Acute analgesic effects of nicotine and tobacco in humans: a meta-analysis.
Acute analgesic effects of nicotine and tobacco in humans: a meta-analysis.
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DOI：
10.1097/j.pain.0000000000000572
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发表时间：
2016-07
期刊：
影响因子：
7.4
通讯作者：
Maisto SA
中科院分区：
文献类型：
--
作者：
Ditre JW;Heckman BW;Zale EL;Kosiba JD;Maisto SA
尽管动物模型一致证明了尼古丁和烟草的急性疼痛抑制作用，但人体实验研究却得出了不同的结果。本荟萃分析的主要目的是量化尼古丁/烟草给药对人类实验疼痛阈值和耐受性评分的影响。检索PubMed和PsychINFO在线数据库确定了13篇符合条件的文章，包括k = 21个疼痛耐受性测试（N = 393）和k = 15个疼痛阈值测试（N = 339）。阈值和耐受性结果的荟萃分析整合显示，通过烟草烟雾和其他输送系统（如贴片、鼻喷雾剂）给药的尼古丁产生的急性镇痛作用可能具有小到中等程度的特征（赫奇斯g = 0.35, 95% CI = 0.21 - 0.50）。发表偏倚校正估计仍然显著，表明这些影响可能更接近于小。性别构成被观察到是一个显著的调节因素，例如，在包含更多男性的样本中，痛阈效应比女性更强。这些结果有助于澄清混杂的文献，并可能最终有助于告知疼痛和尼古丁依赖的治疗。疼痛和吸烟都是非常普遍和合并症，目前吸烟与更严重的慢性疼痛和身体损伤有关，急性尼古丁诱导的镇痛可能使吸烟更有回报，更难戒烟。未来的研究应采用实验疼痛反应的动态测量方法，并进一步探索其作用机制。
Although animal models have consistently demonstrated acute pain-inhibitory effects of nicotine and tobacco, human experimental studies have yielded mixed results. The main goal of this meta-analysis was to quantify the effects of nicotine/tobacco administration on human experimental pain threshold and tolerance ratings. A search of PubMed and PsychINFO online databases identified 13 eligible articles, including k = 21 tests of pain tolerance (N = 393) and k = 15 tests of pain threshold (N = 339). Meta-analytic integration for both threshold and tolerance outcomes revealed that nicotine administered via tobacco smoke and other delivery systems (e.g., patch, nasal spray) produced acute analgesic effects that may be characterized as small to medium in magnitude (Hedges’ g = .35, 95% CI = .21-.50). Publication bias-corrected estimates remained significant and indicated that these effects may be closer to small. Gender composition was observed to be a significant moderator, such that pain threshold effects were more robust among samples that included more men than women. These results help to clarify a mixed literature, and may ultimately help to inform the treatment of both pain and nicotine dependence. Pain and tobacco smoking are both highly prevalent and comorbid conditions, current smoking has been associated with more severe chronic pain and physical impairment, and acute nicotine-induced analgesia could make smoking more rewarding and harder to give up. Future research should employ dynamic measures of experimental pain reactivity and further explore biopsychosocial mechanisms of action.