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

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4. QST and neuropathic pain mechanisms 4.3. QST for mechanism-based studies in neuropathic pain patients QST data can be regarded as a rich source of valuable information of sensory abnormalities in chronic pain patients such as neuropathic pain. It is striking that sensory abnormalities for certain parameter such as Pressure Pain Threshold (PPT) or Mechanical Pain Sensitivity (MPS) of the QST battery were by far more frequently observed than others. The prevalence of sensory gain for PPT and MPS overall in neuropathic pain patients was reported to be 36.4% and 29.2%, respectively (Maier et al 2010). The identification of somatosensory phenotypes based on single QST parameter such as MPS can contribute to the viability of mechanism-based understanding of neuropathic pain. We showed that different “responders” to MPS exist in the population of neuropathic pain patients. From a mechanistic point of view the identification of phenotypical homogenous groups of different “responders” for even a single QST parameter e.g. MPS might be useful. Future studies could evaluate if these different responders show differences in pharmacological responsiveness using different classes of pharmacological agents, e.g. sodium-channel blocker, antidepressants. In addition, if differences in responders to other QST parameters could be identified, with again distinct reactions to pharmacological interventions, a truly mechanistic picture of the somatosensory of neuropathic pain patients could be emerging. As previous mentioned, looking at QST profiles instead of a single parameter has shown its value to generate a mechanistic understanding of somatosensory abnormalities in neuropathic pain (Maier et al 2010). Our results add to that finding that one can even further subdivide the patients based on more detailed testing as we did using our specific MPS analysis approach. Our results indicate that multiple mechanisms e.g. different causes of neuropathic pain, can lead to the same sensory sign e.g. MPS abnormalities. Moreover, that distinct different pattern of sensitisation to pinprick pain is common in different neuropathic pain aetiologies. This observation raises the question if these mechanistic differences in sensitisation could also explain the lack of efficacy of pharmacotherapy in neuropathic pain patients. In summary, a single QST parameter, i.e. MPS, can be used to identify distinct subgroups of neuropathic pain patients, characterised by altered mechanical pain sensitivity. Part of the patients showed a clear stimulus-response to pinprick stimuli, while in the other part a stimulus-response to pinprick stimuli was completely absent. Both types of responses were found within different clinical entities of neuropathic pain. Further evaluation is necessary to identify potential differences in the mechanisms responsible for these distinct MPS abnormalities and their subsequent mechanism-based therapy.
4. QST and neuropathic pain mechanisms 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 patients with respect to their pain diagnosis. 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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0 Contents Chapter 5 Do patients wi
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Chapter 1 General introduction
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1. General introduction stimuli. C-
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1. General introduction Patients re
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1. General introduction 0 drugs (NS
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1. General introduction Table 1-2:
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Chapter 2 Bilateral sensory abnorma
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