Variability in conditioned pain modulation predicts response to NSAID treatment in patients with knee osteoarthritis.
Variability in conditioned pain modulation predicts response to NSAID treatment in patients with knee osteoarthritis.
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DOI：
10.1186/s12891-016-1124-6
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发表时间：
2016-07-13
影响因子：
2.3
通讯作者：
Wasan AD
中科院分区：
文献类型：
--
作者：
Edwards RR;Dolman AJ;Martel MO;Finan PH;Lazaridou A;Cornelius M;Wasan AD
疼痛性膝骨关节炎（OA）患者表现出痛觉过敏和疼痛调节反应的改变。虽然一些先前的工作已经证明了实验室和临床疼痛测量之间的横截面关联，但尚不清楚基线时定量感觉测试（QST）反应的个体差异是否可以前瞻性地预测镇痛治疗反应。将膝关节OA患者（n = 35）的QST反应与人口统计学匹配的无痛对照组（n = 39）进行比较，之后患者完成了为期一个月的双氯芬酸钠局部凝胶（1%）治疗研究，每日最多应用4次。OA患者在多个解剖部位表现出疼痛阈值降低，以及条件性疼痛调制（CPM）降低和疼痛时间总和增强。最疼痛敏感的患者倾向于报告最强烈的神经性OA疼痛。双氯芬酸治疗后，膝关节OA队列显示疼痛改善约30%，无论是否存在神经性症状。基线CPM评分（内源性疼痛抑制能力的指标）与临床疼痛的治疗相关变化具有前瞻性相关性。具体而言，基线时CPM较高的参与者（即，功能更好的内源性疼痛抑制系统）在治疗结束时显示出更多的疼痛减轻（P <0.05）。这些结果支持先前的发现，放大疼痛敏感性和减少疼痛抑制OA患者。此外，基于实验室的疼痛敏感性测量和临床疼痛指数之间的中度至强烈关联突出了QST在该样本中的临床相关性。最后，CPM和双氯芬酸反应之间的前瞻性相关性表明，基于QST的表型可能有助于解释长期镇痛治疗结局的患者间变异性。ClinicalTrials.Gov标识符：NCT 01383954。2011年6月22日注册。
Patients with painful knee osteoarthritis (OA) demonstrate hyperalgesia and altered pain-modulatory responses. While some prior work has demonstrated cross-sectional associations between laboratory and clinical pain measures, it is unknown whether individual variability in quantitative sensory testing (QST) responses at baseline can prospectively predict analgesic treatment responses. Patients with knee OA (n = 35) were compared on QST responses to a demographically-matched pain-free control group (n = 39), after which patients completed a month-long treatment study of diclofenac sodium topical gel (1 %), applied up to 4 times daily. OA patients demonstrated reduced pain thresholds at multiple anatomic sites, as well as reduced conditioned pain modulation (CPM) and enhanced temporal summation of pain. The most pain-sensitive patients tended to report the most intense and neuropathic OA pain. Following diclofenac treatment, the knee OA cohort showed a roughly 30 % improvement in pain, regardless of the presence or absence of neuropathic symptoms. Baseline CPM scores, an index of endogenous pain-inhibitory capacity, were prospectively associated with treatment-related changes in clinical pain. Specifically, participants with higher CPM at baseline (i.e., better functioning endogenous pain-inhibitory systems) showed more reduction in pain at the end of treatment (p < .05). These results support prior findings of amplified pain sensitivity and reduced pain-inhibition in OA patients. Moreover, the moderate to strong associations between laboratory-based measures of pain sensitivity and indices of clinical pain highlight the clinical relevance of QST in this sample. Finally, the prospective association between CPM and diclofenac response suggests that QST-based phenotyping may have utility in explaining inter-patient variability in long-term analgesic treatment outcomes. ClinicalTrials.Gov Identifier: NCT01383954. Registered June 22, 2011.