Pancreatic Quantitative Sensory Testing (P-QST) to Predict Treatment Response for Pain in Chronic Pancreatitis

NCT ID: NCT04996628

Last Updated: 2025-12-22

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

150 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-01-04

Study Completion Date

2026-06-30

Brief Summary

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Abdominal pain in chronic pancreatitis (CP) affects up to 90% of patients during the course of their disease, and response to currently available therapies is suboptimal and unpredictable. The proposed clinical trial will evaluate the predictive capability of Pancreatic Quantitative Sensory Testing (P-QST) - a novel assessment of neurosensory phenotyping- for improvement in pain in patients with CP who are undergoing medically-indicated invasive treatment with endoscopic therapy or surgery.

Detailed Description

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P-QST has been shown to be able to phenotype patients with CP into nociceptive patterns according to degree of central sensitization. As a tool to identify baseline nociceptive pattern in patients with painful CP, P-QST will be performed at baseline prior to planned invasive treatment with endoscopic therapy or decompressive surgery. We will evaluate the ability of P-QST to predict response to invasive treatment for painful CP, and to develop a predictive model for individualized prediction of treatment response.

Patients will undergo pre-procedure P-QST testing before undergoing scheduled invasive treatment as directed by their treating gastroenterologist. The date of first endoscopic therapy or surgery will be used to calculate follow-up timepoints, which will be scheduled at 3, 6, and 12 months after the first endotherapy session or surgery. At each follow-up time point, patients will answer questions about their pain. In addition, patients will complete patient reported outcome tools (HADS, PCS instruments) and the Patient Global Impression of Change. Serum and urine samples will be obtained at baseline and at 6-month follow-up timepoints.

Conditions

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Chronic Pancreatitis Chronic Pain

Keywords

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Chronic Pain Chronic Pancreatitis Recurrent Acute Pancreatitis Chronic Abdominal Pain ERCP Pancreatic Surgery

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Participants are assessed at baseline for nociceptive pattern via P-QST and followed longitudinally for the duration of the study
Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Pancreatic Quantitative Sensory Testing (P-QST)

Definite Chronic Pancreatitis patients undergoing decompressive invasive treatments (endoscopic therapy or surgery) to relieve main pancreatic duct obstruction due to stones and/or stricture for management of pain will undergo P-QST prior to clinically-indicated invasive treatment.

Group Type EXPERIMENTAL

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 Pressure Threshold Testing Conditioned Pain Modulation

Eligibility Criteria

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Inclusion Criteria

* Adult patients ≥ 18 years of age with definite CP undergoing decompressive invasive treatments (endoscopic therapy or surgery) to relieve main pancreatic duct obstruction due to stones and/or stricture for management of pain.

* Endoscopic therapy: Endoscopic Retrograde Cholangiopancreatography (ERCP) with pancreatic duct stone removal, stent placement, and/or stricture dilation, ± intraductal lithotripsy or Extracorporeal Shock Wave Lithotripsy (ESWL).
* Surgery: drainage procedures (Frey and Puestow operations)

Exclusion Criteria

* Patients with chronic pain from conditions other than CP
* Patients \< 18 years of age
* Patients who have had endoscopic therapy within the past 12 months
* Patients who have undergone prior pancreatic surgery
* Patients who have resective surgical procedure planned (eg. Whipple procedure, Total Pancreatectomy)
* Patients with peripheral sensory deficits
* Patients with known pregnancy at the time of study screening\*\*

* Note: Women who become pregnant during the course of the study can no longer participate in P-QST testing.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

NIH

Sponsor Role collaborator

University of Pittsburgh

OTHER

Sponsor Role lead

Responsible Party

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Anna Evans Phillips

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Anna Evans Phillips, MD, MS

Role: PRINCIPAL_INVESTIGATOR

University of Pittsburgh

Locations

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Indiana University Medical Center

Indianapolis, Indiana, United States

Site Status RECRUITING

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, MS

Role: CONTACT

Phone: 412-647-2345

Email: [email protected]

Apsara Mishra

Role: CONTACT

Email: [email protected]

Facility Contacts

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Suzette Schmidt, RN

Role: primary

Mahya Faghih, MD

Role: primary

Anna E Phillips, MD, MS

Role: primary

References

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Phillips AE, Afghani E, Akshintala VS, Benos PY, Das R, Drewes AM, Easler J, Faghih M, Gabbert C, Halappa V, Khashab MA, Olesen SS, Saloman JL, Sholosh B, Slivka A, Wang T, Yadav D, Singh VK. Pancreatic quantitative sensory testing to predict treatment response of endoscopic therapy or surgery for painful chronic pancreatitis with pancreatic duct obstruction: study protocol for an observational clinical trial. BMJ Open. 2024 Mar 21;14(3):e081505. doi: 10.1136/bmjopen-2023-081505.

Reference Type DERIVED
PMID: 38514147 (View on PubMed)

Other Identifiers

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R01DK127042

Identifier Type: NIH

Identifier Source: secondary_id

View Link

STUDY21050169

Identifier Type: -

Identifier Source: org_study_id