Pharmacotherapy for pain: what to measure, how to measure?

Abstract

In this thesis novel techniques are described which are developed to analyze or predict the efficacy of pharmacotherapy for pain. In Chapter 2 an overview is presented on recent pharmacokinetic pharmacodynamic (PKPD) modeling in acute and chronic pain. Chapter 3 describes the analgesic effect of a capsaicin patch in diabetic painful neuropathy (DPN) pain patients. A longitudinal population PD analysis is performed. In Chapter 4 a subgroup analysis is performed on pooled data from 4 multicenter trials on the effect of capsaicin 8% patch in post herpetic neuralgia (PHN). Apart from longitudinal and mixture analyses, covariates are examined to identify predictors of efficacy. In Chapter 5 the analgesic effect of orodispersible oxycodone versus orodispersible paracetamol for the management of breakthrough pain is quantified using a novel pharmacodynamic model. ________________________________Finally, Chapter 6 describes the effect of tapentadol versus morphine on conditional pain modulation (CPM) in healthy volunteers. A difference in CPM engagement between these two __opioids__ might proof the difference in mechanisms of action between the classical mu opioid receptor (MOR) agonist and the combined MOR-noradrenalin reuptake inhibitor (NRI) compound.