title: Effects of pregabalin on central sensitization in patients with chronic pancreatitis in a randomized, controlled trial.
abstract: BACKGROUND
  Intense abdominal pain is the dominant feature of chronic pancreatitis. During the disease changes in central pain processing, e.g. central sensitization manifest as spreading hyperalgesia, can result from ongoing nociceptive input. The aim of the present study is to evaluate the effect of pregabalin on pain processing in chronic pancreatitis as assessed by quantitative sensory testing (QST).
  
  
  METHODS
  This randomized, double-blind, placebo-controlled trial evaluated effects of pregabalin on pain processing. QST was used to quantify pain processing by measuring thresholds to painful electrical and pressure stimulation in six body dermatomes. Descending endogenous pain modulation was quantified using the conditioned pain modulation (CPM) paradigm to elicit a DNIC (diffuse noxious inhibitory controls) response. The main effect parameter was the change in the sum of all body pain threshold values after three weeks of study treatment versus baseline values between both treatment groups.
  
  
  RESULTS
  64 patients were analyzed. No differences in change in sum of pain thresholds were present for pregabalin vs. placebo after three weeks of treatment. For individual dermatomes, change vs. baseline pain thresholds was significantly greater in pregabalin vs. placebo patients for electric pain detection threshold in C5 (P = 0.005), electric pain tolerance threshold in C5 (P = 0.04) and L1 (P = 0.05), and pressure pain tolerance threshold in T4 (P = 0.004). No differences were observed between pregabalin and placebo regarding conditioned pain modulation.
  
  
  CONCLUSIONS
  Our study provides first evidence that pregabalin has moderate inhibitory effects on central sensitization manifest as spreading hyperalgesia in chronic pancreatitis patients. These findings suggest that QST can be of clinical use for monitoring pain treatments in the context of chronic pain.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00755573.
authors.affiliation: Pain and Nociception Neuroscience Research Group, Department of Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Stefan A W
authors.initials: SA
authors.lastname: Bouwense
authors.forename: Søren S
authors.initials: SS
authors.lastname: Olesen
authors.forename: Asbjørn M
authors.initials: AM
authors.lastname: Drewes
authors.forename: Jan-Werner
authors.initials: JW
authors.lastname: Poley
authors.forename: Harry
authors.initials: H
authors.lastname: van Goor
authors.forename: Oliver H G
authors.initials: OH
authors.lastname: Wilder-Smith
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D016022:Case-Control Studies; D059333:Central Nervous System Sensitization / Q000187:drug effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017288:Pain Threshold / Q000187:drug effects; D050500:Pancreatitis, Chronic / Q000188:drug therapy* / Q000503:physiopathology*; D010919:Placebos; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000700:Analgesics; D010919:Placebos; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid