Alfentanil, but not amitriptyline, reduces pain, hyperalgesia, and allodynia from intradermal injection of capsaicin in humans
Alfentanil, but not amitriptyline, reduces pain, hyperalgesia, and allodynia from intradermal injection of capsaicin in humans
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DOI：
10.1097/00000542-199706000-00008
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发表时间：
1997-06-01
期刊：
影响因子：
8.8
通讯作者：
Tong, CY
中科院分区：
文献类型：
--
作者：
Eisenach, JC;Hood, DD;Tong, CY
背景：皮内注射辣椒素会在人体中产生短暂的疼痛，随后出现痛觉过敏和异常性疼痛，而后者的作用是由脊髓 N-甲基-D-天冬氨酸机制介导的。阿米替林最近被证明可以拮抗N-甲基-D-天冬氨酸受体，在本研究中，作者试图确定阿米替林单独使用以及与阿片类阿芬太尼联合使用对皮内注射辣椒素引起的痛觉过敏和异常性疼痛的效果。 方法：综合临床研究中心的46名健康志愿者单独或在全身注射辣椒素之前和之后重复皮内注射辣椒素（100μg）。 4毫克咪达唑仑，25毫克阿米替林，计算机控制输注阿芬太尼，或阿米替林加阿芬太尼，在指定的时间间隔测定急性疼痛以及机械性痛觉过敏和异常性疼痛的面积，采集血液用于阿芬太尼和阿米替林测定。结果：辣椒素注射产生急性疼痛，随后出现痛觉过敏和异常性疼痛。阿芬太尼以血浆浓度依赖性方式减少这些疼痛反应，并且痛觉过敏和异常性疼痛的减少与急性疼痛的减少相关。单独使用阿米替林没有效果，也不会增强阿芬太尼的作用。阿芬太尼产生浓度依赖性恶心，阿米替林可减弱这种效应。 讨论：这些数据与先前对志愿者的研究一致，表明全身施用阿片类药物皮内注射辣椒素后痛觉过敏和异常性疼痛减少，并且他们表明这种减少可能是由于急性镇痛减少伤害性输入所致。这些数据不支持使用阿米替林急性全身给药来治疗急性疼痛、痛觉过敏和异常性疼痛，尽管慢性治疗和脊髓给药的作用正在研究中。
Background: Intradermal injection of capsaicin produces brief pain followed by hyperalgesia and allodynia in humans, and the latter effects are mediated by spinal N-methyl-D-aspartate mechanisms. Amitriptyline recently was shown to antagonize N-methyl-D-aspartate receptors, and in this study, the authors sought to determine the effect of amitriptyline alone and with the opioid alfentanil on hyperalgesia and allodynia produced by intradermal injection of capsaicin.Methods: Forty-six healthy volunteers in the general clinical research center received repeated intradermal injections of capsaicin (100 mu g) alone or before and after systemic injection of 4 mg midazolam, 25 mg amitriptyline, alfentanil by computer-controlled infusion, or amitriptyline plus alfentanil, Acute pain and areas of mechanical hyperalgesia and allodynia were determined at specified intervals, Blood was obtained for alfentanil and amitriptyline assay.Results: Capsaicin injection produced acute pain followed by hyperalgesia and allodynia. Alfentanil reduced these pain responses in a plasma-concentration-dependent manner, and reduction in hyperalgesia and allodynia correlated with reduction in acute pain. Amitriptyline alone had no effect and did not potentiate alfentanil. Alfentanil produced concentration-dependent nausea, an effect diminished by amitriptyline.Discussion: These data correspond with previous studies in volunteers demonstrating reduction in hyperalgesia and allodynia after intradermal injection of capsaicin by systemically administered opioids, and they suggest that this reduction may be secondary to reduced nociceptive input by acute analgesia. These data do not support the use of acute systemic administration of amitriptyline for acute pain, hyperalgesia, and allodynia, although the roles of chronic treatment and spinal administration are being investigated.