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Nicholas Levergood, Stephanie M Cox, Pedram Hamrah; Psychoactive Medication Usage is Predictive of Treatment Response in Neuropathic Corneal Pain (NCP). Invest. Ophthalmol. Vis. Sci. 2020;61(7):4080.
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NCP patients may present with concomitant medications and conditions. How these may impact treatment results for NCP with a centralized component is unknown. The proparacaine challenge test (PCT) allows for presumed centralized pain (PCP) to be determined by using a topical anesthetic to silence the peripheral ocular surface pain. This study aims to investigate the impact of psychiatric conditions or their respective treatments on NCP treatment response.
A retrospective chart review of patients with NCP diagnosed via clinical findings and in vivo confocal microscopy was conducted. Patients were included who had two PCTs recorded, separated by at least 45 days. To perform the PCT test, patients were asked their pain level before and after instillation of 0.5% proparacaine hydrochloride. Pain level before instillation was recorded as total pain (0-10 scale), and percent PCP was calculated by dividing the pain level reported after instillation by that reported prior to instillation and multiplying by 100%.
The average age of patients taking psychiatric medications (n=9, PSYmed group) was 59.4±5.6 years, and 78% were female. The average age of patients not taking psychiatric medications (n=12, nPSYmed group) was 48.7±7.2 years (p=0.335), and 75% were female (p=0.882). The average total pain at the first visit for the PSYmed and nPSYmed groups were 7.0±0.8 and 6.3±0.4, respectively (p=0.409). The percentage of patients in each group prescribed topical and/or systemic treatments was not significantly different (all p>0.05). There was no statistically significant difference in percent change in total pain between the PSYmed group (-12.5±18.3%) and nPSYmed group (-30.8±10.8%; p=0.327) between visits. However, there was a statistically significant difference in percent change in PCP between the PSYmed group (-1.4±25.3%) and nPSYmed group (-63.9±11.6%; p=0.048). Within the PSYmed group, patients with a reported psychiatric diagnosis did not have a significantly different percent change in total pain (p=0.981) or PCP (p=0.857) when compared to those without a psychiatric diagnosis.
There was a greater reduction in PCP in patients not taking psychiatric medications, while there was no significant difference between groups with and without a psychiatric diagnosis, suggesting that therapy for centralized pain may be more effective in these patients.
This is a 2020 ARVO Annual Meeting abstract.
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