Presence of hyperalgesia predicts analgesic efficacy of topically applied capsaicin 8% in patients with peripheral neuropathic pain

Mainka, Tina; Malewicz, Nathalie M.; Baron, Ralf; Enax-Krumova, Elena; Treede, Rolf‐Detlef; Maier, Christoph

doi:10.1002/ejp.703

Cited by 73 publications

(58 citation statements)

References 64 publications

(98 reference statements)

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“…Experimental pain in persons with knee OA appears to be processed within the same brain regions as their clinical pain [34] further justifying the use of experimental pain in humans as a tool for investigating potential mechanisms of pain perception. Indeed, recent studies of neuropathic pain suggest that QST profiles can predict responses to pharmacotherapy [18,36], supporting the notion that QST may provide mechanism-based phenotyping that can be useful in treatment selection. Whether such findings will extend to patients with OA and other forms of musculoskeletal pain remains to be determined.…”

Section: Discussionmentioning

confidence: 89%

Experimental pain phenotyping in community-dwelling individuals with knee osteoarthritis

Cardoso

Riley

Glover

et al. 2016

Pain

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Pain among individuals with knee osteoarthritis (OA) is associated with significant disability in older adults, and recent evidence demonstrates enhanced experimental pain sensitivity. Although previous research showed considerable heterogeneity in the OA clinical pain presentation, less is known regarding the variability in responses to experimental pain. The present study included individuals with knee OA (n = 292) who participated in the Understanding Pain and Limitations in Osteoarthritic Disease study and completed demographic and psychological questionnaires followed by a multimodal quantitative sensory testing (QST) session. Quantitative sensory testing measures were subjected to variable reduction procedures to derive pain sensitivity index scores, which in turn were entered into a cluster analysis. Five clusters were significantly different across all pain sensitivity index variables (P < 0.001) and were characterized by: (1) low pain sensitivity to pressure pain (N = 39); (2) average pain sensitivity across most modalities (N = 88); (3) high temporal summation of punctate pain (N = 38); (4) high cold pain sensitivity (N = 80); and (5) high sensitivity to heat pain and temporal summation of heat pain (N = 41). Clusters differed significantly by race, gender, somatic reactivity, and catastrophizing (P < 0.05). Our findings support the notion that there are distinct subgroups or phenotypes based on experimental pain sensitivity in community-dwelling older adults with knee OA, expanding previous findings of similar cluster characterizations in healthy adults. Future research is needed to further understand the pathophysiological mechanisms underlying pain within these subgroups, which may be of added value in tailoring effective treatments for people with OA.

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Section: Discussionmentioning

confidence: 89%

Experimental pain phenotyping in community-dwelling individuals with knee osteoarthritis

Cardoso

Riley

Glover

et al. 2016

Pain

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“…Importantly, these phenotype groups did not differ in their responses to placebo. Mainka et al 52 treated patients with peripheral neuropathic pain with topical 8% capsaicin patches and analyzed treatment responders and non-responders retrospectively based on their baseline DFNS QST-profile. Capsaicin responders and non-responders could be distinguished based on the presence of cold- and pin-prick hyperalgesia but they did not differ regarding the other QST parameters.…”

Section: Assessment Of Pain Mechanismsmentioning

confidence: 99%

Assessment of Chronic Pain: Domains, Methods, and Mechanisms

Fillingim

Loeser

Baron

et al. 2016

The Journal of Pain

277

225

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Accurate classification of chronic pain conditions requires reliable and valid pain assessment. Moreover, pain assessment serves several additional functions, including documenting severity of the pain condition, tracking the longitudinal course of pain, and providing mechanistic information. Thorough pain assessment must address multiple domains of pain, including the sensory and affective qualities of pain, temporal dimensions of pain, and the location and bodily distribution of pain. Where possible, pain assessment should also incorporate methods to identify pathophysiological mechanisms underlying the pain. This article discusses assessment of chronic pain, including approaches available for assessing multiple pain domains and for addressing pathophysiological mechanisms. We conclude with recommendations for optimal pain assessment.

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“…Protocols for assessment of pain facilitation and pain inhibition has demonstrated some promise in predicting future pain status [16,27,41,43] and the efficacy of analgesics [7,21,24,45].…”

Section: Introductionmentioning

confidence: 99%

Pain modulatory phenotypes differentiate subgroups with different clinical and experimental pain sensitivity

Vægter

Graven‐Nielsen

2016

Pain

104

115

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Pain biomarkers are warranted for individualized pain management. Based on different pain modulatory phenotypes, the objectives of this study were to explore the existence of subgroups within patients with nonmalignant chronic pain and to investigate differences in clinical pain and pain hypersensitivity between subgroups. Cuff algometry was performed on lower legs in 400 patients with chronic pain to assess pressure pain threshold, pressure pain tolerance, temporal summation of pain (TSP: increase in pain scores to 10 repeated stimulations), and conditioned pain modulation (CPM: increase in cuff pressure pain threshold during cuff pain conditioning on the contralateral leg). Heat detection and heat pain thresholds at clinical painful and nonpainful body areas were assessed. Based on TSP and CPM, 4 distinct groups were formed: group 1 (n = 85) had impaired CPM and facilitated TSP; group 2 (n = 148) had impaired CPM and normal TSP; group 3 (n = 45) had normal CPM and facilitated TSP; and group 4 (n = 122) had normal CPM and normal TSP. Group 1 showed more pain regions than the other 3 groups (P < 0.001), indicating that impaired CPM and facilitated TSP play an important role in widespread pain. Groups 1 and 2 compared with group 4 had lower heat pain threshold at nonpainful areas and lower cuff pressure pain tolerance (P < 0.02), indicating that CPM plays a role for widespread hyperalgesia. Moreover, group 1 demonstrated higher clinical pain scores than group 4 (P < 0.05). Although not different between subgroups, patients were profiled on demographics, disability, pain catastrophizing, and fear of movement. Future research should investigate interventions tailored towards these subgroups.

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Presence of hyperalgesia predicts analgesic efficacy of topically applied capsaicin 8% in patients with peripheral neuropathic pain

Abstract: Efficacy of capsaicin does not correlate with the induced loss of function of small fibres, measured by QST. Presence of cold and pinprick hyperalgesia seems to be predictive of response to capsaicin (8%).

Cited by 73 publications

References 64 publications

Experimental pain phenotyping in community-dwelling individuals with knee osteoarthritis

Experimental pain phenotyping in community-dwelling individuals with knee osteoarthritis

Assessment of Chronic Pain: Domains, Methods, and Mechanisms

Pain modulatory phenotypes differentiate subgroups with different clinical and experimental pain sensitivity

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