Low Serum Naproxen Concentrations Are Associated with Minimal Pain Relief: A Preliminary Study in Women with Dysmenorrhea.
Low Serum Naproxen Concentrations Are Associated with Minimal Pain Relief: A Preliminary Study in Women with Dysmenorrhea.
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低血清萘普生浓度与最小程度的疼痛缓解相关：对痛经女性的初步研究。
DOI：
10.1093/pm/pnaa133
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Hellman,KevinM
中科院分区：
文献类型：
--
作者：
Oladosu,FolabomiA;Tu,FrankF;Garrison,EllenF;Dillane,KatlynE;Roth,GenevieveE;Hellman,KevinM
目的非甾体抗炎药(NSAIDs)治疗后疼痛不完全缓解是常见的现象，但目前尚不清楚是吸收不良还是代谢异常导致NSAID耐药。为了解释非甾体类抗炎药抵抗的原因，我们在一项针对痛经妇女的初步研究中，评估了萘普生的吸收和代谢与疼痛缓解的关系。方法在月经期间，参与者在摄入萘普生之前和之后进行疼痛评估。止痛效果以服用萘普生前后疼痛等级的百分比变化来计算。为了评估吸收不良的影响，分析了镇痛效果与血清萘普生的相关性。结果痛经患者(N = 2 3，12 6 ± 10 g/m L，381 ± 5 6 ng/m L)与健康对照组(N = 12,135 ± 8 m g/m L，35 5 ± 5 8 /m L)的血清N N P和O-DMC浓度差异无统计学意义(P&gT；0.0 5)，提示痛经患者月经痛不影响药物的吸收和代谢。然而，9名痛经参与者的止痛有效率为30%。在痛经妇女中，镇痛效果与血清萘普生浓度(r= 0.49，P=0.019)和O-去甲基萘普生浓度(r= 0.45，P=0.032)相关。在控制了其他妇科诊断后，多因素模型分析证实，较低的血清萘普生浓度与疼痛缓解程度降低有关(P=0.038)。结论我们的初步研究结果表明，药物吸收不良导致痛经妇女疼痛缓解无效。未来的研究应该探索吸收不良是否有助于对其他疼痛条件下的非甾体抗炎药的抵抗。
ObjectiveIncomplete pain relief after administration of nonsteroidal anti-inflammatory drugs (NSAIDs) is common, but it is unknown whether malabsorption or heightened metabolism contributes to NSAID resistance. To explain the etiology of NSAID resistance, we evaluated naproxen absorption and metabolism in relation to pain relief in a pilot study of women with dysmenorrhea.MethodsDuring menses, participants completed before and after naproxen ingestion pain assessments. Analgesic effectiveness was calculated as a percent change in pain rating before and after naproxen administration. To evaluate the impact of malabsorption, the correlation between analgesic effectiveness and serum naproxen was analyzed. To identify whether hypermetabolism contributes to NSAID resistance, we also analyzed the metabolite O-desmethylnaproxen.ResultsSerum naproxen and O-desmethylnaproxen concentrations of the dysmenorrheic cohort (N = 23, 126 ± 10 µg/mL, 381 ± 56 ng/mL) and healthy controls (N = 12, 135 ± 8 µg/mL, 355 ± 58 ng/mL) were not significantly different (P> 0.05), suggesting that menstrual pain does not affect drug absorption and metabolism. However, nine dysmenorrhea participants had levels of analgesic effectiveness <30%. Among dysmenorrheic women, analgesic effectiveness was correlated with serum naproxen (r= 0.49,P=0.019) and O-desmethylnaproxen (r= 0.45,P=0.032) concentrations. After controlling for other gynecological diagnoses, a multivariate model analysis confirmed that lower serum naproxen concentrations were associated with reduced pain relief (P=0.038).ConclusionsOur preliminary findings suggest that poor drug absorption contributes to ineffective pain relief in dysmenorrheic women. Future studies should explore whether malabsorption contributes to NSAID resistance for other pain conditions.
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DOI：
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