Neuropathic pain is a unique indication in that the only symptom, pain, is based solely on a patient’s perception. This leads to wild variation in a patient’s “sensory profile” – how they experience pain – and, as a secondary effect, which treatments will be efficacious.

Currently, there is a homogenous treatment guideline for all patients suffering from neuropathic pain, which includes pharmacological treatment with anticonvulsants, antidepressants, opioids, and gabapentinoids. However, due to the variety of symptoms between patients, there cannot be one treatment which is effective in all patients.

In the keynote lecture at the 6th International Congress on Neuropathic Pain (NeuPSIG) in Gothenburg, Sweden, Dr Ralf Baron highlighted the progress that has been made in researching personalized treatments. He highlighted studies hypothesizing that neuropathic pain had various origins, and stated that it was the difference in these underlying mechanisms that caused pain, giving rise to the different sensory profiles of patients.

In a 2017 study that Dr Baron conducted, the sensory profiles of 1,100 patients were identified using the German Research Network on Neuropathic Pain’s Quantitative Sensory Testing (DFNS QST) system, and a cluster analysis was applied. The results showed that patients fell into one of three distinct sub-groups: sensory loss, thermal hyperalgesia, and mechanical hyperalgesia. Further physiological study showed that these profiles are caused by damage to different parts of the central nervous system (CNS) and are likely to respond to differently to treatments. By identifying which subgroup patients fall into, physicians can prescribe a treatment that is more likely to be successful. 

The European Medical Agency (EMA) has deemed this sorting method as adequate, and it is being applied in several industry trials that are currently ongoing. Dr Baron, finishing his lecture on a positive note, stated that while there is still work to do, namely incorporating the method into all industry trials and identifying the underlying mechanisms of these types of pain, researchers are almost at the point where they can begin to personalize treatments for patients suffering from neuropathic pain.

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