Peripheral Neuropathic Pain: A mechanism-related organizing principle based on sensory profiles
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Peripheral Neuropathic Pain: A mechanism-related organizing principle based on sensory profiles. / Baron, Ralf; Maier, Christoph; Attal, Nadine; Binder, Andreas; Bouhassira, Didier; Cruccu, Giorgio; Finnerup, Nanna B; Haanpää, Maija; Hansson, Per; Hüllemann, Philipp; Jensen, Troels S; Freynhagen, Rainer; Kennedy, Jeffrey D; Magerl, Walter; Mainka, Tina; Reimer, Maren; Rice, Andrew S C; Segerdahl, Märta; Serra, Jordi; Sindrup, Sören; Sommer, Claudia; Tölle, Thomas; Vollert, Jan; Treede, Rolf-Detlef; German Neuropathic Pain Research Network (DFNS), and the EUROPAIN and NEUROPAINconsortia.
In: PAIN, Vol. 158, No. 2, 02.2017, p. 261-272.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Peripheral Neuropathic Pain: A mechanism-related organizing principle based on sensory profiles
AU - Baron, Ralf
AU - Maier, Christoph
AU - Attal, Nadine
AU - Binder, Andreas
AU - Bouhassira, Didier
AU - Cruccu, Giorgio
AU - Finnerup, Nanna B
AU - Haanpää, Maija
AU - Hansson, Per
AU - Hüllemann, Philipp
AU - Jensen, Troels S
AU - Freynhagen, Rainer
AU - Kennedy, Jeffrey D
AU - Magerl, Walter
AU - Mainka, Tina
AU - Reimer, Maren
AU - Rice, Andrew S C
AU - Segerdahl, Märta
AU - Serra, Jordi
AU - Sindrup, Sören
AU - Sommer, Claudia
AU - Tölle, Thomas
AU - Vollert, Jan
AU - Treede, Rolf-Detlef
AU - German Neuropathic Pain Research Network (DFNS), and the EUROPAIN and NEUROPAINconsortia.
PY - 2017/2
Y1 - 2017/2
N2 - 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 neuropathic pain patients using hypothesis-free statistical methods on the database of three large multi-national research networks (German Research Network on Neuropathic Pain (DFNS), IMI-Europain, Neuropain).Standardized quantitative sensory testing (QST) 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 QST 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 three profiles may be related to pathophysiological mechanisms and may be useful in clinical trial design to enrich the study population for treatment responders.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.
AB - 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 neuropathic pain patients using hypothesis-free statistical methods on the database of three large multi-national research networks (German Research Network on Neuropathic Pain (DFNS), IMI-Europain, Neuropain).Standardized quantitative sensory testing (QST) 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 QST 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 three profiles may be related to pathophysiological mechanisms and may be useful in clinical trial design to enrich the study population for treatment responders.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.
U2 - 10.1097/j.pain.0000000000000753
DO - 10.1097/j.pain.0000000000000753
M3 - SCORING: Journal article
C2 - 27893485
VL - 158
SP - 261
EP - 272
JO - PAIN
JF - PAIN
SN - 0304-3959
IS - 2
ER -