Journal ArticleDOI
Neuropathic pain phenotyping as a predictor of treatment response in painful diabetic neuropathy: Data from the randomized, double-blind, COMBO-DN study
Didier Bouhassira,Stefan Wilhelm,Alexander Schacht,Serge Perrot,Eva Kosek,Giorgio Cruccu,Rainer Freynhagen,Solomon Tesfaye,Alberto Lledo,Ernest Choy,Paolo Marchettini,Juan Antonio Mico,Michael Spaeth,Vladimir Skljarevski,Thomas R. Tölle +14 more
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TLDR
Two complementary exploratory analyses further endorse the idea that sensory phenotyping might lead to a more stratified treatment and potentially to personalized pain therapy.Abstract:
Sensory profiles are heterogeneous in neuropathic pain disorders, and subgroups of patients respond differently to treatment. To further explore this, patients in the COMBO-DN study were prospectively assessed by the Neuropathic Pain Symptom Inventory (NPSI) at baseline, after initial 8-week therapy with either duloxetine or pregabalin, and after subsequent 8-week combination/high-dose therapy. Exploratory post hoc cluster analyses were performed to identify and characterize potential subgroups through their scores in the NPSI items. In patients not responding to initial 60 mg/d duloxetine, adding 300 mg/d pregabalin for combination treatment was particularly effective regarding the dimensions pressing pain and evoked pain, whereas maximizing the duloxetine dose to 120 mg/d appeared more beneficial regarding paresthesia/dysesthesia. In contrast, adding 60 mg/d duloxetine to 300 mg/d pregabalin in case of nonresponse to initial pregabalin led to numerically higher decreases in all NPSI dimensions/items compared to maximizing the pregabalin dose to 600 mg/d. Cluster analysis revealed 3 patient clusters (defined by baseline scores for the 10 NPSI sensory items) with different pain profiles, not only in terms of overall pain severity, but also across NPSI items. Mean Brief Pain Inventory average pain improved in all clusters during combination/high-dose therapy. However, in patients with severe pain, the treatment effect showed a trend in favor of high-dose monotherapy, whereas combination therapy appeared to be more beneficial in patients with moderate and mild pain (not significant). These complementary exploratory analyses further endorse the idea that sensory phenotyping might lead to a more stratified treatment and potentially to personalized pain therapy.read more
Citations
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Journal ArticleDOI
Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis.
Nanna B. Finnerup,Nadine Attal,Simon Haroutounian,Ewan D McNicol,Ralf Baron,Robert H. Dworkin,Ian Gilron,Maija Haanpää,Per Hansson,Per Hansson,Troels S. Jensen,Troels S. Jensen,Peter R. Kamerman,Karen Lund,Andrew Moore,Srinivasa N. Raja,Andrew S.C. Rice,Andrew S.C. Rice,Michael C. Rowbotham,Emily S. Sena,Emily S. Sena,Philip J. Siddall,Philip J. Siddall,Blair H. Smith,Mark S. Wallace +24 more
TL;DR: The results support a revision of the NeuPSIG recommendations for the pharmacotherapy of neuropathic pain and allow a strong recommendation for use and proposal as first-line treatment in neuropathicPain for tricyclic antidepressants, serotonin-noradrenaline reuptake inhibitors, pregabalin, and gabapentin.
Journal ArticleDOI
Neuropathic Pain: Principles of Diagnosis and Treatment
TL;DR: Individualized multidisciplinary patient care is facilitated by careful consideration of pain-related disability as well as patient education; repeat follow-up and strategic referral to appropriate medical/surgical subspecialties; and physical and psychological therapies.
Journal ArticleDOI
Diabetic Peripheral Neuropathy: Epidemiology, Diagnosis, and Pharmacotherapy.
Zohaib Iqbal,Shazli Azmi,Rahul Yadav,Maryam Ferdousi,Mohit Kumar,Daniel J. Cuthbertson,Jonathan Lim,Rayaz A. Malik,Uazman Alam,Uazman Alam +9 more
TL;DR: Clinical recognition of DPN is imperative for allowing timely symptom management to reduce the morbidity associated with this condition and consider potential new pharmacotherapies for painful DPN.
Journal ArticleDOI
Patient phenotyping in clinical trials of chronic pain treatments: IMMPACT recommendations.
Robert R. Edwards,Robert H. Dworkin,Dennis C. Turk,Martin S. Angst,Raymond A. Dionne,Roy Freeman,Per Hansson,Simon Haroutounian,Lars Arendt-Nielsen,Nadine Attal,R. Baron,Joanna M. Brell,Shay Bujanover,Laurie B. Burke,Daniel B. Carr,Amy S. Chappell,Penney Cowan,Mila Etropolski,Roger B. Fillingim,Jennifer S. Gewandter,Nathaniel P. Katz,Ernest A. Kopecky,John D. Markman,George G. Nomikos,Linda Porter,Bob A. Rappaport,Andrew S.C. Rice,Joseph M. Scavone,Joachim Scholz,Lee S. Simon,Shannon M. Smith,Jeffrey Tobias,Tina Tockarshewsky,Christine Veasley,Mark Versavel,Ajay D. Wasan,Warren Wen,David Yarnitsky +37 more
TL;DR: Evidence is presented on the most promising phenotypic characteristics of patients that are most predictive of individual variation in analgesic treatment outcomes, and the measurement tools that are best suited to evaluate these characteristics.
Journal ArticleDOI
The Pain in Neuropathy Study (PiNS): a cross-sectional observational study determining the somatosensory phenotype of painful and painless diabetic neuropathy.
Andreas C. Themistocleous,Juan D. Ramirez,Pallai Shillo,Jonathan G. Lees,Dinesh Selvarajah,Christine A. Orengo,Solomon Tesfaye,Andrew S.C. Rice,David L.H. Bennett +8 more
TL;DR: This study provides a firm basis to rationalise further phenotyping of painful DPN, for instance, stratification of patients with DPN for analgesic drug trials.
References
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Journal ArticleDOI
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TL;DR: Simple, patient-based, easy-to-use screening questionnaires can determine the prevalence of neuropathic pain components both in individual LBP patients and in heterogeneous cohorts of such patients.
Journal ArticleDOI
Development and validation of the Neuropathic Pain Symptom Inventory
Didier Bouhassira,Nadine Attal,Jacques Fermanian,Haiel Alchaar,Michèle Gautron,Etienne Masquelier,Sylvie Rostaing,Michel Lanteri-Minet,Elisabeth Collin,Jacques Grisart,François Boureau +10 more
TL;DR: The psychometric properties of the NPSI suggest that it might be used to characterize subgroups of neuropathic pain patients and verify whether they respond differentially to various pharmacological agents or other therapeutic interventions.
Journal ArticleDOI
Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): Somatosensory abnormalities in 1236 patients with different neuropathic pain syndromes
Christoph Maier,R. Baron,Thomas R. Tölle,Andreas Binder,Niels Birbaumer,Frank Birklein,Janne Gierthmühlen,Herta Flor,Christian Geber,Volker Huge,Elena K. Krumova,G. B. Landwehrmeyer,Walter Magerl,Christian Maihöfner,Helmut Richter,Roman Rolke,Andrea Scherens,A. Schwarz,Claudia Sommer,V. Tronnier,Nurcan Üçeyler,Michael Valet,Gunnar Wasner,D.-R. Treede +23 more
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Journal ArticleDOI
Development and preliminary validation of a pain measure specific to neuropathic pain The Neuropathic Pain Scale
Bradley S. Galer,Mark P. Jensen +1 more
TL;DR: Results support the discriminant and predictive validity of the NPS items and appear to be sensitive to treatments known to impact neuropathic pain.
Journal ArticleDOI
Deconstructing the Neuropathic Pain Phenotype to Reveal Neural Mechanisms
TL;DR: The pain phenotype can serve as a window on underlying pathophysiological neural mechanisms and as a guide for developing personalized pain medicine.
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