Pain Research Group, Imperial College London, London, United Kingdom.
MSK Labs, Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
Pain. 2021 Dec 1;162(12):2881-2893. doi: 10.1097/j.pain.0000000000002277.
The German Research Network on Neuropathic Pain (DFNS) quantitative sensory testing (QST) method for sensory phenotyping is used to stratify patients by mechanism-associated sensory phenotype, theorised to be predictive of intervention efficacy. We hypothesised that change in pain and sensory dysfunction would relate to change in sensory phenotype. We investigated the responsiveness of sensory phenotype to surgery in patients with an entrapment neuropathy. With ethical approval and consent, this observational study recruited patients with neurophysiologically confirmed carpal tunnel syndrome. Symptom and pain severity parameters and DFNS QST were evaluated before and after carpal tunnel surgery. Surgical outcome was evaluated by patient-rated change. Symptom severity score of the Boston Carpal Tunnel Questionnaire and associated pain and paraesthesia subgroups were comparators for clinically relevant change. Quantitative sensory testing results (n = 76) were compared with healthy controls (n = 54). At 6 months postsurgery, 92% participants reported a good surgical outcome and large decrease in pain and symptom severity (P < 0.001). Change in QST parameters occurred for thermal detection, thermal pain, and mechanical detection thresholds with a moderate to large effect size. Change in mechanical pain measures was not statistically significant. Change occurred in sensory phenotype postsurgery (P < 0.001); sensory phenotype was associated with symptom subgroup (P = 0.03) and patient-rated surgical outcome (P = 0.02). Quantitative sensory testing-derived sensory phenotype is sensitive to clinically important change. In an entrapment neuropathy model, sensory phenotype was associated with patient-reported symptoms and demonstrated statistically significant, clinically relevant change after disease-modifying intervention. Sensory phenotype was independent of disease severity and may reflect underlying neuropathophysiology.
德国神经病理性疼痛研究网络 (DFNS) 的定量感觉测试 (QST) 方法用于根据与机制相关的感觉表型对患者进行分层，理论上这与干预效果的预测有关。我们假设疼痛和感觉功能障碍的变化与感觉表型的变化有关。我们研究了感觉表型在神经卡压性神经病患者手术中的反应性。经过伦理批准和同意，这项观察性研究招募了经神经生理学证实的腕管综合征患者。在腕管手术后，评估患者的症状和疼痛严重程度参数以及 DFNS QST。通过患者自评的变化评估手术效果。波士顿腕管问卷的症状严重程度评分以及相关的疼痛和感觉异常亚组是临床相关变化的比较指标。将定量感觉测试结果（n = 76）与健康对照组（n = 54）进行比较。术后 6 个月，92%的参与者报告手术效果良好，疼痛和症状严重程度明显减轻（P < 0.001）。热探测、热痛和机械探测阈值的 QST 参数发生变化，具有中到大的效应量。机械疼痛测量的变化没有统计学意义。术后感觉表型发生变化（P < 0.001）；感觉表型与症状亚组（P = 0.03）和患者自评的手术效果（P = 0.02）相关。基于 QST 的感觉表型对临床重要变化敏感。在神经卡压性神经病模型中，感觉表型与患者报告的症状相关，并在疾病修饰干预后显示出具有统计学意义的、临床相关的变化。感觉表型独立于疾病严重程度，可能反映潜在的神经病理生理学。
