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Quantitative sensory testing predicts pregabalin efficacy in painful chronic pancreatitis.

Olesen SS, Graversen C, Bouwense SA, van Goor H, Wilder-Smith OH, Drewes AM - PLoS ONE (2013)

Bottom Line: 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.The electrical pain detection ratio was predictive for pregabalin effect with a classification accuracy of 83.9% (P = 0.007).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.

View Article: PubMed Central - PubMed

Affiliation: Mech-Sense, Department of Gastroenterology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.

ABSTRACT

Background: A 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.

Methods: Sixty-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.

Results: The 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.

Conclusions: The 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.

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Predictive power of baseline QST measurements.The SVM was used to screen baseline QST measurements for their predictive power of analgesic response to pregabalin and placebo. Only the electrical pain detection tolerance (ePDT) ratio in the pregabalin treated group reached classification accuracy (80.6%) above chance level (74.2%; dotted line). CPM, conditioned pain modulation. *P = 0.02.
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pone-0057963-g002: Predictive power of baseline QST measurements.The SVM was used to screen baseline QST measurements for their predictive power of analgesic response to pregabalin and placebo. Only the electrical pain detection tolerance (ePDT) ratio in the pregabalin treated group reached classification accuracy (80.6%) above chance level (74.2%; dotted line). CPM, conditioned pain modulation. *P = 0.02.

Mentions: First, the different QST parameters in the pregabalin group were screened by the leave-one-out approach. The ePDT ratio was found to have the highest discriminatory power to separate responders from non-responders (Figure 2). The classification accuracy for this parameter was 80.6%, which was above chance level compared to random performance (P = 0.02). None of the other baseline QST measurements reached classification accuracy above chance level (Figure 2).


Quantitative sensory testing predicts pregabalin efficacy in painful chronic pancreatitis.

Olesen SS, Graversen C, Bouwense SA, van Goor H, Wilder-Smith OH, Drewes AM - PLoS ONE (2013)

Predictive power of baseline QST measurements.The SVM was used to screen baseline QST measurements for their predictive power of analgesic response to pregabalin and placebo. Only the electrical pain detection tolerance (ePDT) ratio in the pregabalin treated group reached classification accuracy (80.6%) above chance level (74.2%; dotted line). CPM, conditioned pain modulation. *P = 0.02.
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3585877&req=5

pone-0057963-g002: Predictive power of baseline QST measurements.The SVM was used to screen baseline QST measurements for their predictive power of analgesic response to pregabalin and placebo. Only the electrical pain detection tolerance (ePDT) ratio in the pregabalin treated group reached classification accuracy (80.6%) above chance level (74.2%; dotted line). CPM, conditioned pain modulation. *P = 0.02.
Mentions: First, the different QST parameters in the pregabalin group were screened by the leave-one-out approach. The ePDT ratio was found to have the highest discriminatory power to separate responders from non-responders (Figure 2). The classification accuracy for this parameter was 80.6%, which was above chance level compared to random performance (P = 0.02). None of the other baseline QST measurements reached classification accuracy above chance level (Figure 2).

Bottom Line: 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.The electrical pain detection ratio was predictive for pregabalin effect with a classification accuracy of 83.9% (P = 0.007).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.

View Article: PubMed Central - PubMed

Affiliation: Mech-Sense, Department of Gastroenterology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.

ABSTRACT

Background: A 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.

Methods: Sixty-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.

Results: The 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.

Conclusions: The 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.

Show MeSH
Related in: MedlinePlus