Division of Neurological Pain Research and -therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany.
Katholisches Marienkrankenhaus, Department. Of Neurology, Hamburg, Germany.
Postgrad Med. 2022 Apr;134(3):277-287. doi: 10.1080/00325481.2021.2017646. Epub 2022 Jan 5.
Treating chronic pain patients with multimodal pain therapy (MMPT) alters perception, awareness, and processing of pain at multiple therapeutic levels. Several clinical observations suggest that the effects of therapy may go beyond the possible sum of each level of therapy and may be due to a central descending inhibitory effect measurable by conditioned pain modulation (CPM). Thus, we investigated whether CPM is able to identify a group of patients that benefit particularly from MMPT.
This was an observational prospective cohort study. Patients were hospitalized on a special pain medicine ward with specially trained staff for 10 days. The patients were questioned and had investigations before and shortly after MMPT and were followed-up on 3 months post discharge. Before and after treatment, subjects were investigated via CPM and quantitative sensory testing (QST) as well as completing questionnaires. The study was registered in the German Clinical Trials Register (DRKS00006850).
During the study period of 24 months, 224 chronic pain patients were recruited. 51 percent of patients completed the study period. There was an improvement in overall groups regarding all domains assessed, lasting beyond the end of the intervention. Patients with a sufficient CPM effect, defined as a reduction in pain during the conditioning stimulus, at baseline did show a more pronounced reduction in mean pain ratings than those without. This was not the case 3 months after therapy. Furthermore, sufficient CPM was identified as a predictor for pain reduction using a linear regression model.
In conclusion, this study shows that while a heterogeneous group of patients with chronic pain disorders does sustainably benefit from MMPT in general, patients with a sufficient CPM effect do show a more pronounced decrease in pain ratings directly after therapy in comparison to those without.
采用多模式疼痛疗法（MMPT）治疗慢性疼痛患者可改变多个治疗层面的疼痛感知、意识和处理。一些临床观察表明，治疗效果可能超出每种治疗水平的可能总和，并且可能归因于可测量的条件性疼痛调制（CPM）的中枢下行抑制作用。因此，我们研究了 CPM 是否能够识别出一组特别受益于 MMPT 的患者。
这是一项观察性前瞻性队列研究。患者在专门的疼痛医学病房住院，由专门培训的工作人员治疗 10 天。在 MMPT 前后对患者进行询问和检查，并在出院后 3 个月进行随访。治疗前后，通过 CPM 和定量感觉测试（QST）以及问卷调查对受试者进行调查。该研究在德国临床试验注册处（DRKS00006850）进行了注册。
在 24 个月的研究期间，共招募了 224 名慢性疼痛患者。51%的患者完成了研究期。所有评估领域的总体组均有改善，且持续到干预结束后。在基线时具有足够 CPM 效果（定义为在条件刺激期间疼痛减轻）的患者，其平均疼痛评分的降低程度明显大于没有 CPM 效果的患者。这在治疗后 3 个月并非如此。此外，使用线性回归模型，足够的 CPM 被确定为疼痛减轻的预测因子。
总之，这项研究表明，虽然慢性疼痛障碍的患者群体存在异质性，但总体上仍可持续受益于 MMPT，但具有足够 CPM 效果的患者在治疗后直接的疼痛评分降低程度明显大于没有 CPM 效果的患者。
