Pain and Nociception Neuroscience Research Group, Department of Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
PLoS One. 2012;7(8):e42096. doi: 10.1371/journal.pone.0042096. Epub 2012 Aug 6.
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).
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.
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.
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.
ClinicalTrials.gov NCT00755573.
剧烈腹痛是慢性胰腺炎的主要特征。在疾病变化过程中，中枢疼痛处理会发生改变，例如中枢敏化表现为扩散性痛觉过敏，这可能是由于持续的伤害性传入。本研究旨在通过定量感觉测试（QST）评估普瑞巴林对慢性胰腺炎疼痛处理的影响。
这是一项随机、双盲、安慰剂对照试验，评估了普瑞巴林对疼痛处理的影响。使用 QST 通过测量六个身体皮区的疼痛电刺激和压力刺激阈值来定量疼痛处理。使用条件疼痛调制（CPM）范式量化下行内源性疼痛调制，以引起 DNIC（弥散性疼痛抑制控制）反应。主要效应参数是在研究治疗 3 周后与基线值相比，两组治疗之间所有身体疼痛阈值值总和的变化。
共分析了 64 例患者。治疗 3 周后，普瑞巴林与安慰剂组之间总和疼痛阈值的变化无差异。对于个体皮区，与基线相比，普瑞巴林组的电痛觉检测阈值（C5，P=0.005）、电痛觉耐受阈值（C5，P=0.04；L1，P=0.05）和压力痛觉耐受阈值（T4，P=0.004）在 C5 和 L1 中均显著增加。普瑞巴林与安慰剂组之间在条件疼痛调制方面没有差异。
本研究首次提供证据表明，普瑞巴林对慢性胰腺炎患者表现为扩散性痛觉过敏的中枢敏化具有中度抑制作用。这些发现表明，QST 可用于监测慢性疼痛背景下的疼痛治疗。
ClinicalTrials.gov NCT00755573。
