Starts:

Tuesday, September 20th
4:30pm-6:00pm EDT

Category:

Topical Workshop

Tracks:

Assessment, Diagnosis & Measurement of Pain

Room

718 B

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Patient Stratification in Chronic Pain by Quantitative Sensory Testing: Way Forward or Failure?

“This house believes that sensory testing is useful for stratifying patients with chronic pain in treatment and clinical trials” There is no doubt that stratification of patients with chronic pain is crucial to improve the success of analgesic therapy and also to increase the number of successful clinical trials. However, it is unclear which instruments and categories are best suited for such a stratification. There is a current controversy about the value of sensory profiles based on the quantitative sensory testing protocol developed by the German Research Network on Neuropathic Pain: on one hand, sensory profiles are thought to provide mechanistic insights into pain pathophysiology and to reduce the number needed to treat for analgesic treatment and clinical trials. On the other hand, the lack of differentiation between painful and painless neuropathy has been discussed as indicating the failure of this QST approach. The controversy on the role of sensory profiles for stratification should be seen as one aspect of the more fundamental question on adequate approaches to assess clinically relevant nociceptor hyperexcitability. It could be simplified as: can evoked pain tests predict non-evoked/spontaneous pain?

Presentations

Time
4:30pm EDT–6:00pm EDT

Sensory QST-Profiles are Not Useful for Stratifying Patients with Chronic Pain in Treatment and Clinical Trials

Tracks: Assessment, Diagnosis & Measurement Of Pain
Categories: Topical Workshop
Presented By: Professor Martin Schmelz

QST profiles are mainly based on pain thresholds - an approach developed to detect small fiber neuropathy. Sensory profiles have failed to show any link to clinical pain levels and do not identify genetically proven phenotypes in chronic pain patients.
In summary, the idea that sensory phenotypes represent certain pain mechanisms is not backed up by the data and known mechanistic factors, such as pure small fiber neuropathy, are not identified by the sensory profiles. Most of the assessed items are found within the normal range and thus, there is considerable overlap between the phenotypes and in particular between phenotypes and a normal profile. Based on the tested items, patients could be separated in small, large and mixed fiber neuropathy and thereby provide mechanistic information about the neuropathy. However, in terms of clinically relevant stratification of pain patients I agree with the 2021 paper of Forstenpointer et al in Pain: “self-reported pain does not influence the sensory profiles” - but it is this pain we are supposed to study and to treat.

4:30pm EDT–6:00pm EDT

Sensory Testing is Useful for Stratifying Patients with Chronic Pain in Treatment and Clinical Trials

Tracks: Assessment, Diagnosis & Measurement Of Pain
Categories: Topical Workshop
Presented By: Jan Vollert

Quantitative Sensory Testing can assess multiple aspects of the sensory nervous system, including peripheral and central aspects, sensation and pain thresholds, and integrity of various pathways. Using comprehensive protocols in a standardized way, QST can thus paint a picture of the individual sensory alterations of each patient. Some of the emerging patterns have been linked to well-characterized surrogate models, indicating a link between patterns seen in patients and mechanistic studies. Although only few studies have been prospectively designed to test differential treatment response, the existing evidence points towards that specific treatments will be more efficient for patient groups with certain sensory patterns. It has also been shown that QST profiles change in response to worsening of the condition or improvement due to disease-modifying treatment. Thus, QST has demonstrated all elements of a biomarker: differentially responsive to treatment, linked to plausible mechanisms of disease, and responsive to changes in disease.

Presenters

Jan Vollert

Research Fellow
Imperial College London

Martine Bordeleau

Postdoctoral researcher in virtual rehabilitation
Université de Sherbrooke

Professor Martin Schmelz

Director
MCTN. Medical Faculty Mannheim, Heidelberg University