Basal heat pain thresholds predict opioid analgesia in patients with postherpetic neuralgia
Basal heat pain thresholds predict opioid analgesia in patients with postherpetic neuralgia
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DOI：
10.1097/00000542-200606000-00020
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发表时间：
2006-06-01
期刊：
影响因子：
8.8
通讯作者：
Raja, Srinivasa
中科院分区：
文献类型：
--
作者：
Edwards, Robert R.;Haythomthwaite, Jennifer A.;Raja, Srinivasa
背景资料：各种各样的止痛药已被研究在带状疱疹后神经痛的治疗中，有几种药物表现出一定程度的疗效。然而，现有的试验已经记录了治疗反应的巨大个体差异，重要的是要确定预测特定干预措施镇痛效果的患者特征。几项动物研究表明，基础伤害敏感性降低，以相对较高的热痛阈值的形式，与更大的阿片类镇痛有关，但这一发现尚未应用于阿片类药物治疗慢性疼痛的人体研究。利用先前发表的阿片类药物和三环类药物治疗带状疱疹后神经痛的交叉试验数据，作者评估了基线热痛阈值，评估在身体部位对侧的受影响的区域，作为一个预测的治疗respons.Results：在阿片类药物治疗期间，更大的减少疼痛和疼痛缓解的较高评级观察到在基线时具有相对较高的热痛阈值的患者。基线疼痛阈值不能预测三环类药物或安慰剂的反应。有趣的是，其他个体差异变量，如年龄和基线疼痛强度也显著预测阿片类药物反应（即，更高的基线疼痛和更年轻的年龄与更大的阿片类药物相关的疼痛减轻有关，这两个因素解释了阿片类药物镇痛的近20%的方差）.结论：这些发现，这将需要复制，表明热痛敏感性的预处理评估可能被证明是有用的，以确定那些患者最有可能对阿片类药物有反应。
Background: A variety of analgesics have been studied in the treatment of postherpetic neuralgia, with several medications demonstrating some degree of efficacy. However, existing trials have documented large individual differences in treatment responses, and it is important to identify patient characteristics that predict the analgesic effectiveness of particular Interventions. Several animal studies have indicated that reduced basal nociceptive sensitivity, in the form of relatively high heat pain thresholds, is associated with greater opioid analgesia, but this finding has not been applied to human studies of opioid treatment for chronic pain.Methods: Using data from a previously published crossover trial of opioids and tricyclics in postherpetic neuralgia, the authors evaluated baseline thermal pain thresholds, assessed at a body site contralateral to the affected area, as a predictor of treatment responses.Results: During opioid treatment, a greater reduction in pain and higher ratings of pain relief were observed in patients with relatively higher heat pain thresholds at baseline. Baseline pain thresholds did not predict responses to tricyclics or placebo. Interestingly, other individual-difference variables such as age and baseline pain intensity also significantly predicted opioid responses (i.e., higher baseline pain and younger age were related to greater opioid-associated pain reduction, with nearly 20% of the variance in opioid analgesia explained by these two factors).Conclusions: These findings, which will require replication, suggest that pretreatment assessment of heat pain sensitivity might prove useful in identifying those patients most likely to respond to opioids.