Peripheral neuropathic pain: a mechanism-related organizing principle based on sensory profiles
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Published version
Author(s)
Type
Journal Article
Abstract
Patients with neuropathic pain are heterogeneous in etiology, pathophysiology, and clinical appearance. They exhibit a variety of pain-related sensory symptoms and signs (sensory profile). Different sensory profiles might indicate different classes of neurobiological mechanisms, and hence subgroups with different sensory profiles might respond differently to treatment. The aim of the investigation was to identify subgroups in a large sample of patients with neuropathic pain using hypothesis-free statistical methods on the database of 3 large multinational research networks (German Research Network on Neuropathic Pain (DFNS), IMI-Europain, and Neuropain). Standardized quantitative sensory testing was used in 902 (test cohort) and 233 (validation cohort) patients with peripheral neuropathic pain of different etiologies. For subgrouping, we performed a cluster analysis using 13 quantitative sensory testing parameters. Three distinct subgroups with characteristic sensory profiles were identified and replicated. Cluster 1 (sensory loss, 42%) showed a loss of small and large fiber function in combination with paradoxical heat sensations. Cluster 2 (thermal hyperalgesia, 33%) was characterized by preserved sensory functions in combination with heat and cold hyperalgesia and mild dynamic mechanical allodynia. Cluster 3 (mechanical hyperalgesia, 24%) was characterized by a loss of small fiber function in combination with pinprick hyperalgesia and dynamic mechanical allodynia. All clusters occurred across etiologies but frequencies differed. We present a new approach of subgrouping patients with peripheral neuropathic pain of different etiologies according to intrinsic sensory profiles. These 3 profiles may be related to pathophysiological mechanisms and may be useful in clinical trial design to enrich the study population for treatment responders.
Date Issued
2016-11-03
Date Acceptance
2016-09-27
Citation
PAIN, 2016, 158 (2), pp.261-272
ISSN
0304-3959
Publisher
Lippincott, Williams & Wilkins
Start Page
261
End Page
272
Journal / Book Title
PAIN
Volume
158
Issue
2
Copyright Statement
© 2016 International Association for the Study of Pain. This is an open-access article distributed under the terms of the Creative Commons Attribution -Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Sponsor
Universitatsklinikum Schleswig - Holstein
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000397015500010&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Grant Number
Neuropain
Subjects
Science & Technology
Life Sciences & Biomedicine
Anesthesiology
Clinical Neurology
Neurosciences
Neurosciences & Neurology
Neuropathic pain
Sensory signs
Clinical trials
QST
Epidemiology
LONG-TERM POTENTIATION
PLACEBO-CONTROLLED TRIAL
GERMAN RESEARCH NETWORK
POSTHERPETIC NEURALGIA
DOUBLE-BLIND
NEUROGENIC HYPERALGESIA
DIABETIC-NEUROPATHY
CUTANEOUS HYPERALGESIA
SYSTEMIC LIDOCAINE
GRADING SYSTEM
Publication Status
Published