Höper Johanna, Helfert Stephanie, Heskamp Marie-Luise S, Maihöfner Christian G, Baron Ralf
Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein , Kiel , Germany.
Curr Med Res Opin. 2014 Apr;30(4):565-74. doi: 10.1185/03007995.2013.869491. Epub 2013 Dec 10.
Pain is usually assessed by spontaneous pain ratings. Time-dependent (brief attacks) or evoked (allodynia) phenomena, common in neuropathic pain, are not captured. To evaluate the overall effectiveness of a treatment, improvement of all sensory symptoms should be measured. Since the pattern of sensory abnormalities might hint at the underlying mechanisms of pain, this baseline information may aid in predicting the treatment effect. Data on sensory neuropathic abnormalities (painDETECT questionnaire) were analyzed aiming to (1) evaluate the frequency of neuropathic symptoms in different peripheral neuropathic pain syndromes, (2) assess the effect of capsaicin 8% patch on neuropathic symptoms and (3) identify treatment responders based on baseline values.
Data analysis of a prospective 12 week non-interventional trial in peripheral neuropathic pain treated with capsaicin 8% cutaneous patch. Average pain intensity during the past 24 hours, pain descriptors and qualities of neuropathic pain were assessed to characterize the patients' sensory symptoms at baseline and to document changes.
(1) Characteristic symptoms of neuropathic pain were present in all peripheral neuropathic pain syndromes, but frequencies varied in the individual syndromes. (2) Topical capsaicin 8% treatment significantly reduced the overall pain intensity and resulted in a reduction of sensory abnormalities. (3) Short disease duration predicted a better treatment effect. High painDETECT scores, the presence of burning and pressure-evoked pain were weakly associated with treatment response.
Topical capsaicin 8% treatment effectively reduced sensory abnormalities in peripheral neuropathic pain. The association of sensory symptoms and treatment response aids in understanding the mechanism of action of high concentration capsaicin. It is, however, not possible to use sensory symptom patterns to predict treatment response to capsaicin on an individual level.
Completion of painDETECT was optional and therefore data was not available for all patients. Further studies for confirmation of these results are needed.
疼痛通常通过自发疼痛评分来评估。时间依赖性（短暂发作）或诱发（痛觉过敏）现象在神经性疼痛中很常见，但未被纳入评估。为了评估一种治疗的总体效果，应该测量所有感觉症状的改善情况。由于感觉异常的模式可能提示疼痛的潜在机制，这些基线信息可能有助于预测治疗效果。分析了关于感觉神经性异常的数据（疼痛DETECT问卷），目的是（1）评估不同外周神经性疼痛综合征中神经性症状的频率，（2）评估8%辣椒素贴剂对神经性症状的影响，以及（3）根据基线值识别治疗反应者。
对一项前瞻性12周的非干预性试验进行数据分析，该试验使用8%辣椒素皮肤贴剂治疗外周神经性疼痛。评估过去24小时内的平均疼痛强度、疼痛描述词和神经性疼痛的性质，以表征患者基线时的感觉症状并记录变化。
（1）所有外周神经性疼痛综合征中均存在神经性疼痛的特征性症状，但各综合征中的频率有所不同。（2）局部应用8%辣椒素治疗显著降低了总体疼痛强度，并减少了感觉异常。（3）病程短预示着治疗效果更好。高疼痛DETECT评分、烧灼样疼痛和压力诱发疼痛的存在与治疗反应的相关性较弱。
局部应用8%辣椒素治疗可有效减轻外周神经性疼痛中的感觉异常。感觉症状与治疗反应之间的关联有助于理解高浓度辣椒素的作用机制。然而，不可能在个体水平上利用感觉症状模式来预测对辣椒素的治疗反应。
疼痛DETECT问卷的填写是可选的，因此并非所有患者都有数据。需要进一步研究以证实这些结果。
