National Harbor, MD—Until recently, the selection of patients for aggressive pain control therapy, including high-dose opioids and implanted delivery systems, has mostly been done on a subjective basis. A new serum test, however, now provides physicians with objective measures.
According to a study presented at the 2015 American Academy of Pain Medicine annual meeting, serum profiles of hormone and neuroinflammatory biomarkers can help identify patients who have active neuroinflammation and/or hormone dysfunction and who require the most advanced and aggressive measures for pain control. Forest Tennant, MD, DrPH, Veract Intractable Pain Clinic, West Covina, CA, presented the study results.
“For the first time in medical history, we’re seeing that we can determine which patients have neural inflammation inside the brain tissue,” Dr Tennant said. “This is probably the most significant development in pain management to come along in many years, because it brings new dimensions to the practical practice.”
Dr Tennant told Value-Based Care in Neurology that the real interest in biomarkers has been stimulated by a deeper understanding of centralized pain, a pathologic process characterized by microglial activation, neuroinflammation, metabolic disturbances, cellular destruction, and overstimulation of the hypothalamic-pituitary-adrenal axis and the autonomic nervous system.
“The upshot of this neural inflammation is that it puts out signals just like any other form of inflammation,” he said. “Certain hormones also increase, and they, too, are measurable in the serum.”
In this study, which was approved by the Intractable Pain Clinic’s Institutional Review Board, 80 patients with chronic pain had a blood test with a profile of 11 biomarkers of neuroinflammation and/or endocrine dysfunction. All patients had constant centralized pain associated with sleep interference and fatigue, and were prescribed a minimum of 80 mg of daily morphine equivalence.
The biomarkers and their frequency in this patient population were:
- C-reactive protein (N = 26)
- Myeloperoxidase (N = 24)
- Erythrocyte sedimentation rate (N = 22)
- Soluble tumor necrosis factor-alpha receptor 2 (N = 20)
- Alpha-1 antitrypsin (N = 14)
- Prolactin (N = 11)
- Apolipoprotein (N = 7)
- Epidermal growth factor (N = 5)
- Resistin (N = 4)
- Cortisol (N = 2)
- Brain-derived neurotrophic factor (N = 0).
Dr Tennant reported that 53 (66.3%) patients had at least 1, and 25 (31.3%) had 2 or more elevated biomarkers. And 4 biomarkers were elevated in at least 25% of patients.
“In cases of centralized pain, these patients are going to show up with biomarkers of inflammation if you test for them,” he said.
Dr Tennant envisions a near future in which inflammatory markers will be used to aid treatment decisions and to monitor the progress of centralized pain.
“You have to measure the inflammatory markers, it has to be treated, and then you are going to monitor the situation to see whether you’re getting where you want,” he said. “It’s with the really severe cases that these markers are the most necessary, because you want to know how severe.”
“Physicians who are treating the more difficult pain patients are starting to see the value of doing this,” he concluded. “The use of hormone biomarkers or inflammatory biomarkers is here to stay.”