Linking altered central pain processing and genetic polymorphism to drug efficacy in chronic low back pain.

Siegenthaler, Andreas; Schliessbach, Jürg; Vuilleumier, Pascal H; Jüni, Peter; Zeilhofer, Hanns U; Arendt-Nielsen, Lars; Curatolo, Michele (2015). Linking altered central pain processing and genetic polymorphism to drug efficacy in chronic low back pain. BMC Pharmacology and Toxicology, 16, p. 23. BioMed Central 10.1186/s40360-015-0023-z

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BACKGROUND Inability to predict the therapeutic effect of a drug in individual pain patients prolongs the process of drug and dose finding until satisfactory pharmacotherapy can be achieved. Many chronic pain conditions are associated with hypersensitivity of the nervous system or impaired endogenous pain modulation. Pharmacotherapy often aims at influencing these disturbed nociceptive processes. Its effect might therefore depend on the extent to which they are altered. Quantitative sensory testing (QST) can evaluate various aspects of pain processing and might therefore be able to predict the analgesic efficacy of a given drug. In the present study three drugs commonly used in the pharmacological management of chronic low back pain are investigated. The primary objective is to examine the ability of QST to predict pain reduction. As a secondary objective, the analgesic effects of these drugs and their effect on QST are evaluated. METHODS/DESIGN In this randomized, double blinded, placebo controlled cross-over study, patients with chronic low back pain are randomly assigned to imipramine, oxycodone or clobazam versus active placebo. QST is assessed at baseline, 1 and 2 h after drug administration. Pain intensity, side effects and patients' global impression of change are assessed in intervals of 30 min up to two hours after drug intake. Baseline QST is used as explanatory variable to predict drug effect. The change in QST over time is analyzed to describe the pharmacodynamic effects of each drug on experimental pain modalities. Genetic polymorphisms are analyzed as co-variables. DISCUSSION Pharmacotherapy is a mainstay in chronic pain treatment. Antidepressants, anticonvulsants and opioids are frequently prescribed in a "trial and error" fashion, without knowledge however, which drug suits best which patient. The present study addresses the important need to translate recent advances in pain research to clinical practice. Assessing the predictive value of central hypersensitivity and endogenous pain modulation could allow for the implementation of a mechanism-based treatment strategy in individual patients. TRIAL REGISTRATION Clinicaltrials.gov, NCT01179828.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
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UniBE Contributor:

Siegenthaler, Andreas; Schliessbach, Jürg; Vuilleumier, Pascal Henri and Jüni, Peter

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

2050-6511

Publisher:

BioMed Central

Language:

English

Submitter:

Jeannie Wurz

Date Deposited:

05 Nov 2015 11:30

Last Modified:

23 Jan 2018 12:14

Publisher DOI:

10.1186/s40360-015-0023-z

PubMed ID:

26376691

BORIS DOI:

10.7892/boris.72890

URI:

https://boris.unibe.ch/id/eprint/72890

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