pregabalin on pain processing in chronic pancreatitis as assessed by quantitative sensory testing (QST).

Methods: This randomized, double-blind, placebo-controlled trial evaluated effects of pregabalin on pain processing. QST was used to quantify pain processing by measuring thresholds to painful electrical and pressure stimulation in six body dermatomes. Descending endogenous pain modulation was quantified using the conditioned pain modulation (CPM) paradigm to elicit a DNIC (diffuse noxious inhibitory controls) response. The main effect parameter was the change in the sum of all body pain threshold values after three weeks of study treatment versus baseline values between both treatment groups.

Results: 64 patients were analyzed. No differences in change in sum of pain thresholds were present for pregabalin vs. placebo after three weeks of treatment. For individual dermatomes, change vs. baseline pain thresholds was significantly greater in pregabalin vs. placebo patients for electric pain detection threshold in C5 (P = 0.005), electric pain tolerance threshold in C5 (P = 0.04) and L1 (P = 0.05), and pressure pain tolerance threshold in T4 (P = 0.004). No differences were observed between pregabalin and placebo regarding conditioned pain modulation.

Conclusion: Our study provides first evidence that pregabalin has moderate inhibitory effects on central sensitization manifest as spreading hyperalgesia in chronic pancreatitis patients. These findings suggest that QST can be of clinical use for monitoring pain treatments in the context of chronic pain.

Trial registration: ClinicalTrials.gov NCT00755573.

Show MeSH
Related in: MedlinePlus