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      Reproducibility of a battery of human evoked pain models to detect pharmacological effects of analgesic drugs

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          Abstract

          Background

          Although reproducibility is considered essential for any method used in scientific research, it is investigated only rarely; thus, strikingly little has been published regarding the reproducibility of evoked pain models involving human subjects. Here, we studied the reproducibility of a battery of evoked pain models for demonstrating the analgesic effects of two analgesic compounds.

          Methods

          A total of 81 healthy subjects participated in four studies involving a battery of evoked pain tests in which mechanical, thermal and electrical stimuli were used to measure pain detection and tolerance thresholds. Pharmacodynamic outcome variables were analysed using a mixed model analysis of variance, and a coefficient of variation was calculated by dividing the standard deviation by the least squares means.

          Results

          A total of 76 subjects completed the studies. After being administered pregabalin, the subjects’ pain tolerance thresholds in the cold pressor and pressure stimulation tests were significantly increased compared to the placebo group. Moreover, the heat pain detection threshold in UVB‐irradiated skin was significantly increased in subjects who were administered ibuprofen compared to the placebo group. Variation among all evoked pain tests ranged from 2.2% to 30.6%.

          Conclusions

          Four studies using a similar design showed reproducibility with respect to the included evoked pain models. The relatively high consistency and reproducibility of two analgesics at doses known to be effective in treating clinically relevant pain supports the validity of using this pain test battery to investigate the analgesic activity and determine the active dosage of putative analgesic compounds in early clinical development.

          Significance

          The consistency and reproducibility of measuring the profile of an analgesic at clinically relevant doses illustrates that this pain test battery is a valid tool for demonstrating the analgesic activity of a test compound and for determining the optimal active dose in early clinical drug development.

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          Most cited references48

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          Test-retest and interobserver reliability of quantitative sensory testing according to the protocol of the German Research Network on Neuropathic Pain (DFNS): a multi-centre study.

          Quantitative sensory testing (QST) is an instrument to assess positive and negative sensory signs, helping to identify mechanisms underlying pathologic pain conditions. In this study, we evaluated the test-retest reliability (TR-R) and the interobserver reliability (IO-R) of QST in patients with sensory disturbances of different etiologies. In 4 centres, 60 patients (37 male and 23 female, 56.4±1.9years) with lesions or diseases of the somatosensory system were included. QST comprised 13 parameters including detection and pain thresholds for thermal and mechanical stimuli. QST was performed in the clinically most affected test area and a less or unaffected control area in a morning and an afternoon session on 2 consecutive days by examiner pairs (4 QSTs/patient). For both, TR-R and IO-R, there were high correlations (r=0.80-0.93) at the affected test area, except for wind-up ratio (TR-R: r=0.67; IO-R: r=0.56) and paradoxical heat sensations (TR-R: r=0.35; IO-R: r=0.44). Mean IO-R (r=0.83, 31% unexplained variance) was slightly lower than TR-R (r=0.86, 26% unexplained variance, P<.05); the difference in variance amounted to 5%. There were no differences between study centres. In a subgroup with an unaffected control area (n=43), reliabilities were significantly better in the test area (TR-R: r=0.86; IO-R: r=0.83) than in the control area (TR-R: r=0.79; IO-R: r=0.71, each P<.01), suggesting that disease-related systematic variance enhances reliability of QST. We conclude that standardized QST performed by trained examiners is a valuable diagnostic instrument with good test-retest and interobserver reliability within 2days. With standardized training, observer bias is much lower than random variance. Quantitative sensory testing performed by trained examiners is a valuable diagnostic instrument with good interobserver and test-retest reliability for use in patients with sensory disturbances of different etiologies to help identify mechanisms of neuropathic and non-neuropathic pain. Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
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            Test-retest reliability of Quantitative Sensory Testing in knee osteoarthritis and healthy participants.

            Quantitative Sensory Testing (QST), which assesses somatosensory function by recording participant's responses to external stimuli of controlled intensity, is a useful tool to provide insight into the complex pathophysiology of osteoarthritis (OA) pain. However, QST is not commonly used in rheumatology because the test-retest reliability properties of QST in OA patients have not yet been established. This brief report presents the finding of a study which assessed the test-retest reliability of light touch thresholds, pressure pain thresholds, thermal sensation thresholds and thermal pain thresholds in 50 knee OA patients and 50 healthy participants. Pressure pain thresholds were found to be the least variable measurement, as median thresholds did not differ significantly over the 1 week period and the results were highly correlated. This provides support for the inclusion of pressure algometry in studies assessing pain perception abnormalities in OA. Copyright © 2011 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.
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              Pregabalin for treatment of generalized anxiety disorder: a 4-week, multicenter, double-blind, placebo-controlled trial of pregabalin and alprazolam.

              Pregabalin inhibits release of excess excitatory neurotransmitters, presumably by binding to the alpha2-delta subunit protein of widely distributed voltage-dependent calcium channels in the brain and spinal cord. To assess the anxiolytic efficacy of pregabalin in patients with generalized anxiety disorder. Double-blind, placebo-controlled, active-comparator trial. Patients were randomized to 4 weeks of treatment with pregabalin, 300 mg/d (n = 91), 450 mg/d (n = 90), or 600 mg/d (n = 89); alprazolam, 1.5 mg/d (n = 93); or placebo (n = 91). Psychiatry research and clinic settings. Outpatients meeting the DSM-IV criteria for generalized anxiety disorder, with a baseline Hamilton Anxiety Rating Scale (HAM-A) total score of 20 or greater. Change from baseline to end point in total HAM-A score in the pregabalin and alprazolam groups compared with the placebo group. The end point response criterion was 50% or greater reduction in the HAM-A total score. Pregabalin and alprazolam produced a significantly greater reduction in mean +/- SE HAM-A total score at last-observation-carried-forward end point compared with placebo (-8.4 +/- 0.8): pregabalin, 300 mg (-12.2 +/- 0.8, P<.001), 450 mg (-11.0 +/- 0.8, P = .02), and 600 mg (-11.8 +/- 0.8, P = .002), and alprazolam (-10.9 +/- 0.8, P = .02). By week 1 and at last-observation-carried-forward end point, the 3 pregabalin groups and the alprazolam group had significantly (P<.01) improved HAM-A psychic anxiety symptoms compared with the placebo group. Compared with the placebo group, HAM-A somatic anxiety symptoms were also significantly (P<.02) improved by the 300- and 600-mg pregabalin groups, but not by the 450-mg pregabalin (week 1, P = .06; week 4, P = .32) and the alprazolam groups (week 1, P = .21; week 4, P = .15). Of the 5 treatment groups, the 300-mg pregabalin group was the only medication group that differed statistically in global improvement at treatment end point not only from the placebo group but also from the alprazolam group. Pregabalin was significantly more efficacious than placebo for the treatment of psychic and somatic symptoms of generalized anxiety disorder and was well tolerated by most study patients.
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                Author and article information

                Contributors
                gjgroeneveld@chdr.nl
                Journal
                Eur J Pain
                Eur J Pain
                10.1002/(ISSN)1532-2149
                EJP
                European Journal of Pain (London, England)
                John Wiley and Sons Inc. (Hoboken )
                1090-3801
                1532-2149
                05 April 2019
                July 2019
                : 23
                : 6 ( doiID: 10.1002/ejp.2019.23.issue-6 )
                : 1129-1140
                Affiliations
                [ 1 ] Centre for Human Drug Research Leiden The Netherlands
                [ 2 ] Pfizer Inc. Cambridge Massachusetts
                [ 3 ] Pfizer Ltd. Cambridge UK
                [ 4 ] Leiden University Medical Center Leiden The Netherlands
                [ 5 ]Present address: Human Predictions LLC Cambridge Massachusetts
                Author notes
                [*] [* ] Correspondence

                Geert J. Groeneveld, Centre for Human Drug Research, Leiden, The Netherlands.

                Email: gjgroeneveld@ 123456chdr.nl

                Author information
                https://orcid.org/0000-0001-5505-9454
                Article
                EJP1379
                10.1002/ejp.1379
                6618124
                30793411
                1259daff-d8fe-4175-9bb5-7c9cac933202
                © 2019 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation ‐EFIC ®

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 29 August 2018
                : 01 February 2019
                : 17 February 2019
                Page count
                Figures: 2, Tables: 2, Pages: 12, Words: 9318
                Funding
                Funded by: Pfizer
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                ejp1379
                July 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.5 mode:remove_FC converted:10.07.2019

                Anesthesiology & Pain management
                Anesthesiology & Pain management

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