Gabapentin improves cold-pressor pain responses in methadone-maintained patients.
Gabapentin improves cold-pressor pain responses in methadone-maintained patients.
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DOI：
10.1016/j.drugalcdep.2010.01.006
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发表时间：
2010-06-01
影响因子：
4.2
通讯作者：
Ling W
中科院分区：
文献类型：
--
作者：
Compton P;Kehoe P;Sinha K;Torrington MA;Ling W
与匹配的对照组和前阿片类药物成瘾者相比，美沙酮维持治疗成瘾（MM）的个体对冷加压疼痛表现出痛觉过敏，这一发现被描述为阿片类药物诱导的痛觉过敏（OIH）的临床证据。有趣的是，阿片类药物通过许多与神经性疼痛发展相同的神经炎症和中枢致敏过程诱导痛觉过敏。本研究评价了神经性疼痛的关键药物加巴喷丁（GPN）逆转MM患者OIH的疗效。利用临床试验设计和双盲条件，在良好表征的MM样本中，在美沙酮血浆峰和谷水平下评价了GPN（滴定至2400 mg/天）5周试验后冷加压疼痛阈值和耐受性的变化。通过递增的支付计划鼓励药物戒断，并通过药丸计数和GPN血浆水平监测依从性;仅在整个研究期间依从和戒断的受试者（约45%）进入分析。利用从基线的变化分数，在美沙酮的峰值和谷值水平上观察到冷加压痛阈值和疼痛耐受性的显著改善（p < 0.05）。值得注意的是，由于药物副作用导致的脱落率很低（2%），药物耐受性良好。这些结果支持GPN，作为治疗神经性疼痛的处方，在美沙酮治疗中戒断和稳定的患者中有效减少OIH。
Individuals on methadone maintenance for the treatment of addiction (MM) are demonstrated to be hyperalgesic to cold-pressor pain in comparison to matched controls and ex-opioid addicts, a finding described as clinical evidence of opioid-induced hyperalgesia (OIH). Interestingly, opioids induce hyperalgesia via many of the same neuro-inflammatory and central sensitization processes that occur with the development of neuropathic pain. Evaluated in this study was the efficacy of a key pharmacotherapy for neuropathic pain, gabapentin (GPN), to reverse OIH in MM patients. Utilizing a clinical trial design and double blind conditions, changes in cold-pressor pain threshold and tolerance following a five-week trial of GPN (titrated to 2400mg/day) were evaluated at peak and trough methadone plasma levels in a well-characterized MM sample. Drug abstinence was encouraged via an escalating payment schedule, and compliance monitored via pill counts and GPN plasma levels; entered into the analyses were only those subjects compliant and abstinent throughout the study (approx 45%). Utilizing change scores from baseline, significant improvements in cold-pressor pain threshold and pain tolerance were observed at both peak and trough methadone levels (p < 0.05). Notably, drop-out rates due to medication side effects were low (2%) and the medication was well-tolerated. These results support that GPN, as prescribed for the treatment of neuropathic pain, is effective in decreasing OIH in patients who are abstinent and stable in methadone treatment.
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