Pancreatic quantitative sensory testing (P-QST) for pain assessment in Indian patients with chronic pancreatitis

Pain is the predominant symptom of chronic pancreatitis (CP). Pancreatic quantitative sensory testing (P-QST) provides a semi-objective assessment of pain processing, but has not been previously reported for Indian patients. This study aimed to evaluate pain characteristics using P-QST in Indian patients with CP.

Patients with painful CP and age- and sex-matched healthy controls (HCs) from two tertiary centers in northern (All India Institute of Medical Sciences, AIIMS) and southern India (Asian Institute of Gastroenterology, AIG) were included. P-QST assessed temporal summation (spinal hyperexcitability), pressure pain detection (pPDT), and tolerance thresholds (pPTT) across five dermatomes, tolerance to tonic cold pain, and conditioned pain modulation (descending pain inhibition). P-QST parameters were compared between CP and HC subgroups, stratified by center, and inter-center differences were evaluated.

A total of 451 participants (251 CP, 200 HCs) were enrolled. TS scores were comparable between groups. Patients with CP had lower pPDT and pPTT sums than HCs at both centers (AIG: 2513 vs 2717 kPa, P = 0.006; 2966 vs 3337 kPa, P < 0.001; AIIMS: 1666 vs 1870 kPa, P < 0.001; 2355 vs 3033 kPa, P=<0.001). Cold pressor endurance time was shorter in CP (AIG: 54 vs 74 s, P < 0.001; AIIMS: 103 vs 114 s, P = 0.013). CPM responses were higher in CP (AIG: 5% vs 0%, P = 0.002; AIIMS: 5% vs 3%, P = 0.014) CONCLUSION: P-QST showed consistent, widespread hyperalgesia in Indian patients with painful CP, providing a window of opportunity to identify central sensitization and validating its clinical utility in assessing central pain modulation across diverse populations.