A cross-sectional cohort survey in 2100 patients with painful diabetic neuropathy and postherpetic neuralgia: Differences in demographic data and sensory symptoms
A cross-sectional cohort survey in 2100 patients with painful diabetic neuropathy and postherpetic neuralgia: Differences in demographic data and sensory symptoms
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DOI：
10.1016/j.pain.2009.06.001
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发表时间：
2009-11-01
期刊：
影响因子：
7.4
通讯作者：
Freynhagen, Rainer
中科院分区：
文献类型：
--
作者：
Baron, Ralf;Toelle, Thomas R.;Freynhagen, Rainer
神经病理性疼痛综合征的患者是异质性的。它们表现出各种感觉症状和疼痛性质。了解这些数据和病因特异性差异对于优化临床试验设计和开发更有效的药物非常重要。本研究使用来自横断面调查（painDETEM）的2100例痛性糖尿病神经病变（DPN）和带状疱疹后神经痛（PHN）患者的神经病学流行病学和临床数据，以（1）描述特征性流行病学差异，（2）分析两个队列中感觉症状的典型模式，（3）确定问卷是否可以捕获这些特征。PHN患者更经常遭受临床相关的感觉障碍，尽管平均疼痛强度仅略高。这种差异在动态机械性异常性疼痛中尤其明显，一半的PHN患者和18%的DPN患者存在动态机械性异常性疼痛。PHN的热痛觉过敏发生率是PHN的两倍。麻木在DPN中更常见。年龄对这两个实体的感觉症状没有影响。分层聚类分析揭示了五个不同的亚组的患者表现出特征性的感觉档案，一个典型的星座和神经性症状的组合。所有亚型在两个实体中均以相关数量出现，但PHN和DPN之间的频率不同。由于感觉症状可能转化为疼痛产生机制，因此在临床试验中通过评估感觉特征来丰富潜在的治疗反应者可能是可能的。患者报告结果可用于获得每位患者的精确感觉表征。(C)2009年国际疼痛研究协会。Elsevier B.V.出版，保留所有权利。
Patients with neuropathic pain syndromes are heterogeneous. They present with a variety of sensory symptoms and pain qualities. The knowledge of these data and etiology-specific differences is important to optimize clinical trial design and to develop more effective drugs. This investigation uses epidemiological and clinical data on the symptomatology of 2 100 patients with painful diabetic neuropathy (DPN) and postherpetic neuralgia (PHN) from a cross-sectional survey (painDETEM to (1) describe characteristic epidemiological differences, (2) analyse typical patterns of sensory symptoms in both cohorts and (3) determine whether questionnaires can capture these characteristics. PHN patients suffer more often from clinically relevant sensory disturbances although the average pain intensity is only marginally higher. This difference is particularly obvious with dynamic mechanical allodynia which is present in half of the PHN patients and in 18% of the DPN patients. Thermal hyperalgesia occurs twice as often in PHN. Numbness is described more often in DPN. Age has no influence on sensory symptoms in both entities. A hierarchical Cluster analysis revealed five distinct subgroups of patients showing a characteristic sensory profile, a typical constellation and combination of neuropathic symptoms. All Subgroups occur in relevant numbers in both entities but the frequencies differ between PHN and DPN. Since sensory symptoms likely translate into pain-generating mechanisms enrichment for potential treatment responders might be possible in clinical trials by assessing the sensory profiles. Patient-Reported Outcomes can be used to obtain a precise sensory characterization of each patient. (C) 2009 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.