Pancreatic QST Differentiates Chronic Pancreatitis Patients into Distinct Pain Phenotypes Independent of Psychiatric Comorbidities

Faghih, Mahya; Phillips, Anna E.; Kuhlmann, Louise; Afghani, Elham; Drewes, Asbjørn Mohr; Yadav, Dhiraj; Singh, Vikesh K.; Olesen, Søren Schou

doi:10.1016/j.cgh.2020.10.036

Cited by 29 publications

(39 citation statements)

References 41 publications

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“…Widespread hyperalgesia in CP patients has been associated with higher pain intensity, constant pain, lower QOL, and lower physical functioning. 61 Of note, these associations were seen as independent of any psychiatric comorbidities.…”

Section: Quantitative Sensory Testingmentioning

confidence: 90%

“…[8][9][10] In its early stages before spreading to the central nervous system, neurologic changes may be confined to the spinal cord and peripancreatic nerves of the pancreatic viscerotome, resulting in a condition termed segmental sensitization. 61 There are multiple localized and integrated brain networks involved in the perception of physical and psychological pain. Activation of nociceptors is an alarm signal to the brain.…”

Section: Central Sensitization/central Painmentioning

confidence: 99%

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Severe Pain in Chronic Pancreatitis Patients: Considering Mental Health and Associated Genetic Factors

Dunbar¹,

Saloman²,

Phillips³

et al. 2021

JPR

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Pain is the most distressing and disruptive feature of recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) resulting in low quality of life (QOL) and disabilities. There is no single, characteristic pain pattern in patients with RAP and CP. Abdominal imaging features of CP accurately reflect morphologic features but they do not correlate with pain. Pain is the major driver of poor quality of life (QOL) and it is the constant pain, rather than intermittent pain that drives poor QOL. Furthermore, the most severe constant pain experience in CP is also a complex condition. The ability to target the etiopathogenesis of severe pain requires new methods to detect the exact pain mechanisms in an individual at cellular, tissue, system and psychiatric levels. In patients with complex and severe disease, it is likely that multiple overlapping mechanisms are simultaneously driving pain, anxiety and depression. Quantitative sensory testing (QST) shows promise in detecting alterations in central processing of pain signals and to classify patients for mechanistic and therapeutic studies. New genetic research suggests that genetic loci for severe pain in CP overlap with genetic loci for depression and other psychiatric disorders, providing additional insights and therapeutic targets for individual patients with severe CP pain. Well-designed clinical trials that integrate clinical features, QST, genetics and psychological assessments with targeted treatment and assessment of responses are required for a quantum leap forward. A better understanding of the context and mechanisms contributing to severe pain experiences in individual patients is predicted to lead to better therapies and quality of life.

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Section: Quantitative Sensory Testingmentioning

confidence: 90%

Section: Central Sensitization/central Painmentioning

confidence: 99%

Severe Pain in Chronic Pancreatitis Patients: Considering Mental Health and Associated Genetic Factors

Dunbar¹,

Saloman²,

Phillips³

et al. 2021

JPR

View full text Add to dashboard Cite

show abstract

“…With regards to efficacy, a 2018 meta-analysis of RCTs estimated the efficacy of infliximab and adalimumab in achieving remission in CD [ 38 ]. Furthermore, a more recent 2020 review and network meta-analysis of RCTs estimated outcomes consistent with deep remission in UC using infliximab, adalimumab, and ustekinumab [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Recent meta-analyses have examined the rate of achieving DR with anti-TNFα agents in randomized controlled trials (RCTs) among ulcerative colitis (UC) patients [ 7 ], but none have evaluated DR in a real-world environment or in patients with Crohn’s disease (CD). Differences between the efficacy of a drug’s performance during a clinical trial and its effectiveness during use in everyday clinical practice has been described as the “efficacy-effectiveness gap” [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Systematic review and meta-analysis: real-world data rates of deep remission with anti-TNFα in inflammatory bowel disease

et al. 2021

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Background Deep remission (DR) is a treatment target in IBD associated with reduced hospitalization and improved outcome. Randomized control trial (RCT) data demonstrates efficacy of anti-TNFα agents in achieving DR; however, real-world data (RWD) can provide information complementary to RCTs, specifically regarding treatment duration. In this systematic review with meta-analysis, we use real-world data (RWD) to determine rates of DR in IBD treated with anti-TNFα. Methods We completed a systematic search of MEDLINE and EMBASE on July 8, 2019 with review of major gastrointestinal conference abstracts from 2012 to 2019. Studies utilizing RWD (data not from phase I-III RCTs) of adult IBD patients treated with anti-TNFα agents were included. DR was defined by clinical and endoscopic remission at minimum. DR was assessed at 8 weeks, 6 months, 1 year, and 2 years. Risk of bias was assessed with the Newcastle Ottawa Scale. Results 29,033 publications were identified. Fifteen publications, nine manuscripts and six conference abstracts, were included encompassing 1212 patients (769 Crohn’s disease-CD, 443 ulcerative colitis-UC), and analyzed using Comprehensive Meta-Analysis. Rate of DR was 36.4% (95% CI 12.6–69.4%) at 8 weeks, 39.1% (95% CI 10.4–78%) at 6 months, 44.4% (95% CI 34.6–54.6%) at 1 year, and 36% (95% CI 18.7–58%) at 2 years. DR in CD at 1 year was 48.6% (95% CI 32.8–64.7%) and in UC was 43.6% (95% CI 32.8–55.1%). Conclusions The rate of DR was highest after 1 year of therapy, in nearly 45% of IBD patients treated with anti-TNFα. Similar rates were achieved between patients with UC and CD. The findings highlight the efficacy of anti-TNFα in real-world setting. Future studies using RWD can determine efficacy of newer IBD therapeutics in routine clinical practice.

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“…Psychiatric comorbidities (anxiety and depression) were not associated with pain phenotypes, suggesting that P-QST phenotypes provide an unbiased proxy of the sensory pain component. 21 We completed a pilot study involving 30 subjects who underwent either endoscopic treatment (endoscopic retrograde cholangiopancreatography [ERCP] ± extracorporeal shock wave lithotripsy [ESWL]) or surgery after P-QST assessment. 30 Response to intervention was defined as a ≥30% reduction in pain at 6 months after intervention compared with baseline.…”

Section: Consortium Workmentioning

confidence: 99%

Rationale for and Development of the Pancreatic Quantitative Sensory Testing Consortium to Study Pain in Chronic Pancreatitis

et al. 2021

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on behalf of the Pancreatic Quantitative Sensory Testing (P-QST) ConsortiumObjectives: Abdominal pain is the primary symptom of chronic pancreatitis (CP), but pain is difficult to assess, and objective methods for pain assessment are lacking. The characterization of the sensory component of pain as a surrogate for nociception can be achieved by sensory testing using standardized stimuli. Herein, we describe the rationale for and development of an international consortium to better understand and characterize CP pain.Methods: A collaboration was initially formed between the University of Aalborg, Johns Hopkins University, and the University of Pittsburgh. This group refined the protocol for pancreatic quantitative sensory testing (P-QST) and then expanded the collaboration with plans for incorporating P-QST into prospective studies. Results:The collaboration has successfully developed a P-QST nomogram. Chronic pancreatitis patients identified with P-QST as having widespread hyperalgesia had higher pain intensity scores, higher prevalence of constant pain, and decreased quality of life. Psychiatric comorbidities were independent of pain phenotypes. Multiple studies are underway to validate these findings and evaluate their utility in clinical trials.Conclusions: Development of the P-QST Consortium will facilitate collaborative efforts to use P-QST as a means for evaluation and characterization of pain in CP patients, and optimize methods to guide individualized pain management approaches.

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Pancreatic QST Differentiates Chronic Pancreatitis Patients into Distinct Pain Phenotypes Independent of Psychiatric Comorbidities

Cited by 29 publications

References 41 publications

Severe Pain in Chronic Pancreatitis Patients: Considering Mental Health and Associated Genetic Factors

Severe Pain in Chronic Pancreatitis Patients: Considering Mental Health and Associated Genetic Factors

Systematic review and meta-analysis: real-world data rates of deep remission with anti-TNFα in inflammatory bowel disease

Rationale for and Development of the Pancreatic Quantitative Sensory Testing Consortium to Study Pain in Chronic Pancreatitis

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