Quantitative Sensory Testing (QST) - Does assessing ... - TI Pharma

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3. Somatosensory function and neuropathic pain grading 4.3.1. Somatosensory function across the grading of neuropathic pain The pattern of sensory abnormalities for nociceptive and non-nociceptive parameters did not differ for the different neuropathic pain grades. A similar distribution of nociceptive and non-nociceptive parameters was previously reported in neuropathic pain patients (Maier et al 2010). Recently, Maier and colleagues reported in a QST study of 1236 neuropathic pain patients that profiles of sensory abnormalities differ in the neuropathic pain conditions (Maier et al 2010). Differences in profiles of sensory abnormalities were also observed in our study based on the grading system of neuropathic pain. The presence of sensory gain and loss and only sensory loss was similar for the grade of ‘definite’ and ‘probable’ but was significantly different to the grade ‘unlikely’ neuropathic pain. Our results indicate that the grading system allows a separation of neuropathic and nonneuropathic pain based on profiles of sensory abnormalities. 4.4. Background pain, number of sensory abnormalities and neuropathic pain grading QST revealed that the numbers of sensory abnormalities did not differ between the different neuropathic pain grades. This observation challenges the hypothesis that the number of sensory abnormalities is positively related to neuropathic pain grades using the grading system (Maier et al 2010). In a study with 618 neuropathic- and non-neuropathic pain patients, Dworkin and colleagues showed that pain intensity, unpleasantness, quality, and spatial characteristics differed significantly between these groups (Dworkin et al 2007a). In the present study we have assessed the intensity of background pain prior to QST. There was no correlation between background pain intensity and numbers of somatosensory abnormalities in patients clinically diagnosed as neuropathic pain or for the different grades of neuropathy. The majority of patients investigated (93%) used their regular medication when the QST assessment took place. The medication could have influenced the sensory profiles detected. This is not ideal, but it reflects the most common situation in which QST testing is performed, clinically. Furthermore, all categories of the neuropathic pain grading include patients with medication. Apart from the ethical aspect of drug withdrawal leading to increased pain, many neuropathic pain medications have long elimination times and possible active metabolites, making drug withdrawal prior to testing both unwarranted and unpractical.
3. Somatosensory function and neuropathic pain grading In conclusion, our results indicate that there is a mismatch between clinical neuropathic pain diagnoses and neuropathic pain grading outcome. Only 60% of patients with clinically diagnosed neuropathy were categorized as ‘definite’ and ‘probable’ neuropathic pain patients. Even if such a stringent grading system may provide advantages in selecting homogenous groups for clinical research, numbers of somatosensory abnormalities within the different certainties of neuropathic pain are remarkably similar. The only significant finding to differentiate “true” neuropathic pain from “unlikely” neuropathic pain was the difference in somatosensory profiles, in particular with regard to the presence of the mixture of sensory gain and loss and only sensory loss. Neuropathic pain grades as well as numbers of sensory abnormalities were not correlated with patients reported background pain intensity. Acknowledgement We would like to thank P. Koole and A. Kuil for the excellent work assessing QST profiles and Dr. F. Said for his great work of categorizing patient with respect to their pain diagnosis and neuropathic pain grading. This study was performed within the framework of Dutch Top Institute Pharma project T5-108. Partners in this project include Merck Co., PRA International and UMC Groningen.
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Quantitative Sensory Testing (QST)
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Promotores: Prof. dr. M.M.R.F. Stru
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Paranimfen Marten Harbers Aribert B
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Contents 3.3.4. Sensory changes at
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Nederlandse samenvatting Met de ont
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Acknowledgement To produce a work s
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