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Article

Association between the Use of Quantitative Sensory Testing and Conditioned Pain Modulation and the Prescription of Medication and Interventional Procedures in Children with Chronic Pain Conditions

by
Alice Bruneau
1,
Catherine E. Ferland
2,3,4,5,
Rafael Pérez-Medina-Carballo
6,
Marta Somaini
3,7,
Nada Mohamed
3,
Michele Curatolo
8,
Jean A. Ouellet
2,5,8 and
Pablo Ingelmo
3,4,5,9,*
1
Division of Experimental Medicine, McGill University, Montreal, QC H3A 0G4, Canada
2
Department of orthopedic surgery, Shriners Hospitals for Children-Canada, Montreal, QC H4A 0A9, Canada
3
Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, Montreal, QC H4A 3J1, Canada
4
Department of Anesthesia, McGill University, Montreal, QC H3A 3J1, Canada
5
Alan Edward Centre for Research on Pain, Montreal, QC H3A 0G1, Canada
6
Integrated Program in Neurosciences, McGill University, Montreal, QC H3A 0G4, Canada
7
Department of Anesthesia, Niguarda Ca’Granda Hospital, 20162 Milan, Italy
8
Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA 98195, USA
9
Research Institute, McGill University Health Center, Montreal, QC H3G 3J1, Canada
*
Author to whom correspondence should be addressed.
Children 2022, 9(8), 1157; https://doi.org/10.3390/children9081157
Submission received: 20 June 2022 / Revised: 15 July 2022 / Accepted: 28 July 2022 / Published: 2 August 2022
(This article belongs to the Special Issue Advances in Pediatric Anesthesiology, Pain and Perioperative Medicine)
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Abstract

The evidence supporting the use of pharmacological treatments in pediatric chronic pain is limited. Quantitative sensory testing (QST) and conditioned pain modulation evaluation (CPM) provide information on pain phenotype, which may help clinicians to tailor the treatment. This retrospective study aimed to evaluate the association between the use of QST/CPM phenotyping on the selection of the treatment for children with chronic pain conditions. We retrospectively analyzed the medical records of 208 female patients (mean age 15 ± 2 years) enrolled in an outpatient interdisciplinary pediatric complex pain center. Pain phenotype information (QST/CPM) of 106 patients was available to the prescribing physician. The records of 102 age- and sex-matched patients without QST/CPM were used as controls. The primary endpoint was the proportion of medications and interventions prescribed. The secondary endpoint was the duration of treatment. The QST/CPM group received less opioids (7% vs. 28%, respectively, p < 0.001), less anticonvulsants (6% vs. 25%, p < 0.001), and less interventional treatments (29% vs. 44%, p = 0.03) than controls. Patients with an optimal CPM result tended to be prescribed fewer antidepressants (2% vs. 18%, p = 0.01), and patients with signs of allodynia and/or temporal summation tended to be prescribed fewer NSAIDs (57% vs. 78%, p = 0.04). There was no difference in the duration of the treatments between the groups. QST/CPM testing appears to provide more targeted therapeutic options resulting in the overall drop in polypharmacy and reduced use of interventional treatments while remaining at least as effective as the standard of care.
Keywords: quantitative sensory testing; conditioned pain modulation; chronic pain; pharmacotherapy quantitative sensory testing; conditioned pain modulation; chronic pain; pharmacotherapy

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MDPI and ACS Style

Bruneau, A.; Ferland, C.E.; Pérez-Medina-Carballo, R.; Somaini, M.; Mohamed, N.; Curatolo, M.; Ouellet, J.A.; Ingelmo, P. Association between the Use of Quantitative Sensory Testing and Conditioned Pain Modulation and the Prescription of Medication and Interventional Procedures in Children with Chronic Pain Conditions. Children 2022, 9, 1157. https://doi.org/10.3390/children9081157

AMA Style

Bruneau A, Ferland CE, Pérez-Medina-Carballo R, Somaini M, Mohamed N, Curatolo M, Ouellet JA, Ingelmo P. Association between the Use of Quantitative Sensory Testing and Conditioned Pain Modulation and the Prescription of Medication and Interventional Procedures in Children with Chronic Pain Conditions. Children. 2022; 9(8):1157. https://doi.org/10.3390/children9081157

Chicago/Turabian Style

Bruneau, Alice, Catherine E. Ferland, Rafael Pérez-Medina-Carballo, Marta Somaini, Nada Mohamed, Michele Curatolo, Jean A. Ouellet, and Pablo Ingelmo. 2022. "Association between the Use of Quantitative Sensory Testing and Conditioned Pain Modulation and the Prescription of Medication and Interventional Procedures in Children with Chronic Pain Conditions" Children 9, no. 8: 1157. https://doi.org/10.3390/children9081157

APA Style

Bruneau, A., Ferland, C. E., Pérez-Medina-Carballo, R., Somaini, M., Mohamed, N., Curatolo, M., Ouellet, J. A., & Ingelmo, P. (2022). Association between the Use of Quantitative Sensory Testing and Conditioned Pain Modulation and the Prescription of Medication and Interventional Procedures in Children with Chronic Pain Conditions. Children, 9(8), 1157. https://doi.org/10.3390/children9081157

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