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Q uantitative S ensory T esting to assess the sensory characteristics of cancer‐induced bone pain after radiotherapy and potential clinical biomarkers of response

2011; Wiley; Volume: 16; Issue: 1 Linguagem: Inglês

10.1016/j.ejpain.2011.05.002

1532-2149

Angela C Scott, Stewart McConnell, Barry Laird, Lesley Colvin, Marie Fallon,

Pain Management and Opioid Use

Abstract Background/aims Radiotherapy ( XRT ) is the gold standard treatment for cancer‐induced bone pain ( CIBP ), but only 50% of patients achieve adequate pain relief within 6 weeks. No predictors of analgesic response to XRT are known. The aim of this preliminary study was to explore the effect of XRT on sensory changes in CIBP with a view to predicting response. Methods After ethics committee approval, patients with CIBP were assessed prior to and 4–6 weeks after palliative XRT . This included completion of the Brief Pain Inventory ( BPI ) and bedside Q uantitative S ensory T esting ( QST ) measuring evoked sensations to quantified stimuli on the skin over the area of CIBP and a control site. Results Twenty‐three patients were assessed pre and post XRT . Thirteen (57%) had an analgesic response (defined as ≥30% reduction in total BPI ). Those patients who had normalisation of abnormal warm sensation (“warm responders”, n = 6) were different in that they had higher baseline functional BPI pain scores (median score ( IQR ) in warm responders = 43 (31.75–58) compared to 31 (12–39.5) in the remaining patients, p = 0.039), larger reductions in pain scores (median difference of 33.5 in total BPI , p = 0.027) and increased likelihood of resolution of sensitivity to pinprick. Conclusions This is the first clinical study to demonstrate alterations in sensory responses in CIBP . Alterations in specific sensory characteristics seem to be associated with an increased likelihood of successful analgesia from palliative XRT . This supports the use of QST in further biomarker studies to predict response to therapy and aid clinical decision making.