Evaluation by Survival Analysis of Cold Pain Tolerance in Patients with Fibromyalgia and Opioid Use.
Evaluation by Survival Analysis of Cold Pain Tolerance in Patients with Fibromyalgia and Opioid Use.
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DOI：
10.2147/jpr.s368805
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发表时间：
2022
影响因子：
2.7
通讯作者：
Martucci, Katherine
中科院分区：
文献类型：
--
作者：
Deng, Eden Z.;Weikel, Daniel P.;Martucci, Katherine
冷压试验（CPT）是一种用于测量冷痛耐受性的临床疼痛研究方法。在这项测试中，参与者将四肢（如手或脚）浸入冷水中，时间越长越好。测试的持续时间（传统上直到实验规定的截止时间为2分钟）表明参与者对冷痛的耐受程度。先前的研究调查了慢性疼痛患者的冷痛耐受性。然而，这些研究很少使用生存分析，生存分析允许适当处理数据审查，因此是CPT数据分析的最佳统计方法。本研究的目的是使用生存分析来评估纤维肌痛患者的冷痛耐受性。此外，我们旨在建立心理和临床变量以及阿片类药物使用和冷痛耐受性之间的关系模型。共有85名纤维肌痛患者（42名正在服用阿片类药物）和47名健康无痛对照者提供CPT和问卷数据（从2个研究地点收集）进行病例对照研究。我们使用Cox回归的生存分析来评估冷痛耐受性的组间差异（患者与对照组），并评估冷痛耐受性与心理、临床和药物使用的关系。与健康对照组相比，纤维肌痛患者的CPT生存率显著降低（HR = 2.17, 95% CI: [1.42, 3.31], p = 0.00035）。Cox回归模型显示，CPT生存率的组间显著差异与我们选择的心理和临床措施无关（p < 0.05）。非阿片类药物患者组和健康对照组在研究地点显示一致的CPT生存率。然而，服用阿片类止痛药的患者在不同研究地点的CPT生存率存在差异。通过生存分析，一种最佳的疼痛时间-事件测量方法，如CPT，我们证实了先前发现的纤维肌痛患者冷痛耐受性降低。虽然我们选择的心理和临床措施与冷痛耐受性没有显著相关性，但我们的数据表明，阿片类药物的使用可能会使一些患者对冷痛耐受性更强。
The cold pressor test (CPT) is a clinical pain research method used to measure cold pain tolerance. During this test, participants immerse an extremity (ie, hand or foot) into cold water for as long as tolerable. The duration of the test (traditionally up to an experimentally imposed cut-off at 2 minutes) indicates the amount of cold pain tolerance by the participant. Prior research studies have investigated cold pain tolerance in patients with chronic pain. However, few of these studies have used survival analysis, which allows for proper handling of data censoring and is therefore, an optimal statistical method for CPT data analysis. The goal of the present study was to use survival analysis to evaluate cold pain tolerance in patients with fibromyalgia. Furthermore, we aimed to model relationships between psychological and clinical variables as well as opioid medication use and cold pain tolerance. A total of 85 patients with fibromyalgia (42 who were taking opioids) and 47 healthy pain-free controls provided CPT and questionnaire data (collected across 2 study sites) for a case–control study. We used survival analysis using Cox regression to evaluate group differences (patients vs controls) in cold pain tolerance and to evaluate cold pain tolerance relationships with psychological, clinical, and medication use. As compared to healthy controls, patients with fibromyalgia exhibited significantly lower CPT survival (HR = 2.17, 95% CI: [1.42, 3.31], p = 0.00035). As indicated by Cox regression models, the significant group difference in CPT survival did not relate to our selected psychological and clinical measures (p > 0.05). The groups of non-opioid-taking patients and healthy controls showed consistent CPT survival across study sites. However, patients taking opioid pain medications showed differences in CPT survival across study sites. By using survival analysis, an optimal method for time-to-event pain measures such as the CPT, we confirmed previously identified reductions in cold pain tolerance in patients with fibromyalgia. While our selected psychological and clinical measures were not significantly associated with cold pain tolerance, our data suggest that opioid medication use may impart greater cold pain tolerance in some patients.