Sensory bedside testing: a simple stratification approach for sensory phenotyping.

Autor:	Reimer M; Division of Neurological Pain Research and Therapy, University Hospital Schleswig- Holstein, Campus Kiel, Germany., Forstenpointner J; Division of Neurological Pain Research and Therapy, University Hospital Schleswig- Holstein, Campus Kiel, Germany., Hartmann A; Division of Neurological Pain Research and Therapy, University Hospital Schleswig- Holstein, Campus Kiel, Germany., Otto JC; Division of Neurological Pain Research and Therapy, University Hospital Schleswig- Holstein, Campus Kiel, Germany., Vollert J; Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom.; Neurophysiology, Centre for Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, Ruprecht-Karls-University, Heidelberg, Germany., Gierthmühlen J; Division of Neurological Pain Research and Therapy, University Hospital Schleswig- Holstein, Campus Kiel, Germany., Klein T; Neurophysiology, Centre for Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, Ruprecht-Karls-University, Heidelberg, Germany.; Mundipharma Research GmbH & Co. KG, Limburg (Lahn), Germany., Hüllemann P; Division of Neurological Pain Research and Therapy, University Hospital Schleswig- Holstein, Campus Kiel, Germany., Baron R; Division of Neurological Pain Research and Therapy, University Hospital Schleswig- Holstein, Campus Kiel, Germany.
Jazyk:	angličtina
Zdroj:	Pain reports [Pain Rep] 2020 May 21; Vol. 5 (3), pp. e820. Date of Electronic Publication: 2020 May 21 (Print Publication: 2020).
DOI:	10.1097/PR9.0000000000000820
Abstrakt:	Introduction: Stratification of patients according to the individual sensory phenotype has been suggested a promising method to identify responders for pain treatment. However, many state-of-the-art sensory testing procedures are expensive or time-consuming. Objectives: Therefore, this study aimed to present a selection of easy-to-use bedside devices. Methods: In total, 73 patients (39 m/34 f) and 20 controls (11 m/9 f) received a standardized laboratory quantitative sensory testing (QST) and a bedside-QST. In addition, 50 patients were tested by a group of nonexperienced investigators to address the impact of training. The sensitivity, specificity, and receiver-operating characteristics were analyzed for each bedside-QST parameter as compared to laboratory QST. Furthermore, the patients' individual sensory phenotype (ie, cluster) was determined using laboratory QST, to select bedside-QST parameters most indicative for a correct cluster allocation. Results: The bedside-QST parameters "loss of cold perception to 22°C metal," "hypersensitivity towards 45°C metal," "loss of tactile perception to Q-tip and 0.7 mm CMS hair," as well as "the allodynia sum score" indicated good sensitivity and specificity (ie, ≳ 70%). Results of interrater variability indicated that training is necessary for individual parameters (ie, CMS 0.7). For the cluster assessment, the respective bedside quantitative sensory testing (QST) parameter combination indicated the following agreements as compared to laboratory QST stratification: excellent for "sensory loss" (area under the curve [AUC] = 0.91), good for "thermal hyperalgesia" (AUC = 0.83), and fair for "mechanical hyperalgesia" (AUC = 0.75). Conclusion: This study presents a selection of bedside parameters to identify the individual sensory phenotype as cost and time efficient as possible. Competing Interests: M. Reimer has received speaking fees and travel expenses from Pfizer, Grünenthal, Astellas, and grant/research support from Mundipharma and Grünenthal. J.C. Otto reports research support from Grünenthal GmbH and travel costs from Pfizer. J. Forstenpointner reports personal fees and nonfinancial support from Grünenthal GmbH and Sanofi Genzyme, personal fees from Bayer, nonfinancial support from Novartis, outside the submitted work. J. Vollert has received consulting fees from CASQUAR GmbH, outside this work. J. Gierthmühlen has received speaking fees and travel grants from Pfizer, Sanofi Pasteur, and Grünenthal and has been a consultant for Glenmark Pharmaceuticals. T. Klein was an employee of Mundipharma Research GmbH & Co.KG. P. Hüllemann reports speaking fees from Pfizer and Genzyme and travel reimbursement from Grünenthal. R. Baron reports personal fees from Pfizer Pharma GmbH, Genzyme GmbH, Grünenthal GmbH, Mundipharma Research GmbH und Co. KG, Allergan, Sanofi Pasteur, Medtronic, Eisai, Lilly GmbH, Boehringer Ingelheim Pharma GmbH& Co.KG, Astellas Pharma GmbH, Novartis Pharma GmbH, Bristol-Myers Squibb, Biogenidec, AstraZeneca GmbH, Merck, Abbvie, Bayer-Schering, MSD GmbH, Daiichi Sankyo, Glenmark Pharmaceuticals S.A., Seqirus Australia Pty. Ltd, Teva Pharmaceuticals Europe Niederlande, Teva GmbH, Genentech, Mundipharma International Ltd. UK, Astellas Pharma Ltd. UK, TAD Pharma GmbH, Galapagos NV, Kyowa Kirin GmbH, Vertex Pharmaceuticals Inc., Biotest AG, Celgene GmbH, Desitin Arzneimittel GmbH, Regeneron Pharmaceuticals Inc. USA, Theranexus DSV CEA Frankreich, Grünenthal SA Portugal, Abbott Products Operations AG Schweiz, Bayer AG, Grünenthal Pharma AG Schweiz, Mundipharma Research Ltd. UK, Akcea Therapeutics Germany GmbH, Asahi Kasei Pharma Corporation, AbbVie Deutschland GmbH & Co. KG, Air Liquide Sante International Frankreich, Alnylam Germany GmbH, Lateral Pharma Pty Ltd, Hexal AG, Ethos Srl Italien, Janssen, Sanofi-Aventis Deutschland GmbH, Agentur Brigitte Süss, Grünenthal B.V. Niederlande and grants/research support from EU Projects: Europain (115007). DOLORisk (633491). IMI Paincare (777500). German Federal Ministry of Education and Research (BMBF): Verbundprojekt: Frühdetektion von Schmerzchronifizierung (NoChro) (13GW0338C). German Research Network on Neuropathic Pain (01EM0903). Pfizer Pharma GmbH, Genzyme GmbH, Grünenthal GmbH, Mundipharma Research GmbH und Co. KG., Alnylam Pharmaceuticals Inc., Zambon GmbH. The remaining author has no conflicts of interest to declare. This study was funded by Mundipharma Research Ltd. This work was supported by the European Union's Horizon 2020 research and innovation program under grant agreement No 633491 (DOLORisk). The authors acknowledge financial support by Land Schleswig-Holstein within the funding program Open Access Publikationsfonds.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. (Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain.)
Databáze:	MEDLINE
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