Intravenous adenosine alleviates neuropathic pain: a double blind placebo controlled crossover trial using an enriched enrolment design
Intravenous adenosine alleviates neuropathic pain: a double blind placebo controlled crossover trial using an enriched enrolment design
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DOI：
10.1016/s0304-3959(02)00419-0
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发表时间：
2003-05-01
期刊：
影响因子：
7.4
通讯作者：
Sawynok, J
中科院分区：
文献类型：
--
作者：
Lynch, ME;Clark, AJ;Sawynok, J
腺苷类似物在啮齿动物的神经损伤模型中在伤害感受范例中产生镇痛作用并减轻神经病理性疼痛的表现。在人类中，先前的工作表明腺苷静脉给药在术后和神经性疼痛中具有镇痛作用。在这项双盲安慰剂对照交叉试验中，我们采用了一种丰富的招募设计来确定静脉注射腺苷（50 μ g/kg/min，持续60分钟）对神经性疼痛的影响。在试验的第1阶段中，腺苷以开放标签的方式给药，而在第2阶段中，腺苷以双盲安慰剂对照的方式给药于23名腺苷应答者，这些应答者在开放试验中经历了30%或更高的应答。结局指标包括麦吉尔疼痛问卷（MPQ），其生成疼痛评级指数（PRI），并包含疼痛强度的视觉模拟量表（VAS）、神经病变疼痛量表（VAS）和疼痛缓解VAS。受试者还使用VAS对异常性疼痛和痛觉过敏的程度进行分级。根据MPQ-PRI、MPQ-VAS和疼痛缓解VAS，腺苷可显著降低自发性疼痛。疼痛表现出与MPQ-PRI相似的模式，在1级（强度）、3级（热）、6级（敏感）、7级（发痒）和9级（不愉快）中具有统计学显著性降低。腺苷还导致针刺痛敏的显著减少，但在异常性疼痛中没有。来自试验1期的3名患者在静脉注射腺苷后疼痛长期缓解（5、16、25个月）。这项研究的结果支持以前的报告，表明静脉注射腺苷减轻神经病理性疼痛和痛觉过敏。(C)2002年国际疼痛研究协会。由Elsevier Science B. V.出版，版权所有。
Adenosine analogs produce analgesic actions in nociceptive paradigms and alleviate manifestations of neuropathic pain in nerve injury models in rodents. In humans, previous work indicates an analgesic effect for adenosine administered intravenously in postoperative and neuropathic pain. In this double blind placebo controlled crossover trial, we used an enriched enrolment design to determine the effects of intravenous adenosine (50 mug/kg/min over 60 min) on neuropathic pain. In Phase 1 of the trial, adenosine was administered in an open label manner, while in Phase 2 adenosine was administered in a double blind placebo controlled manner to 23 adenosine responders who had experienced a 30% or greater response in the open trial. Outcome measures included the McGill pain questionnaire (MPQ), which generates a pain rating index (PRI), and contains a visual analog scale (VAS) of pain intensity, the neuropathy pain scale (NPS), and a VAS for pain relief. Subjects also graded the degree of allodynia and hyperalgesia using a VAS. Adenosine led to a significant reduction in spontaneous pain according to the MPQ-PRI, the MPQ-VAS and the VAS for pain relief. The NPS showed a pattern similar to the MPQ-PRI, with statistically significant reductions in scales 1 (intensity), 3 (hot), 6 (sensitive), 7 (itchy) and 9 (unpleasant). Adenosine also led to a significant reduction in pinprick hyperalgesia, but not in allodynia. Three patients from Phase 1 of the trial experienced long term resolution of their pain following intravenous adenosine (5,16,25 months). The results of this study support previous reports that indicate intravenous adenosine alleviates neuropathic pain and hyperalgesia. (C) 2002 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.