Gastroparesis shows loss of pain sensation, increased pain-related worry
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Implementing quantitative sensory testing for patients with gastroparesis showed less sensation in idiopathic cases vs. diabetic gastroparesis, but both phenotypes had increased concern about pain, according to a presentation at Digestive Diseases Week.
“We found that idiopathic gastroparesis was associated with an abnormal somatic peripheral loss of protective sensation to the noxious stimulation,” Helen Burton Murray, PhD, of Massachusetts General Hospital, said in her presentation on behalf of the NIH/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Gastroparesis Clinical and Research Consortium. “Twenty one percent screened positively for having a likely neuropathic pain and 46% screened positively for having significant pain-related worry.”
Burton Murray presented data from a study funded by the NIH/NIDDK with centers from Massachusetts General Hospital/Harvard Medical School, Johns Hopkins University Medical Center/School of Medicine, Temple University, Wake Forest University Medical Sciences, University of Louisville, and Texas Tech University Medical Center. Participants underwent quantitative sensory testing (QST) assessing mechanical pain thresholds with pinprick stimulators on the arm and an algometer finger, increasing force to determine thresholds. They also completed questionnaires on neuropathic pain (Pain DETECT) and pain-related worry (Pain Catastrophizing Scale). The analysis included 158 participants, 69 with diabetic gastroparesis and 89 with idiopathic gastroparesis.
“In the past, people used to think gastroparesis was purely a disorder of stomach muscle function. In other words, it takes a long time for something in the stomach to move from one end to another. And that would cause nausea, vomiting,” Braden Kuo, MD, also of Massachusetts General Hospital, said in an interview with Healio. Abdominal pain is now being seen as an equally important symptom from previous work published by the NIH/NIDDK Gastroparesis Clinical and Research Consortium, he added.
“[Gastrointestinal specialists| have to deal with abdominal pain if you want to make a difference,” Kuo said. “This sort of study is the first attempt to begin to understand some of the neurosensory aspects of abdominal pain using formal pain methodology testing that is used in a whole host of other conditions such as fibromyalgia.”
Participants with idiopathic gastroparesis had greater loss of protective sensation on the QST sharp prick on the arm vs. their diabetic counterparts (median interquartile range [IQR] = 4 vs. 15 g force; P = .004). They did not differ on other peripheral QST parameters and had similar self-reported neuropathic pain and pain-related worry.
The pain-related worry scores showed that 46% of participants tested positive for pain-related worry, leading the researchers to hypothesize that perhaps cognitive behavioral therapy (CBT) could be a treatment in the future. Additionally, they hope to understand if neuropathic profiles could predict response to treatments.
Burton Murray explained that although the QST is not yet validated in gastroparesis, the pain-related worry score is widely accepted.
“That could be something that would help screen for widespread neuropathic pain in these patients and potentially inform the types of treatment approach the gastroenterology provider uses,” Burton Murray told Healio.
In the future, Burton Murray told Healio they will look at QST in the abdomen and validate that approach.
“We will be conducting an [randomized controlled trial] of CBT for patients with gastroparesis and looking at QST pretesting to see if different phenotypes on that QST may inform better response for some patients over others; and this approach could apply in pharmacologic studies as well,” she said.
Kuo added that although many drugs in development focus on the motility within gastroparesis, a number of medications also have the potential to impact the sensory aspects through neurotransmitters such as serotonin and neurokinins.
“Ultimately, for the clinician, neuropathic pain is present in a portion of patients with gastroparesis. Abdominal pain is a consistent symptom as we’ve shown in the gastroparesis consortium, but now we are doing further tests to try to characterize that pain with standardized methodology used in other chronic pain conditions,” Kuo said. “While [QST for gastroparesis]is not ready for prime time, we hope it will give new insights into gastroparesis in the pain perspective and that it may be helpful in clinical development of treatment options, whether it be psychological treatment options such as CBT or future drug development that may be focused on neuropathic pain in gastroparesis.”
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Burton Murray H. Abstract 96. Presented at: Digestive Disease Week; May 21-24, 2021. Virtual.
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