Greater Conditioned Pain Modulation Is Associated With Enhanced Morphine Analgesia in Healthy Individuals and Patients With Chronic Low Back Pain.
Greater Conditioned Pain Modulation Is Associated With Enhanced Morphine Analgesia in Healthy Individuals and Patients With Chronic Low Back Pain.
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DOI：
10.1097/ajp.0000000000000887
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发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
Burns JW
中科院分区：
文献类型：
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作者：
Bruehl S;France CR;Stone AL;Gupta R;Buvanendran A;Chont M;Burns JW
条件性疼痛调节 (CPM) 方案对下行疼痛抑制的程度进行索引。本研究评估了控制 CPM 预期混杂的 CPM 程度是否与吗啡镇痛和主观反应相关，以及慢性疼痛状态或性别是否调节了这些影响。参与者包括 92 名慢性腰痛 (CLBP) 患者和 99 名健康对照者，没有人每天使用阿片类镇痛药。在交叉设计中，参与者参加了两次相同的实验室会议，期间他们接受静脉注射吗啡（0.08 mg/kg）或盐水安慰剂，然后进行诱发疼痛评估。在每次会议中，参与者都参与缺血性前臂和热痛任务，以及结合缺血性疼痛（条件刺激）和热痛（测试刺激）的 CPM 方案。安慰剂对照的吗啡结果是根据药物条件下疼痛和主观效果的差异得出的。在控制 CPM 预期的分层回归中，在缺血性疼痛任务（VAS 疼痛强度和不愉快）和热痛任务（VAS 疼痛强度、麦吉尔疼痛问卷-感觉和当前疼痛强度 [PPI] 上，较高的安慰剂条件 CPM 与较少的主观吗啡不适感 (p=.001) 和较高的吗啡镇痛效果 (p's<.05) 相关。子量表）。性别或 CLBP 状态没有调节作用，但缺血性 PPI 结果除外，注意到显着的双向相互作用 (p<.05)，男性在 CPM 和吗啡镇痛之间表现出比女性更强的正相关关系。结果表明，CPM 可以预测阿片类药物的镇痛反应和主观反应。作为精准疼痛医学算法的一个要素，可能有必要对 CPM 进行进一步评估。
Conditioned pain modulation (CPM) protocols index magnitude of descending pain inhibition. This study evaluated whether degree of CPM, controlling for CPM expectancy confounds, was associated with analgesic and subjective responses to morphine, and whether chronic pain status or sex moderated these effects. Participants included 92 individuals with chronic low back pain (CLBP) and 99 healthy controls, none using daily opioid analgesics. In a crossover design, participants attended two identical laboratory sessions during which they received either intravenous morphine (0.08 mg/kg) or saline placebo before undergoing evoked pain assessment. In each session, participants engaged in ischemic forearm and heat pain tasks, and a CPM protocol combining ischemic pain (conditioning stimulus) and heat pain (test stimulus). Placebo-controlled morphine outcomes were derived as differences in pain and subjective effects across drug conditions. In hierarchical regressions controlling for CPM expectancies, greater placebo condition CPM was associated with less subjective morphine unpleasantness (p=.001) and greater morphine analgesia (p’s<.05) on both the ischemic pain task (VAS Pain Intensity and Unpleasantness) and heat pain task (VAS Pain Intensity, McGill Pain Questionnaire-Sensory and Present Pain Intensity [PPI] subscales). There was no moderation by sex or CLBP status, except for the ischemic PPI outcome for which a significant 2-way interaction (p<.05) was noted, with men showing a stronger positive relationship between CPM and morphine analgesia than women. Result suggest that CPM might predict analgesic and subjective responses to opioid administration. Further evaluation of CPM as an element of precision pain medicine algorithms may be warranted.