Serrano A, Torres D, Veciana M, Caro C, Montero J, Mayoral V
Department of Anesthesiology, Critical Care and Pain Clinics, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
Department of Anesthesiology, Critical Care and Pain Clinics, Hospital Universitario de Santiago de Compostela, 15701 Santiago, Spain.
Pain Res Treat. 2017;2017:7425907. doi: 10.1155/2017/7425907. Epub 2017 Feb 21.
There are no reliable predictors of response to treatment with capsaicin. Given that capsaicin application causes heat sensation, differences in quantitative thermal testing (QTT) profiles may predict treatment response. The aim of this study was to determine whether different QTT profiles could predict treatment outcomes in patients with localized peripheral neuropathic pain (PeLNP). We obtained from medical records QTT results and treatment outcomes of 55 patients treated between 2010 and 2013. Warm sensation threshold (WST) and heat pain threshold (HPT) values were assessed at baseline at the treatment site and in the asymptomatic, contralateral area. Responders were defined as those who achieved a > 30% decrease in pain lasting > 30 days. Two distinct groups were identified based on differences in QTT profiles. Most patients (27/31; 87.1%) with a homogenous profile were nonresponders. By contrast, more than half of the patients (13/24, 54.2%) with a nonhomogenous profile were responders ( = 0.0028). A nonhomogenous QTT profile appears to be predictive of response to capsaicin. We hypothesize patients with a partial loss of cutaneous nerve fibers or receptors are more likely to respond. By contrast, when severe nerve damage or normal cutaneous sensations are present, the pain is likely due to central sensitization and thus not responsive to capsaicin. Prospective studies with larger patient samples are needed to confirm this hypothesis.
目前尚无可靠的指标来预测辣椒素治疗的反应。鉴于涂抹辣椒素会引起热感，定量热测试（QTT）曲线的差异可能预测治疗反应。本研究的目的是确定不同的QTT曲线是否能预测局限性周围神经性疼痛（PeLNP）患者的治疗结果。我们从病历中获取了2010年至2013年期间接受治疗的55例患者的QTT结果和治疗结果。在基线时，于治疗部位及无症状的对侧区域评估温觉阈值（WST）和热痛阈值（HPT）值。反应者定义为疼痛减轻>30%且持续>30天的患者。根据QTT曲线的差异确定了两个不同的组。大多数（27/31；87.1%）曲线均匀的患者无反应。相比之下，超过一半（13/24，54.2%）曲线不均匀的患者有反应（P = 0.0028）。QTT曲线不均匀似乎可预测对辣椒素的反应。我们推测，皮肤神经纤维或感受器部分丧失的患者更有可能有反应。相比之下，当存在严重神经损伤或皮肤感觉正常时，疼痛可能是由于中枢敏化，因此对辣椒素无反应。需要更大样本量的前瞻性研究来证实这一假设。
