Sensory phenotypes in complex regional pain syndrome and chronic low back pain - Indication of common underlying pathomechanisms

Iara De Schoenmacker; Laura Sirucek; Paulina S. Scheuren; Robin Lütolf; Lindsay M. Gorrell; Florian Brunner; Armin Curt; Jan Rosner; Petra Schweinhardt; Michèle Hubli

doi:10.1097/PR9.0000000000001110

Sensory phenotypes in complex regional pain syndrome and chronic low back pain - Indication of common underlying pathomechanisms

Iara De Schoenmacker^*, Laura Sirucek, Paulina S. Scheuren, Robin Lütolf, Lindsay M. Gorrell, Florian Brunner, Armin Curt, Jan Rosner, Petra Schweinhardt, Michèle Hubli

^*Corresponding author for this work

Department of Clinical Medicine - The Danish Pain Research Center

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

1 Citation (Scopus)

Abstract

Introduction:First-line pain treatment is unsatisfactory in more than 50% of chronic pain patients, likely because of the heterogeneity of mechanisms underlying pain chronification.Objectives:This cross-sectional study aimed to better understand pathomechanisms across different chronic pain cohorts, regardless of their diagnoses, by identifying distinct sensory phenotypes through a cluster analysis.Methods:We recruited 81 chronic pain patients and 63 age-matched and sex-matched healthy controls (HC). Two distinct chronic pain cohorts were recruited, ie, complex regional pain syndrome (N = 20) and low back pain (N = 61). Quantitative sensory testing (QST) was performed in the most painful body area to investigate somatosensory changes related to clinical pain. Furthermore, QST was conducted in a pain-free area to identify remote sensory alterations, indicating more widespread changes in somatosensory processing.Results:Two clusters were identified based on the QST measures in the painful area, which did not represent the 2 distinct pain diagnoses but contained patients from both cohorts. Cluster 1 showed increased pain sensitivities in the painful and control area, indicating central sensitization as a potential pathomechanism. Cluster 2 showed a similar sensory profile as HC in both tested areas. Hence, either QST was not sensitive enough and more objective measures are needed to detect sensitization within the nociceptive neuraxis or cluster 2 may not have pain primarily because of sensitization, but other factors such as psychosocial ones are involved.Conclusion:These findings support the notion of shared pathomechanisms irrespective of the pain diagnosis. Conversely, different mechanisms might contribute to the pain of patients with the same diagnosis.

Original language	English
Article number	e1110
Journal	Pain Reports
Volume	8
Issue	6
ISSN	2471-2531
DOIs	https://doi.org/10.1097/PR9.0000000000001110
Publication status	Published - Dec 2023

Keywords

Chronic pain
Cluster analysis
Pain phenotyping
Quantitative sensory testing
Sensory function

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10.1097/PR9.0000000000001110Licence: CC BY

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@article{72bfda77ceda433fbd179fbffc2ee24a,

title = "Sensory phenotypes in complex regional pain syndrome and chronic low back pain - Indication of common underlying pathomechanisms",

abstract = "Introduction:First-line pain treatment is unsatisfactory in more than 50% of chronic pain patients, likely because of the heterogeneity of mechanisms underlying pain chronification.Objectives:This cross-sectional study aimed to better understand pathomechanisms across different chronic pain cohorts, regardless of their diagnoses, by identifying distinct sensory phenotypes through a cluster analysis.Methods:We recruited 81 chronic pain patients and 63 age-matched and sex-matched healthy controls (HC). Two distinct chronic pain cohorts were recruited, ie, complex regional pain syndrome (N = 20) and low back pain (N = 61). Quantitative sensory testing (QST) was performed in the most painful body area to investigate somatosensory changes related to clinical pain. Furthermore, QST was conducted in a pain-free area to identify remote sensory alterations, indicating more widespread changes in somatosensory processing.Results:Two clusters were identified based on the QST measures in the painful area, which did not represent the 2 distinct pain diagnoses but contained patients from both cohorts. Cluster 1 showed increased pain sensitivities in the painful and control area, indicating central sensitization as a potential pathomechanism. Cluster 2 showed a similar sensory profile as HC in both tested areas. Hence, either QST was not sensitive enough and more objective measures are needed to detect sensitization within the nociceptive neuraxis or cluster 2 may not have pain primarily because of sensitization, but other factors such as psychosocial ones are involved.Conclusion:These findings support the notion of shared pathomechanisms irrespective of the pain diagnosis. Conversely, different mechanisms might contribute to the pain of patients with the same diagnosis.",

keywords = "Chronic pain, Cluster analysis, Pain phenotyping, Quantitative sensory testing, Sensory function",

author = "{De Schoenmacker}, Iara and Laura Sirucek and Scheuren, {Paulina S.} and Robin L{\"u}tolf and Gorrell, {Lindsay M.} and Florian Brunner and Armin Curt and Jan Rosner and Petra Schweinhardt and Mich{\`e}le Hubli",

year = "2023",

month = dec,

doi = "10.1097/PR9.0000000000001110",

language = "English",

volume = "8",

journal = "Pain Reports",

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Sensory phenotypes in complex regional pain syndrome and chronic low back pain - Indication of common underlying pathomechanisms. / De Schoenmacker, Iara; Sirucek, Laura; Scheuren, Paulina S. et al.
In: Pain Reports, Vol. 8, No. 6, e1110, 12.2023.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Sensory phenotypes in complex regional pain syndrome and chronic low back pain - Indication of common underlying pathomechanisms

AU - De Schoenmacker, Iara

AU - Sirucek, Laura

AU - Scheuren, Paulina S.

AU - Lütolf, Robin

AU - Gorrell, Lindsay M.

AU - Brunner, Florian

AU - Curt, Armin

AU - Rosner, Jan

AU - Schweinhardt, Petra

AU - Hubli, Michèle

PY - 2023/12

Y1 - 2023/12

N2 - Introduction:First-line pain treatment is unsatisfactory in more than 50% of chronic pain patients, likely because of the heterogeneity of mechanisms underlying pain chronification.Objectives:This cross-sectional study aimed to better understand pathomechanisms across different chronic pain cohorts, regardless of their diagnoses, by identifying distinct sensory phenotypes through a cluster analysis.Methods:We recruited 81 chronic pain patients and 63 age-matched and sex-matched healthy controls (HC). Two distinct chronic pain cohorts were recruited, ie, complex regional pain syndrome (N = 20) and low back pain (N = 61). Quantitative sensory testing (QST) was performed in the most painful body area to investigate somatosensory changes related to clinical pain. Furthermore, QST was conducted in a pain-free area to identify remote sensory alterations, indicating more widespread changes in somatosensory processing.Results:Two clusters were identified based on the QST measures in the painful area, which did not represent the 2 distinct pain diagnoses but contained patients from both cohorts. Cluster 1 showed increased pain sensitivities in the painful and control area, indicating central sensitization as a potential pathomechanism. Cluster 2 showed a similar sensory profile as HC in both tested areas. Hence, either QST was not sensitive enough and more objective measures are needed to detect sensitization within the nociceptive neuraxis or cluster 2 may not have pain primarily because of sensitization, but other factors such as psychosocial ones are involved.Conclusion:These findings support the notion of shared pathomechanisms irrespective of the pain diagnosis. Conversely, different mechanisms might contribute to the pain of patients with the same diagnosis.

AB - Introduction:First-line pain treatment is unsatisfactory in more than 50% of chronic pain patients, likely because of the heterogeneity of mechanisms underlying pain chronification.Objectives:This cross-sectional study aimed to better understand pathomechanisms across different chronic pain cohorts, regardless of their diagnoses, by identifying distinct sensory phenotypes through a cluster analysis.Methods:We recruited 81 chronic pain patients and 63 age-matched and sex-matched healthy controls (HC). Two distinct chronic pain cohorts were recruited, ie, complex regional pain syndrome (N = 20) and low back pain (N = 61). Quantitative sensory testing (QST) was performed in the most painful body area to investigate somatosensory changes related to clinical pain. Furthermore, QST was conducted in a pain-free area to identify remote sensory alterations, indicating more widespread changes in somatosensory processing.Results:Two clusters were identified based on the QST measures in the painful area, which did not represent the 2 distinct pain diagnoses but contained patients from both cohorts. Cluster 1 showed increased pain sensitivities in the painful and control area, indicating central sensitization as a potential pathomechanism. Cluster 2 showed a similar sensory profile as HC in both tested areas. Hence, either QST was not sensitive enough and more objective measures are needed to detect sensitization within the nociceptive neuraxis or cluster 2 may not have pain primarily because of sensitization, but other factors such as psychosocial ones are involved.Conclusion:These findings support the notion of shared pathomechanisms irrespective of the pain diagnosis. Conversely, different mechanisms might contribute to the pain of patients with the same diagnosis.

KW - Chronic pain

KW - Cluster analysis

KW - Pain phenotyping

KW - Quantitative sensory testing

KW - Sensory function

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U2 - 10.1097/PR9.0000000000001110

DO - 10.1097/PR9.0000000000001110

M3 - Journal article

C2 - 38027464

AN - SCOPUS:85179040007

SN - 2471-2531

VL - 8

JO - Pain Reports

JF - Pain Reports

IS - 6

M1 - e1110

ER -

Sensory phenotypes in complex regional pain syndrome and chronic low back pain - Indication of common underlying pathomechanisms

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