Predicting Treatment Response with Sensory Phenotyping in Post-Traumatic Neuropathic Pain. Issue 10 (21st March 2022)

• Record Type: Journal Article
• Authors: Gewandter, Jennifer S; Sohn, Michael B; De Guzman, Rachel; Frazer, Maria E; Chiodo, Valerie; Sharma, Sonia; Geha, Paul; Markman, John D
• Is Part Of: Pain medicine. Volume 23:Issue 10(2022)
• Page Start: 1726
• Page End: 1732
• Publication Date: 2022-03-21
• Subjects: Phenotyping -- Post-Traumatic Neuropathic Pain -- Hyperalgesia -- Clinical Trials; Pain -- Periodicals; Pain -- Treatment -- Periodicals; Analgesics -- Periodicals; Pain -- Periodicals; Pain Management -- Periodicals; Douleur -- Périodiques; Douleur -- Traitement -- Périodiques; Analgésiques -- Périodiques; Analgésique; Soulagement de la douleur; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.047205
• DOI: 10.1093/pm/pnac045
• Languages: English
• ISSNs: 1526-2375

Abstract

Abstract: Objective: Currently available treatments for neuropathic pain are only modestly efficacious when assessed in randomized clinical trials and work for only some patients in the clinic. Induced-pain or gain-of-function phenotypes have been shown to predict response to analgesics (vs placebos) in patients with neuropathic pain. However, the predictive value of these phenotypes has never been studied in post-traumatic neuropathic pain. Methods: Mixed-effects models for repeated measures were used to evaluate the efficacy of pregabalin vs placebo in subgroups with induced-pain phenotypes (i.e., hyperalgesia or allodynia) in data from a recent, multinational randomized clinical trial (N = 539) that identified phenotypic subgroups through the use of a structured clinical exam. Results: The difference in mean pain score between the active and placebo groups (i.e., delta) after 15 weeks of treatment for the subgroup with hyperalgesia was –0.76 ( P = 0.001), compared with 0.19 ( P = 0.47) for the subgroup that did not have hyperalgesia. The treatment-by-phenotype interaction, which tests whether subgroups have statistically different treatment responses, was significant ( P = 0.0067). The delta for the subgroup with allodynia was –0.31 ( P = 0.22), compared with –0.30 ( P = 0.22) for the subgroup that did not have allodynia (treatment-by-phenotype interaction P = 0.98). Conclusions: These data suggest that hyperalgesia, but not allodynia, predicts response to pregabalin in patients with chronic post-traumatic neuropathic pain. This study extends the growing data supporting the utility of induced-pain phenotypes to predict response to analgesics in post-traumatic neuropathic pain. Sensory phenotyping in large, multisite trials through the use of a structured clinical exam has the potential to accelerate the development of new analgesics and improve the generalizability of clinical trial results.