Opioid resistance in chronic daily headache: a synthesis of ideas from the bench and bedside.
Opioid resistance in chronic daily headache: a synthesis of ideas from the bench and bedside.
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DOI：
10.1007/s11916-003-0013-5
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发表时间：
2003-02-01
影响因子：
3.7
通讯作者：
Biondi, David M
中科院分区：
文献类型：
--
作者：
Biondi, David M
慢性每日头痛是一种复杂的疼痛疾病，包含许多诊断和治疗挑战。在过去的十年中，我们对间歇性偏头痛的病理生理过程的了解有所提高，但慢性每日头痛的生物学基础仍然不清楚。困扰慢性日常头痛患者治疗的一些更常见问题是药物过度使用、精神合并症、药物治疗无效和残疾。长效阿片类镇痛药似乎为那些对其他治疗干预措施仍然无效的患者提供了可行的治疗选择；然而，临床经验往往并不支持这种信念。目前关于慢性疼痛的病理生理学基础和相关神经可塑性的概念可能阐明阿片类药物在治疗慢性日常头痛中普遍无效的生物学基础。本文探讨了偏头痛和慢性每日头痛的病理生理学模型、慢性每日头痛作为神经性疼痛综合征的概念、神经性疼痛状态下的神经可塑性、阿片类药物耐受性和阿片类药物引起的痛觉过敏的生理基础，以及这些情况如何相互作用导致在慢性每日头痛治疗中经常观察到的阿片类药物疗效普遍缺乏。
Chronic daily headache is a complex pain disorder that encompasses many diagnostic and therapeutic challenges. Our understanding of the pathophysiologic processes of intermittent migraine has improved over the past decade, but the biologic basis of chronic daily headache remains obscure. Some of the more common issues confounding management of patients who experience chronic daily headache are medication overuse, psychiatric comorbidity, refractoriness to pharmacologic treatments, and disability. Long-acting opioid analgesics would appear to provide a viable treatment option for those patients who remain refractory to other treatment interventions; however, clinical experience often does not support this belief. Current concepts of the pathophysiologic basis of chronic pain and associated neural plasticity may elucidate a biologic basis for the general inefficacy of opioids in the management of chronic daily headache. This article explores the models of pathophysiology for migraine and chronic daily headache, the concept of chronic daily headache as a neuropathic pain syndrome, neural plasticity in the context of neuropathic pain states, the physiologic basis for opioid tolerance and opioid-induced hyperalgesia, and how each of these conditions interact to provoke the general lack of opioid efficacy often observed in the management of chronic daily headache.