Petersen, Kristian Kjær

English

Osteoarthritis Research International (OARSI) er et international forbund, som giver guidelines til behandling af patienter med slidgigt. Nogle af de meste anvendte behandlinger er Non-Steroidal Anti-Inflammatory Drug (NSAID) plus paracetamol og total led alloplastik (TLA).Det er påvist, at mange patienter vil have god gavn af disse behandlinger Dog vides det, at nogle patienter responderer dårligere og/eller har mange bivirkninger, hvorfor selektion af den rigtige patient til den korrekte behandling vil være fordelagtig og promoverer konceptet ”Personlig Medicin”. Kvantitativ sensorisk testning (QST) kan anvendes til at smerteprofilere patienter med slidgigt, og her benyttes ofte mål for udbredt tryksmerteoverfølsomhed, (som måles ved hjælp af tryksmertetærskler, PPT), temporal summation (TSP) og konditionerende smertemodulation (CPM). Denne afhandling beskriver studier, som har anvendt QST før standard-smertebehandling til at forudsige smerter eller smertereduktion efter behandling.Afhandlingen beskriver, at præoperativt udbredt tryksmerteoverfølsomhed (artikel 2), øget TSP (artikel 1, 3 og 4) og nedsat CPM (artikel 5) er associeret til kroniske postoperative smerter efter TLA. Ligeledes findes det, at øget TSP før behandling er associeret til manglende analgesisk respons efter 4-ugers behandling med COX-2-hæmmer (artikel 6) og 3-ugers behandling med NSAIDs plus paracetamol (artikel 7). Slutteligt vises det, at nedsat CPM før behandling er associeret med begrænset analgesisk respons af 3-ugers behandling med NSAIDs plus paracetamol (artikel 8).Denne afhandling indeholder et systematisk review over alle studier, som anvender QST og undersøger kroniske postoperative smerter eller analgesisk respons til længerevarende farmakologiske behandlinger (artikel 9), hvori det findes, at PPT, TSP og CPM er meget ofte brugte målemetoder, og TSP (50%) og CPM (ca. 44%) målt før behandlingsstart ofte er associeret til kroniske postoperative smerter eller analgesisk respons af farmakologiske behandlinger.Denne afhandling konkluderer, at smerteoverfølsomme patienter med slidgigt er fundet associeret med dårligere behandlingsrespons til standard slidgigtsbehandling, som er anbefalet af OARSI (artikel 1-8). Det systematisk review kan indikere, at disse fund ikke kun er gældende for patienter med slidgigt, men vil kunne anvendes for andre smertefulde patientgrupper (artikel 9).The Osteoarthritis Research International (OARSI) provides clinical guidelines for the treatment of pain in osteoarthritis, and some of the most utilized treatments are Non-Steroidal Anti-Inflammatory Drug (NSAID) plus paracetamol and total joint arthroplasty. Most patients will benefit from these treatments, but some patients are less responsive or showing unwanted side effects, and selecting the right patients for the most optimal treatment would further highlight the opportunities of personalize pain medicine. Quantitative sensory testing (QST) of patients with OA includes measures of widespread pressure hyperalgesia (assessed by pressure pain thresholds, PPTs), temporal summation of pain (TSP), and conditioned pain modulation (CPM). The current dissertation has focus on how assessment of central pain pathways using QST prior to treatment can predict pain and pain reduction after treatment.The studies presented here found associations between preoperative widespread hyperalgesia (paper 2), facilitated TSP (paper 1, 3, and 4), and impaired CPM (paper 5) and chronic postoperative pain in patients with painful osteoarthritis after total joint arthroplasty. In addition, pre-treatment facilitated TSP was associated with limited analgesic response to 4 weeks of COX-2 inhibitors (paper 6) and 3-weeks of NSAIDs plus paracetamol (paper 7). Finally, impaired CPM was associated to limited analgesic response of 3 weeks of NSAIDs plus paracetamol (paper 8).A systematic review on all studies related to QST, chronic postoperative pain, and responses to pharmacological interventions is included in this dissertation (paper 9), which highlights that pressure pain stimuli, TSP, and CPM were the most frequently assessed QST modalities, and TSP (50%) and CPM (approx. 44%) were most frequently associated with chronic postoperative pain or response to pharmacological treatments.Conclusively, these studies (paper 1-8) demonstrate that patients with a pro-nociceptive sensory profile might respond poorly to the standard OA pain treatment as recommended by OARSI, and the systematic review (paper 9) might indicate that this information is useful in other painful disorders than osteoarthritis

Mechanistic Pain Profiling of Patients with Osteoarthritis:Current Knowledge and Future Directions

https://vbn.aau.dk/files/450213713/1061952_thesis_mechanistic_pain_profiling_of_patients_with_osteoarthritis_kkp.pdf

Mechanistic Pain Profiling of Patients with Osteoarthritis:Current Knowledge and Future Directions

Abstract

Similar works

Full text

Available Versions

VBN