Pancreatic QST Differentiates Chronic Pancreatitis Patients into Distinct Pain Phenotypes Independent of Psychiatric Comorbidities.
Pancreatic QST Differentiates Chronic Pancreatitis Patients into Distinct Pain Phenotypes Independent of Psychiatric Comorbidities.
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DOI：
10.1016/j.cgh.2020.10.036
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发表时间：
2022-01
期刊：
影响因子：
--
通讯作者：
Pancreatic Quantitative Sensory Testing (P-QST) Consortium
中科院分区：
文献类型：
--
作者：
Faghih M;Phillips AE;Kuhlmann L;Afghani E;Drewes AM;Yadav D;Singh VK;Olesen SS;Pancreatic Quantitative Sensory Testing (P-QST) Consortium
定量感觉测试（QST）以前曾用于研究慢性胰腺炎（CP）的疼痛，但包括不适合临床目的的方法。本研究的目的是确定胰腺QST（P-QST）是否可以将患者区分为不同的疼痛表型，并确定这些表型与临床疼痛和精神共病的相关性。进行了一项多中心横断面研究，其中患者完成了经验证的问卷调查，评估生活质量（QoL）、抑郁和焦虑评分以及临床疼痛症状，随后进行P-QST，包括冷加压试验、重复针刺刺激和上腹部（T10）和对照皮区的压力刺激。P-QST根据先前建立的列线图将患者分类为疼痛表型。在这些组中比较生活质量、临床疼痛和精神评估评分。共入组179例患者，平均年龄为54.1±13.6岁，其中59%为男性，42%有酒精病因。P-QST显示91例（51%）无痛觉过敏，50例（28%）节段性痛觉过敏，38例（21%）广泛性痛觉过敏。与其他两种疼痛表型相比，广泛性痛觉过敏患者的疼痛强度评分（P = 0.03）和持续疼痛率（P = 0.002）显著更高，QoL（P <0.001）和身体功能（P = 0.03）降低。相比之下，所有组的精神病合并症相似。P-QST可作为CP的新的无偏倚疼痛评估工具，因为它将患者分类为独立于其精神共病的不同疼痛表型。
Quantitative sensory testing (QST) has been previously used to study pain in chronic pancreatitis (CP) but included methods that are not suitable for clinical purposes. The aims of this study were to determine if pancreatic QST (P-QST) can differentiate patients into distinct pain phenotypes and to determine the association of these with their clinical pain and psychiatric comorbidities. A multicenter cross-sectional study was conducted where patients completed validated questionnaires assessing quality of life (QoL), depression and anxiety scores as well as clinical pain symptoms followed by P-QST which included a cold pressor test, repetitive pin prick stimuli and pressure stimulation of the upper abdominal (T10) and control dermatomes. P-QST categorized patients into pain phenotypes based on a previously established nomogram. QoL, clinical pain and psychiatric assessment scores were compared across these groups. A total of 179 patients were enrolled with a mean age of 54.1±13.6 years among whom 59% were males and 42% had an alcohol etiology. P-QST showed no hyperalgesia in 91 (51%), segmental hyperalgesia in 50 (28%) and widespread hyperalgesia in 38 (21%) patients. Patients with widespread hyperalgesia had significantly higher pain intensity scores (P = .03) and rates of constant pain (P = .002) as well as decreased QoL (P < .001) and physical functioning (P =.03) in comparison with the other two pain phenotypes. In contrast, psychiatric comorbidities were similar across all groups. P-QST may serve as novel unbiased pain assessment tool in CP as it categorizes patients into distinct pain phenotypes independent of their psychiatric comorbidities.
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