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Pain modulatory phenotypes differentiate chronic pancreatitis patients with distinct clinical pain profilesLarsen IM, Faghih M, Phillips AE, Drewes AM, Singh VK, Yadav D, Olesen SSBackground and aims: Pain therapy remains challenging in chronic pancreatitis (CP) patients. Methods based on quantitative sensory testing (QST) provide information on pain modulation. This study explores the existence of CP subgroups with different pain modulatory phenotypes and investigates associations with patientsu2019 clinical pain and psychological profiles. Methods: This was a cross-sectional, multicentre study. Patients completed questionnaires and a standardized QST protocol was used to record pain detection thresholds (PDTs) to muscle pressure stimulations at pancreatic dermatomes and three control areas. Ratio between pancreatic and control PDTs were calculated (PDT-index) to offset inter-individual differences.PDT-index was used with repetitive pinprick stimulations, applied at the abdominal pancreatic dermatome, to obtain a measure of segmental hyperalgesia. Conditioned pain modulation (CPM) paradigm was performed to investigate descending pain modulation. Patients were grouped based on normative QST reference values and questionnaire scores were compared across subgroups to investigate associations with clinical pain and psychological profiles.Results: Ninety-one patients completed the study. Four distinct pain modulatory phenotypes were found: group 1 (n=34) had normal pain modulation; group 2 (n=27) had impaired CPM; group 3 (n=14) had segmental hyperalgesia; and group 4 (n=16) had impaired CPM and segmental hyperalgesia. Significant differences in pain scores were observed across subgroups (all p

Item does not contain fulltext AIM: To identify electroencephalographic (EEG) biomarkers for the analgesic effect of pregabalin in patients with chronic visceral pain. METHODS: This was a double-blind, placebo-controlled study in 31 patients suffering from visceral pain due to chronic pancreatitis. Patients received increasing doses of pregabalin (75mg-300mg twice a day) or matching placebo during 3 weeks of treatment. Pain scores were documented in a diary based on a visual analogue scale. In addition, brief pain inventory-short form (BPI) and quality of life questionnaires were collected prior to and after the study period. Multi-channel resting EEG was recorded before treatment onset and at the end of the study. Changes in EEG spectral indices were extracted, and individual changes were classified by a support vector machine (SVM) to discriminate the pregabalin and placebo responses. Changes in individual spectral indices and pain scores were correlated. RESULTS: Pregabalin increased normalized intensity in low spectral indices, most prominent in the theta band (3.5-7.5Hz), difference of -3.18, 95% CI -3.57, -2.80; P= 0.03. No changes in spectral indices were seen for placebo. The maximum difference between pregabalin and placebo treated patients was seen in the parietal region, with a classification accuracy of 85.7% (P= 0.009). Individual changes in EEG indices were correlated with changes in pain diary (P= 0.04) and BPI pain composite scores (P= 0.02). CONCLUSIONS: Changes in spectral indices caused by slowing of brain oscillations were identified as a biomarker for the central analgesic effect of pregabalin. The developed methodology may provide perspectives to assess individual responses to treatment in personalized medicine. 01 maart 2012

Item does not contain fulltext Protocols for testing conditioned pain modulation (CPM) vary between different labs/clinics. In order to promote research and clinical application of this tool, we summarize the recommendations of interested researchers consensus meeting regarding the practice of CPM and report of its results.

WOS: 000445193400001, PubMed ID: 29577508, Although neurogastroenterology and motility (NGM) disorders are some of the most frequent disorders encountered by practicing gastroenterologists, a structured competency-based training curriculum developed by NGM experts is lacking. The American Neurogastroenterology and Motility Society (ANMS) and the European Society of Neurogastroenterology and Motility (ESNM) jointly evaluated the components of NGM training in North America and Europe. Eleven training domains were identified within NGM, consisting of functional gastrointestinal disorders, visceral hypersensitivity and pain pathways, motor disorders within anatomic areas (esophagus, stomach, small bowel and colon, anorectum), mucosal disorders (gastro-esophageal reflux disease, other mucosal disorders), consequences of systemic disease, consequences of therapy (surgery, endoscopic intervention, medications, other therapy), and transition of pediatric patients into adult practice. A 3-tiered training curriculum covering these domains is proposed here and endorsed by all NGM societies. Tier 1 NGM knowledge and training is expected of all gastroenterology trainees and practicing gastroenterologists. Tier 2 knowledge and training is appropriate for trainees who anticipate NGM disorder management and NGM function test interpretation being an important part of their careers, which may require competency assessment and credentialing of test interpretation skills. Tier 3 knowledge and training is undertaken by trainees interested in a dedicated NGM career and may be restricted to specific domains within the broad NGM field. The joint ANMS and ESNM task force anticipates that the NGM curriculum will streamline NGM training in North America and Europe and will lead to better identification of centers of excellence where Tier 2 and Tier 3 training can be accomplished.