University of Pittsburgh School of Medicine, Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Pittsburgh, PA, USA.
Johns Hopkins University School of Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, Baltimore, MD, USA.
Pancreatology. 2020 Jan;20(1):25-34. doi: 10.1016/j.pan.2019.11.007. Epub 2019 Nov 20.
Pain is the primary symptom of chronic pancreatitis (CP), but methods for sensory testing and pain characterization have not previously been validated for clinical use. We present a clinically feasible method for the assessment and characterization of pain mechanisms in patients with CP based on quantitative sensory testing (QST).
This was a cross-sectional, multicenter study of 122 control subjects without pancreatic disease and another 60 patients with painful CP. All subjects underwent standardized QST assessments including a cold pressor test, a conditioned pain modulation paradigm, repetitive pin-prick stimuli (temporal summation) and pressure stimulation of the upper abdominal (pancreatic) and control dermatomes. The effects of age and gender on QST assessment parameters were investigated and normative reference values based on quartile regression were derived and implemented in algorithms to categorize patients according to their patterns of central pain processing (normal vs. segmental sensitization vs. widespread sensitization).
Absolute pressure thresholds were subject to clinically relevant gender effects (all p < 0.001), while the remainder of QST parameters were unaffected by age and gender. The algorithm with the best discriminatory capacity showed good separation between patients and controls (p < 0.001); 50% of patients had normal central pain processing, 23% had evidence of segmental sensitization and 27% had evidence of widespread sensitization.
We show normative reference values for a clinically feasible method for assessment and characterization of pain mechanisms in patients with CP. Application of this method streamlines the evaluation of pancreatic pain and may be used to inform treatment. CLINICALTRIALS.
NCT03434392.
疼痛是慢性胰腺炎（CP）的主要症状，但以前尚未对用于临床的感觉测试和疼痛特征描述方法进行验证。我们提出了一种基于定量感觉测试（QST）评估和描述 CP 患者疼痛机制的临床可行方法。
这是一项横断面、多中心研究，纳入 122 名无胰腺疾病的对照者和另外 60 名有疼痛 CP 的患者。所有受试者均接受了标准化 QST 评估，包括冷加压试验、条件性疼痛调制范式、重复刺痛刺激（时间总和）和上腹部（胰腺）和对照皮区的压力刺激。研究了年龄和性别对 QST 评估参数的影响，并基于四分位回归得出了正常参考值，并将其纳入算法，根据患者的中枢疼痛处理模式（正常、节段性敏感、广泛敏感）对其进行分类。
绝对压力阈值受明显的性别影响（均 p<0.001），而其余 QST 参数不受年龄和性别影响。具有最佳区分能力的算法在患者和对照者之间有良好的区分（p<0.001）；50%的患者有正常的中枢疼痛处理，23%的患者有节段性敏感的证据，27%的患者有广泛敏感的证据。
我们为 CP 患者疼痛机制评估和特征描述的临床可行方法提供了正常参考值。该方法的应用简化了胰腺疼痛的评估，可用于指导治疗。临床试验注册：NCT03434392。
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