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神经病理性疼痛的个性化结局:一项随机对照试验的临床相关性与检测敏感性分析

Personalized outcomes in neuropathic pain: a clinical relevance and assay sensitivity analysis from a randomized controlled trial.

作者信息

Saab Karim, Gada Umang, Culakova Eva, Burnette Brian, Jorgensen Carla, Shah Dhaval, Morrow Gary, Mustian Karen, Sohn Michael B, Edwards Robert R, Freeman Roy, Langford Dale J, McDermott Michael P, Gewandter Jennifer S

机构信息

Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, United States.

Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester, NY 14642, United States.

出版信息

Pain Med. 2025 Jan 1;26(1):22-29. doi: 10.1093/pm/pnae095.

Abstract

OBJECTIVE

To explore the clinical relevance and assay sensitivity of using personalized outcomes using data from a randomized clinical trial (RCT) in people with chemotherapy-induced peripheral neuropathy (CIPN).

DESIGN

This study is a secondary analysis that leveraged data from a RCT of transcutaneous electrical stimulation for CIPN to test whether personalized outcomes could minimize potential floor effects and increase the assay sensitivity of pain clinical trials (ie, ability to detect a true treatment effect).

SETTING

Participants were recruited for a RCT from community oncology clinics in the United States.

PARTICIPANTS

Adults with CIPN (N = 72) who reported on average ≥4 intensity (measured via a 7-day baseline diary) for at least 1 of the following pain qualities: hot/burning pain, sharp/shooting pain, and/or cramping.

METHODS

Personalized outcomes were defined based on participants' unique presentation of pain qualities at baseline, measured via 0-10 numeric rating scales (NRS), or ranking of the distress caused by the pain qualities. Analysis of covariance models estimated the treatment effect as measured by personalized and non-personalized outcomes.

RESULTS

The adjusted mean difference between groups was higher using personalized outcomes (ie, 1.21-1.25 NRS points) compared to a non-personalized outcome (ie, 0.97 NRS points), although the standardized effect sizes were similar between outcomes (0.49-0.54).

CONCLUSIONS

These results suggest that personalized pain quality outcomes could minimize floor effects, while providing similar assay sensitivity to non-personalized pain quality outcomes. Personalized outcomes better reflect an individual's unique experience, inherently providing more clinically relevant estimates of treatment effects. Personalized outcomes may be advantageous, particularly for clinical trials in populations with high inter-individual variability in pain qualities.

摘要

目的

利用一项针对化疗引起的周围神经病变(CIPN)患者的随机临床试验(RCT)数据,探讨使用个性化结局指标的临床相关性和检测敏感性。

设计

本研究是一项二次分析,利用了一项针对CIPN的经皮电刺激RCT数据,以测试个性化结局指标是否能将潜在的地板效应降至最低,并提高疼痛临床试验的检测敏感性(即检测真实治疗效果的能力)。

设置

参与者是从美国社区肿瘤诊所招募参加一项RCT的。

参与者

患有CIPN的成年人(N = 72),他们报告至少以下一种疼痛性质(通过7天基线日记测量)的平均强度≥4:热/灼痛、刺痛/射痛和/或痉挛性疼痛。

方法

个性化结局指标是根据参与者在基线时独特的疼痛性质表现来定义的,通过0至10的数字评分量表(NRS)或疼痛性质引起的痛苦程度排名来衡量。协方差分析模型估计了通过个性化和非个性化结局指标测量的治疗效果。

结果

与非个性化结局指标(即0.97 NRS分)相比,使用个性化结局指标时组间调整后平均差异更高(即1.21 - 1.25 NRS分),尽管结局指标之间的标准化效应大小相似(0.49 - 0.54)。

结论

这些结果表明,个性化疼痛性质结局指标可以将地板效应降至最低,同时提供与非个性化疼痛性质结局指标相似的检测敏感性。个性化结局指标能更好地反映个体的独特体验,本质上能提供更具临床相关性的治疗效果估计。个性化结局指标可能具有优势,特别是对于疼痛性质个体间变异性高的人群的临床试验。

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