Exploring Holistic Sensory Profiling for Mechanism-Driven Subclassification of Peripheral Neuropathic Pain

Scientific Abstract :

Neuropathic pain is a chronic pain state that presents as a constellation of heterogenous clinical features, across aetiologies. Alongside significant variability in treatment efficacy, this suggests patient-specific neural pathophysiology. The sensory signs and symptoms exhibited by patients correlate with intrinsic somatosensory dysfunction, forming characteristic sensory profiles. Patient stratification consistent with patterns between these profiles can therefore provide a mechanism-driven approach to subclassifying neuropathic pain. The objective of this study was to explore the capacity of distinct sensory profiling approaches for subgrouping patients according to shared neuropathic features. These sensory profiling approaches were composed by integrating the PainPREDICT questionnaire, an emerging self-assessment tool, with two distinct methods of physiological assessment: standardised, lab-based quantitative sensory testing and easy-to-use bedside testing. Hypothesis-free, data-driven methods were used to achieve sensory pattern recognition within the sensory profiles derived from each approach. The defining characteristics of the three resulting subgroups were largely consistent between approaches and in line with those defined in previous research. However, the integrated profiling approaches evaluated in this study provide a more comprehensive characterisation of the associated sensory abnormalities. External validation of these findings is necessary, to isolate the reproducibility and stability of the subgroups derived.

Lay abstract:

Neuropathic pain is a condition characterised by ongoing pain and unusual sensations, often described as shooting, stabbing, burning, or tingling. The abnormal features presented by each patient provide insight into what’s happening inside their bodies to cause this persistent pain and influence their response to treatment. There are two main ways to capture these abnormal features: asking patients to describe their symptoms using questionnaires or using specialised equipment to measure them. This study explores new methods that combine a questionnaire called PainPREDICT with two types of specialised tests, one using advanced lab-based equipment and another that is more accessible and can be done at the patient’s bedside. The aim was to identify whether these new combined methods could accurately identify patient features and then group patients based on their similarities. The findings of this study suggest that a specific type of neuropathic pain, called peripheral neuropathic pain, can be further divided into three distinct subgroups. These findings align with previously introduced subgroups and even provide a more complete picture, by integrating two sources of information rather than just one, which has been the case in previous studies.