Phenotyping Chronic Musculoskeletal Pain in Male and Female Adolescents: Psychosocial Profiles, Somatosensory Profiles and Pain Modulatory Profiles

Abstract

Don Daniel Ocay,1,2 Cynthia L Larche,2 Natalie Betinjane,2 Alexandre Jolicoeur,2 Marie Josee Beaulieu,2 Neil Saran,3 Jean A Ouellet,3 Pablo M Ingelmo,4– 7 Catherine E Ferland1,2,5– 7 1Department of Experimental Surgery, McGill University, Montreal, QC, Canada; 2Department of Clinical Research, Shriners Hospitals for Children Canada, Montreal, QC, Canada; 3Department of Pediatric Orthopedics, McGill University, Montreal, QC, Canada; 4Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, Montreal, QC, Canada; 5Department of Anesthesia, McGill University, Montreal, QC, Canada; 6Research Institute-McGill University Health Centre, Montreal, QC, Canada; 7Alan Edwards Research Center for Pain, McGill University, Montreal, QC, CanadaCorrespondence: Catherine E Ferland, Shriners Hospitals for Children-Canada, 1003, Decarie Blvd, Montreal, H4A 0A9, Canada, Tel [phone], extension 7177, Fax [phone], Email [email protected]: A major limitation in treatment outcomes for chronic pain is the heterogeneity of the population. Therefore, a personalized approach to the assessment and treatment of children and adolescents with chronic pain conditions is needed. The objective of the study was to subgroup pediatric patients with chronic MSK pain that will be phenotypically different from each other based on their psychosocial profile, somatosensory function, and pain modulation.Patients and Methods: This observational cohort study recruited 302 adolescents (10– 18 years) with chronic musculoskeletal pain and 80 age-matched controls. After validated self-report questionnaires on psychosocial factors were completed, quantitative sensory tests (QST) and conditioned pain modulation (CPM) were performed.Results: Three psychosocial subgroups were identified: adaptive pain (n=125), high pain dysfunctional (n=115), high somatic symptoms (n=62). Based on QST, four somatosensory profiles were observed: normal QST (n=155), thermal hyperalgesia (n=98), mechanical hyperalgesia (n=34) and sensory loss (n=15). Based on CPM and temporal summation of pain (TSP), four distinct groups were formed, dysfunctional central processing group (n=27) had suboptimal CPM and present TSP, dysfunctional inhibition group (n=136) had suboptimal CPM and absent TSP, facilitation group (n=18) had optimal CPM and present TSP, and functional central processing (n=112) had optimal CPM and absent TSP. A significant association between the psychosocial and somatosensory profiles. However, no association was observed between the psychosocial or somatosensory profiles and pain modulatory profiles.Conclusion: Our results provide evidence that adolescents with chronic musculoskeletal pain are a heterogenous population comprising subgroups that may reflect distinct mechanisms and may benefit from different treatment approaches. The combination of screening self-reported questionnaires, QST, and CPM facilitate subgrouping of adolescents with chronic MSK pain in the clinical context and may ultimately contribute to personalized therapy.Keywords: adolescents, chronic pain, musculoskeletal pain, quantitative sensory testing, conditioned pain modulation, temporal summation of pain

Keywords

• adolescents
• chronic pain
• musculoskeletal pain
• quantitative sensory testing
• conditioned pain modulation
• temporal summation of pain