QST Study: Predicting Treatment Response in Chronic Pancreatitis Using Quantitative Sensory Testing

NCT ID: NCT03434392

Last Updated: 2025-12-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

500 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-10-24

Study Completion Date

2026-06-30

Brief Summary

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Quantitative Sensory Testing (QST) is a novel investigative technique used in other pain conditions to evaluate patterns of chronic pain, and in this study will be used to elucidate pain patterns in patients with Chronic Pancreatitis (CP). QST uses a specific series of standardized stimulations to map the pain system. QST has the potential to change and improve the treatment paradigm for patients with CP and may eventually be able to predict response to invasive CP therapies.

Detailed Description

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In Chronic Pancreatitis (CP), clinical pain symptoms correlate poorly with pancreatic ductal morphology, response to endoscopic or surgical therapy is unpredictable, and the rationale for invasive therapies is often questioned. Quantitative sensory testing (QST) is a technique used to map the pain system based on the rationale that different neural pathways and networks can be explored using standardized stimulation and simultaneous recording of the evoked pain response by psychophysical and/or objective methods. In this study, the investigators aim to distinguish phenotypes characterized by segmental sensitization of the pancreatic viscerotome, and systemic sensitization with pathological central pain processing.

The investigators will perform QST on controls and CP subjects consisting of stimulation in several different dermatomes including pancreatic and control areas. All subjects will also answer standardized questionnaires assessing pain, depression, anxiety, and quality of life at baseline. Subjects undergoing endoscopic or surgical therapy will also undergo follow-up testing consisting of the same tests at 1, 3, and 6 months post-procedure for evaluation of changes in their pain profile.

Conditions

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Chronic Pancreatitis Chronic Pain

Keywords

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Chronic Pain Chronic Pancreatitis Sphincter of Oddi Dysfunction Recurrent Acute Pancreatitis Chronic Abdominal Pain Functional Dyspepsia

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Participants are assigned to one of four groups in parallel for the duration of the study based on prior clinical history.
Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Healthy Controls

Subjects with no pancreatic disease and no abdominal pain.

Subjects will undergo the following Interventions:

Quantitative Sensory Test 1, Quantitative Sensory Test 2, and Quantitative Sensory Test 3, They will also fill out validated questionnaires.

Group Type ACTIVE_COMPARATOR

Quantitative Sensory Test 1

Intervention Type DIAGNOSTIC_TEST

Subject will give pain rating (on Visual Analogue Scale (VAS) 0-10) of single as well as multiple stimulation with round-tip non-invasive pin-prick device. Difference is recorded as Temporal Summation Score.

Quantitative Sensory Test 2

Intervention Type DIAGNOSTIC_TEST

Subject will state when they first detect pain and pain detection threshold in response to pressure administration with pressure algometer. Pressure threshold recorded in kilopascals(kP). Stimulation will be repeated in pancreatic and control dermatomes. Subject will then state pain tolerance threshold at same locations. Sensitization will be characterized by ratio of pancreatic vs. control dermatome scores.

Quantitative Sensory Test 3

Intervention Type DIAGNOSTIC_TEST

Subject will apply dominant hand to ice-chilled water bath (36F) for up to 2 minutes. Pain score (VAS 0-10) will be assessed each 10 seconds. Pain tolerance threshold (in kP) will be assessed with algometer on non-dominant thigh before and after water bath to determine change in threshold. Difference in pain tolerance recorded as Conditioned Pain Modulation Score.

Suspected CP

Suspected Chronic Pancreatitis patients.

Subjects will undergo the following Interventions:

Quantitative Sensory Test 1, Quantitative Sensory Test 2, and Quantitative Sensory Test 3, They will also fill out validated questionnaires.

Group Type ACTIVE_COMPARATOR

Quantitative Sensory Test 1

Intervention Type DIAGNOSTIC_TEST

Subject will give pain rating (on Visual Analogue Scale (VAS) 0-10) of single as well as multiple stimulation with round-tip non-invasive pin-prick device. Difference is recorded as Temporal Summation Score.

Quantitative Sensory Test 2

Intervention Type DIAGNOSTIC_TEST

Subject will state when they first detect pain and pain detection threshold in response to pressure administration with pressure algometer. Pressure threshold recorded in kilopascals(kP). Stimulation will be repeated in pancreatic and control dermatomes. Subject will then state pain tolerance threshold at same locations. Sensitization will be characterized by ratio of pancreatic vs. control dermatome scores.

Quantitative Sensory Test 3

Intervention Type DIAGNOSTIC_TEST

Subject will apply dominant hand to ice-chilled water bath (36F) for up to 2 minutes. Pain score (VAS 0-10) will be assessed each 10 seconds. Pain tolerance threshold (in kP) will be assessed with algometer on non-dominant thigh before and after water bath to determine change in threshold. Difference in pain tolerance recorded as Conditioned Pain Modulation Score.

Definite CP

Definite Chronic Pancreatitis patients.

Subjects will undergo the following Interventions:

Quantitative Sensory Test 1, Quantitative Sensory Test 2, and Quantitative Sensory Test 3, They will also fill out validated questionnaires.

A subset of these patients who undergo endotherapy as per clinical recommendation from clinical provider independent of this study will be followed for 6 months after their clinical intervention for repeat Quantitative Sensory Test 1, Quantitative Sensory Test 2, and Quantitative Sensory Test 3 and questionnaires.

Group Type ACTIVE_COMPARATOR

Quantitative Sensory Test 1

Intervention Type DIAGNOSTIC_TEST

Subject will give pain rating (on Visual Analogue Scale (VAS) 0-10) of single as well as multiple stimulation with round-tip non-invasive pin-prick device. Difference is recorded as Temporal Summation Score.

Quantitative Sensory Test 2

Intervention Type DIAGNOSTIC_TEST

Subject will state when they first detect pain and pain detection threshold in response to pressure administration with pressure algometer. Pressure threshold recorded in kilopascals(kP). Stimulation will be repeated in pancreatic and control dermatomes. Subject will then state pain tolerance threshold at same locations. Sensitization will be characterized by ratio of pancreatic vs. control dermatome scores.

Quantitative Sensory Test 3

Intervention Type DIAGNOSTIC_TEST

Subject will apply dominant hand to ice-chilled water bath (36F) for up to 2 minutes. Pain score (VAS 0-10) will be assessed each 10 seconds. Pain tolerance threshold (in kP) will be assessed with algometer on non-dominant thigh before and after water bath to determine change in threshold. Difference in pain tolerance recorded as Conditioned Pain Modulation Score.

Sphincter of Oddi Dysfunction or Functional Dyspepsia

Patients with Sphincter of Oddi Dysfunction Type 1 or Type 2, or who have a prior diagnosis of Functional Dyspepsia.

Subjects will undergo the following Interventions:

Quantitative Sensory Test 1, Quantitative Sensory Test 2, and Quantitative Sensory Test 3, They will also fill out validated questionnaires.

Group Type ACTIVE_COMPARATOR

Quantitative Sensory Test 1

Intervention Type DIAGNOSTIC_TEST

Subject will give pain rating (on Visual Analogue Scale (VAS) 0-10) of single as well as multiple stimulation with round-tip non-invasive pin-prick device. Difference is recorded as Temporal Summation Score.

Quantitative Sensory Test 2

Intervention Type DIAGNOSTIC_TEST

Subject will state when they first detect pain and pain detection threshold in response to pressure administration with pressure algometer. Pressure threshold recorded in kilopascals(kP). Stimulation will be repeated in pancreatic and control dermatomes. Subject will then state pain tolerance threshold at same locations. Sensitization will be characterized by ratio of pancreatic vs. control dermatome scores.

Quantitative Sensory Test 3

Intervention Type DIAGNOSTIC_TEST

Subject will apply dominant hand to ice-chilled water bath (36F) for up to 2 minutes. Pain score (VAS 0-10) will be assessed each 10 seconds. Pain tolerance threshold (in kP) will be assessed with algometer on non-dominant thigh before and after water bath to determine change in threshold. Difference in pain tolerance recorded as Conditioned Pain Modulation Score.

Interventions

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Quantitative Sensory Test 1

Subject will give pain rating (on Visual Analogue Scale (VAS) 0-10) of single as well as multiple stimulation with round-tip non-invasive pin-prick device. Difference is recorded as Temporal Summation Score.

Intervention Type DIAGNOSTIC_TEST

Quantitative Sensory Test 2

Subject will state when they first detect pain and pain detection threshold in response to pressure administration with pressure algometer. Pressure threshold recorded in kilopascals(kP). Stimulation will be repeated in pancreatic and control dermatomes. Subject will then state pain tolerance threshold at same locations. Sensitization will be characterized by ratio of pancreatic vs. control dermatome scores.

Intervention Type DIAGNOSTIC_TEST

Quantitative Sensory Test 3

Subject will apply dominant hand to ice-chilled water bath (36F) for up to 2 minutes. Pain score (VAS 0-10) will be assessed each 10 seconds. Pain tolerance threshold (in kP) will be assessed with algometer on non-dominant thigh before and after water bath to determine change in threshold. Difference in pain tolerance recorded as Conditioned Pain Modulation Score.

Intervention Type DIAGNOSTIC_TEST

Other Intervention Names

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Temporal Summation Segmental v Systemic Sensitization Conditioned Pain Modulation

Eligibility Criteria

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Inclusion Criteria

1. Subjects with no pancreatic disease and no abdominal pain, or patients with a diagnosis of functional dyspepsia.

* Subjects are 18 years or older in age
* Subjects must be able to read and understand the study information.
* Personally signed and dated informed consent document indicating that the subject has been informed of all pertinent aspects of the study.
* Subject is willing and able to comply with the scheduled visits, questionnaires, treatment plan, and other study procedures.

* Subjects are 18 years or older in age
* Subjects with a) Indeterminate CP (Cambridge 1 or 2 on CT scan or MRI/MRCP) who have abdominal pain without prior history of AP, or b) those with acute (AP) or recurrent acute pancreatitis (RAP) who have recovered from their attack(s) of AP, whose imaging studies are either normal or show changes consistent with Cambridge classification of 1 or 2, and they have ongoing abdominal pain. Both diabetic and non-diabetic subjects will be allowed to enter the study.
* Subjects must be able to read and understand the study information.
* Subjects must suffer from abdominal pain suspected to be pancreatic origin with an intensity above 3 on the visual analogue scale (VAS, where 0=no pain and 10= intolerable pain), and meet the criteria for chronic pain (pain ≥ 3 days per week for at least 3 months).
* Personally signed and dated informed consent document indicating that the subject has been informed of all pertinent aspects of the study.
* Subjects willing and able to comply with the scheduled visits, questionnaires, and other study procedures.

* Subjects are 18 years or older in age
* Subjects will have a prior confirmed diagnosis of CP on CT scan or MRI/MRCP according to Cambridge Classification (grade 3 or 4). Both diabetic and non-diabetic subjects will be allowed to enter the study.
* Subjects must be able to read and understand the study information.
* Personally signed and dated informed consent document indicating that the subject has been informed of all pertinent aspects of the study.
* Subjects willing and able to comply with the scheduled visits, questionnaires, and other study procedures.

* Subjects are 18 years or older in age
* Subjects have prior diagnosis of Type 1 or Type 2 Sphincter of Oddi Dysfunction (subjects with biliary pain accompanied by biochemical features of transient biliary tract obstruction including elevated transaminases, alkaline phosphatase, or conjugated bilirubin; may also be accompanied by biliary or pancreatic ductal dilation on imaging)
* Subjects must be able to read and understand the study information.
* Personally signed and dated informed consent document indicating that the subject has been informed of all pertinent aspects of the study.
* Subjects willing and able to comply with the scheduled visits, questionnaires, and other study procedures.

Exclusion Criteria

1. Subjects with no pancreatic disease and no abdominal pain, or patients with a diagnosis of functional dyspepsia.

* Subjects with evidence or history of medical or surgical disease of importance for this study as judged by investigator.
* Subjects suffering from painful conditions that make them unable to distinguish the pain associated with CP from chronic pain of other origins.
* Subjects with known pregnancy at the time of enrolment.
* Subjects who have previously undergone surgical intervention on their pancreas.

* Subjects with evidence or history of medical or surgical disease of importance for this study as judged by investigator.
* Subjects suffering from painful conditions other than pancreatitis or SOD type 1 or 2 that make them unable to distinguish the pain associated with pancreatitis or SOD from chronic pain of other origins.
* Subjects with known pregnancy at the time of enrolment.
* Subjects who have previously undergone surgical intervention on their pancreas.

* Subjects with evidence or history of medical or surgical disease of importance for this study as judged by investigator.
* Subjects suffering from painful conditions other than pancreatitis or SOD type 1 or 2 that make them unable to distinguish the pain associated with pancreatitis or SOD from chronic pain of other origins.
* Subjects with known pregnancy at the time of enrolment.
* Subjects who have previously undergone surgical intervention on their pancreas.

* Subjects with evidence or history of medical or surgical disease of importance for this study as judged by investigator.
* Subjects suffering from painful conditions other than pancreatitis or SOD that make them unable to distinguish the pain associated with pancreatitis or SOD from chronic pain of other origins.
* Subjects with known pregnancy at the time of enrolment.
* Subjects who have previously undergone surgical intervention on their pancreas.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Johns Hopkins University

OTHER

Sponsor Role collaborator

Aalborg University

OTHER

Sponsor Role collaborator

Anna Evans Phillips

OTHER

Sponsor Role lead

Responsible Party

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Anna Evans Phillips

Assistant Professor of Medicine

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Anna Evans-Phillips, MD

Role: PRINCIPAL_INVESTIGATOR

University of Pittsburgh

Locations

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Johns Hopkins Medical Institutions

Baltimore, Maryland, United States

Site Status RECRUITING

University of Pittsburgh Medical Center

Pittsburgh, Pennsylvania, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Anna Evans-Phillips, MD

Role: CONTACT

Phone: 412-624-4560

Email: [email protected]

Apsara Mishra

Role: CONTACT

Email: [email protected]

Facility Contacts

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Mahya Faghih, M.D.

Role: primary

Anna Evans-Phillips, MD

Role: primary

References

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Phillips AE, Faghih M, Singh VK, Bick B, Yadav D, Drewes AM, Olesen SS. Widespread Hyperalgesia by Pancreatic Quantitative Sensory Testing Is Associated With Reduced Pain Response in Chronic Pancreatitis. Pancreas. 2023 Apr 1;52(4):e257-e258. doi: 10.1097/MPA.0000000000002247. Epub 2023 Nov 13. No abstract available.

Reference Type DERIVED
PMID: 37967828 (View on PubMed)

Phillips AE, Faghih M, Singh VK, Olesen SS, Kuhlmann L, Novovic S, Bick B, Hart PA, Ramsey ML, Talukdar R, Garg PK, Yadav D, Drewes AM; Pancreatic Quantitative Sensory Testing (P-QST) Consortium. Rationale for and Development of the Pancreatic Quantitative Sensory Testing Consortium to Study Pain in Chronic Pancreatitis. Pancreas. 2021 Oct 1;50(9):1298-1304. doi: 10.1097/MPA.0000000000001912.

Reference Type DERIVED
PMID: 34860815 (View on PubMed)

Olesen SS, Phillips AE, Faghih M, Kuhlmann L, Steinkohl E, Frokjaer JB, Bick BL, Ramsey ML, Hart PA, Garg PK, Singh VK, Yadav D, Drewes AM; Pancreatic Quantitative Sensory Testing (P-QST) Consortium. Overlap and cumulative effects of pancreatic duct obstruction, abnormal pain processing and psychological distress on patient-reported outcomes in chronic pancreatitis. Gut. 2022 Dec;71(12):2518-2525. doi: 10.1136/gutjnl-2021-325855. Epub 2021 Oct 21.

Reference Type DERIVED
PMID: 34675068 (View on PubMed)

Phillips AE, Faghih M, Kuhlmann L, Larsen IM, Drewes AM, Singh VK, Yadav D, Olesen SS; Pancreatic Quantitative Sensory Testing (P-QST) Consortium. A clinically feasible method for the assessment and characterization of pain in patients with chronic pancreatitis. Pancreatology. 2020 Jan;20(1):25-34. doi: 10.1016/j.pan.2019.11.007. Epub 2019 Nov 20.

Reference Type DERIVED
PMID: 31787527 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Other Identifiers

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PRO17060648

Identifier Type: -

Identifier Source: org_study_id