The effect of opioid dose and treatment duration on the perception of a painful standardized clinical stimulus
The effect of opioid dose and treatment duration on the perception of a painful standardized clinical stimulus
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DOI：
10.1016/j.rapm.2007.10.009
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发表时间：
2008-05-01
影响因子：
5.1
通讯作者：
Mao, Jianren
中科院分区：
文献类型：
--
作者：
Cohen, Steven P.;Christo, Paul J.;Mao, Jianren
背景和目标：阿片类药物引起的痛觉过敏的概念最近作为阿片类药物耐受性和长期治疗失败的影响因素而受到重视。但是，尽管这种现象的临床前数据很强，但混合的临床数据主要来自在志愿者和海洛因成瘾者中进行的实验性疼痛模型，以及非标准化的临床刺激，例如手术。本研究的主要目的是描述阿片类药物剂量和治疗持续时间对标准化临床疼痛刺激后疼痛强度和不愉快评级的影响。方法：355 名患者接受稳定的镇痛药物治疗并计划进行介入手术，在全剂量局部麻醉前接受标准化皮下注射利多卡因。在注射之前和注射之后，受试者被要求以 0 到 10 的数字评分量表对疼痛和不愉快的强度进行评分。根据阿片类药物剂量将受试者分为 6 组。对照组由 27 名没有疼痛且未服用镇痛药的志愿者组成，也进行了注射。结果：阿片类药物的剂量和治疗持续时间与疼痛强度和不愉快评分直接相关。基线疼痛强度也与这两个结果变量呈正相关。研究发现，性别与疼痛强度和不愉快程度有关，女性在这两方面的得分均高于男性。与未接受阿片类药物治疗的患者相比，接受阿片类药物治疗的患者更有可能认为标准化疼痛刺激更令人不快，而不是痛苦。结论：这项研究的结果支持了临床前和实验性疼痛模型，表明接受阿片类药物治疗的受试者的疼痛感知增强。这种简单的临床模型可能为检查阿片类药物引起的痛觉过敏提供有用的工具。
Background and objectives: The concept of opioid-induced hyperalgesia has recently gained prominence as a contributing factor for opioid tolerance and long-term treatment failure. But whereas the preclinical data for this phenomenon are strong, the mixed clinical data derive primarily from experimental pain models conducted in volunteers and heroin addicts, and nonstandardized clinical stimuli, e.g., surgery. The primary objective of this study is to delineate the effect of opioid dose and treatment duration on pain intensity and unpleasantness ratings following a standardized clinical pain stimulus.Methods: Three hundred and fifty-five patients, on a steady regimen of analgesic medications and scheduled for an interventional procedure, received a standardized subcutaneous injection of lidocaine prior to a full dose of local anesthetic. Before and immediately following the injection, subjects were asked to rate pain and unpleasantness intensity on a 0 to 10 numerical rating scale. Subjects were stratified into 6 groups based on opioid dosage. A control group of 27 volunteers who had no pain and were taking no analgesics were also injected.Results: Both opioid dose and duration of treatment directly correlated with pain intensity and unpleasantness scores. Baseline pain intensity was also positively associated with both outcome variables. Gender was found to be associated with pain intensity and unpleasantness, with females scoring higher in both categories than males. Compared with patients not receiving opioid treatment, patients receiving opioid therapy were more likely to rate the standardized pain stimulus as being more unpleasant than painful.Conclusions: The results of this study bolster preclinical and experimental pain models demonstrating enhanced pain perception in subjects receiving opioid therapy. This simple clinical model may provide a useful tool in examining opioid-induced hyperalgesia.