Altered quantitative sensory testing outcome in subjects with opioid therapy.
Altered quantitative sensory testing outcome in subjects with opioid therapy.
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DOI：
10.1016/j.pain.2009.01.022
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发表时间：
2009-05
期刊：
影响因子：
7.4
通讯作者：
Mao J
中科院分区：
文献类型：
--
作者：
Chen L;Malarick C;Seefeld L;Wang S;Houghton M;Mao J
临床前研究表明，阿片类药物暴露可能会引起伤害性阈值的矛盾降低，通常称为阿片类药物引起的痛觉过敏（OIH）。虽然 OIH 可能对急性和慢性疼痛治疗有影响，但其临床特征仍不清楚。使用基于办公室的定量感觉测试（QST）方法，我们比较了三组受试者的疼痛阈值、疼痛耐受性和对热刺激的第二次疼痛的时间总和程度：既没有疼痛也没有阿片类药物治疗的受试者（第1组），患有慢性疼痛但没有阿片类药物治疗的受试者（第2组），以及同时接受慢性疼痛和阿片类药物治疗的受试者（第3组）。我们还检查了第 3 组受试者的 QST 对热刺激的反应与阿片类药物剂量、阿片类药物治疗持续时间、阿片类镇痛类型、疼痛持续时间或性别之间可能的相关性。与第 1 组 (n = 41) 和第 2 组 (n = 41) 受试者相比，第 3 组受试者 (n = 58) 表现出较低的热痛阈值，并且对热刺激的第二次疼痛的时间总和加剧。相比之下，三组之间的冷感或热感没有差异。在临床因素中，每日阿片类药物剂量与第 3 组受试者的热痛阈值降低和第二次疼痛的加剧时间总和一致相关。这些结果表明，热痛阈值降低和第二次疼痛的时间总和加剧可能是阿片类药物治疗受试者的特征性 QST 变化。数据表明 QST 可能是 OIH 临床评估的有用工具。
Preclinical studies have suggested that opioid exposure may induce a paradoxical decrease in the nociceptive threshold, commonly referred as opioid-induced hyperalgesia (OIH). While OIH may have implications in acute and chronic pain management, its clinical features remain unclear. Using an office-based quantitative sensory testing (QST) method, we compared pain threshold, pain tolerance, and the degree of temporal summation of the second pain in response to thermal stimulation among three groups of subjects: those with neither pain nor opioid therapy (Group 1), with chronic pain but without opioid therapy (Group 2), and with both chronic pain and opioid therapy (Group 3). We also examined the possible correlation between QST responses to thermal stimulation and opioid dose, opioid treatment duration, opioid analgesic type, pain duration, or gender in group 3 subjects. As compared with both group 1 (n = 41) and group 2 (n = 41) subjects, group 3 subjects (n = 58) displayed a decreased heat pain threshold and exacerbated temporal summation of the second pain to thermal stimulation. In contrast, there were no differences in cold or warm sensation among three groups. Among clinical factors, daily opioid dose consistently correlated with the decreased heat pain threshold and exacerbated temporal summation of the second pain in group 3 subjects. These results indicate that decreased heat pain threshold and exacerbated temporal summation of the second pain may be characteristic QST changes in subjects with opioid therapy. The data suggest that QST may be a useful tool in the clinical assessment of OIH.
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