Association between the Use of Quantitative Sensory Testing and Conditioned Pain Modulation and the Prescription of Medication and Interventional Procedures in Children with Chronic Pain Conditions

Abstract

The evidence supporting the use of pharmacological treatments in pediatric chronic pain is limited. Quantitative sensory testing (QST) and conditioned pain modulation evaluation (CPM) provide information on pain phenotype, which may help clinicians to tailor the treatment. This retrospective study aimed to evaluate the association between the use of QST/CPM phenotyping on the selection of the treatment for children with chronic pain conditions. We retrospectively analyzed the medical records of 208 female patients (mean age 15 ± 2 years) enrolled in an outpatient interdisciplinary pediatric complex pain center. Pain phenotype information (QST/CPM) of 106 patients was available to the prescribing physician. The records of 102 age- and sex-matched patients without QST/CPM were used as controls. The primary endpoint was the proportion of medications and interventions prescribed. The secondary endpoint was the duration of treatment. The QST/CPM group received less opioids (7% vs. 28%, respectively, p < 0.001), less anticonvulsants (6% vs. 25%, p < 0.001), and less interventional treatments (29% vs. 44%, p = 0.03) than controls. Patients with an optimal CPM result tended to be prescribed fewer antidepressants (2% vs. 18%, p = 0.01), and patients with signs of allodynia and/or temporal summation tended to be prescribed fewer NSAIDs (57% vs. 78%, p = 0.04). There was no difference in the duration of the treatments between the groups. QST/CPM testing appears to provide more targeted therapeutic options resulting in the overall drop in polypharmacy and reduced use of interventional treatments while remaining at least as effective as the standard of care.

The Treatment of Pediatric Pain in Spain: A Survey Study

“…Moreover, the incidence of adverse effects is largely unknown. Clinicians can only follow what has been used in previous studies as well as the recommendations for treating adults and children [42]. Not surprisingly, almost all participants (99%) advocated evidence-based guidelines to support their daily practice.…”

The Psychosocial Characteristics and Somatosensory Function of Children and Adolescents Who Meet the Criteria for Chronic Nociplastic Pain

“…The results of the QST were available during the first evaluation and were used to personalize the treatment program of each patient. 13 , 14 …”

“…At the end of the evaluation, the diagnosis and personalized treatment plan (eg medications, physiotherapy, psychology, nursing, social worker, and interventional procedures) was discussed with the patients and their parents/caregivers. 13–18 Medication prescribed included non-steroidal anti-inflammatory drugs (eg ibuprofen, celecoxib), muscle relaxants (eg baclofen), opiates (eg morphine), anti-depressants (eg amitriptyline), anti-epileptics (eg gabapentin), anti-migraine agents, oral corticosteroids, sedatives (eg benzodiazepines), or other analgesics and antipyretics agents (eg acetaminophen, clonidine, magnesium, etc.). Interventional procedures included primarily peripheral nerve and interfascial plane single blocks, pulsed radiofrequency or local infiltrations.…”

Chronic Postsurgical Pain in Children and Adolescents: A Call for Action

“…107 Recent studies suggested that personalized treatment approaches to various pediatric chronic pain conditions in general, and in pediatric neuropathic pain in particular, can be developed based on the individual nociceptive phenotypes as determined by the use of Quantitative Sensory Testing and conditioned pain modulation evaluation (QST/CPM). [108][109][110] QST/CPM testing appears to provide more targeted therapeutic options, resulting in less polypharmacotherapy and the use of interventional treatments, while still being at least as effective as standard treatment protocols. However, further studies are needed to examine the potential benefits of pain phenotyping and to confirm these hypotheses.…”