Interplay between noxious heat sensitivity and temporal summation magnitude in patients with fibromyalgia and long-term opioid use.
Interplay between noxious heat sensitivity and temporal summation magnitude in patients with fibromyalgia and long-term opioid use.
复制标题
DOI：
10.3389/fnins.2023.1275921
复制
发表时间：
2023
影响因子：
4.3
通讯作者：
Martucci, Katherine T.
中科院分区：
文献类型：
--
作者：
Bao, Jason D.;Rosser, Morgan A.;Park, Su Hyoun;Baker, Anne K.;Martucci, Katherine T.
关键词：
在慢性疼痛病症中，如纤维肌痛（FM），中枢神经系统内的疼痛放大或“中枢致敏”可能有助于慢性疼痛的发展和维持。慢性疼痛治疗包括阿片类药物治疗，阿片类药物治疗可能会不适应地增加中枢致敏作用，特别是对于长期服用阿片类药物的患者。然而，在长期使用阿片类药物的患者中，中枢致敏性如何受到影响仍然未知。为了研究长期阿片类药物治疗如何影响中枢致敏，我们使用了经验证的时间总和测量。时间总和测量包括对患者的皮肤施加一系列有害刺激，然后计算患者对每个刺激的疼痛等级的变化。使用这种测量方法，我们评估了长期服用阿片类药物的纤维肌痛研究参与者的时间总和（即，持续时间大于90天; n = 24，阿片样物质-FM）。我们将阿片类药物FM反应与2个对照组进行了比较：未服用阿片类药物的纤维肌痛参与者（n = 33，非阿片类药物FM）和健康对照组（n = 31）。对于时间总和测量，我们对前臂腹侧施加了一系列10个有害热刺激（敏感性调节温度）（每个刺激持续2秒，每3秒施加一次）。此外，我们收集了对标准疼痛和认知情感问卷的回答，以评估疼痛的严重程度和其他因素。观察到敏感性调整刺激温度的组间差异，只有非阿片类FM组需要显著较低的刺激温度（阿片类FM组也需要较低的温度，但与对照组无显著差异）。然而，所有3组均表现出相似的时间总和幅度。在联合FM组中，时间总和与疼痛严重程度呈负相关（r =-0.31，p = 0.021）。在阿片样物质-FM组中，对热的疼痛敏感性较高（即，较低的敏感度调整温度）显示出与较高阿片类药物剂量的趋势关系（r =-0.45，p = 0.036），可能反映了阿片类药物相关的痛觉过敏。我们的研究结果还表明，疼痛的严重程度可能会扭曲敏感性调整的时间总和，从而限制了它的效用测量中枢致敏。总体而言，在服用阿片类药物的参与者中，时间总和可能受到对热痛的超敏反应的影响，这似乎随阿片类药物剂量而变化。
In chronic pain conditions such as fibromyalgia (FM), pain amplification within the central nervous system, or “central sensitization,” may contribute to the development and maintenance of chronic pain. Chronic pain treatments include opioid therapy, and opioid therapy may maladaptively increase central sensitization, particularly in patients who take opioids long-term. However, it has remained unknown how central sensitization is impacted in patients who use opioids long-term. To investigate how long-term opioid therapy affects central sensitization, we used the validated measure of temporal summation. The temporal summation measurement consists of applying a series of noxious stimuli to a patient’s skin and then calculating changes in the patient’s pain rating to each stimulus. Using this measurement, we evaluated temporal summation in study participants with fibromyalgia who take opioids long-term (i.e., greater than 90 days duration; n = 24, opioid-FM). We compared opioid-FM responses to 2 control groups: participants with fibromyalgia who do not take opioids (n = 33, non-opioid FM), and healthy controls (n = 31). For the temporal summation measurement, we applied a series of 10 noxious heat stimuli (sensitivity-adjusted temperatures) to the ventral forearm (2s duration of each stimulus, applied once every 3 s). Additionally, we collected responses to standard pain and cognitive-affective questionnaires to assess pain severity and other factors. Group differences in sensitivity-adjusted stimulus temperatures were observed, with only the non-opioid FM group requiring significantly lower stimulus temperatures (The opioid-FM group also required lower temperatures, but not significantly different from the control group). However, all 3 groups exhibited similar magnitudes of temporal summation. Across combined FM groups, temporal summation negatively correlated with pain severity (r = −0.31, p = 0.021). Within the opioid-FM group, higher pain sensitivity to heat (i.e., lower sensitivity-adjusted temperatures) showed a trend relationship with higher opioid dosage (r = −0.45, p = 0.036), potentially reflective of opioid-related hyperalgesia. Our findings also indicated that heightened pain severity may skew sensitivity-adjusted temporal summation, thereby limiting its utility for measuring central sensitization. Overall, in participants taking opioids, temporal summation may be influenced by hypersensitivity to heat pain, which appeared to vary with opioid dosage.
登录
查看更多内容
影响因子：
7.4
作者：
Chen L;Malarick C;Seefeld L;Wang S;Houghton M;Mao J
通讯作者：
Mao J
影响因子：
3.6
作者：
Lacourt, T. E.;Houtveen, J. H.;Elsenbruch, S.
通讯作者：
Elsenbruch, S.
影响因子：
2.5
作者：
Coghill, RC;Gilron, I;Iadarola, MJ
通讯作者：
Iadarola, MJ
影响因子：
3.4
作者：
Lomas, LM;Picker, MJ
通讯作者：
Picker, MJ
影响因子：
5.7
作者：
McMahon, S B;Lewin, G R;Wall, P D
通讯作者：
Wall, P D