Opioid-induced analgesia among persons with opioid use disorder receiving methadone or buprenorphine: A systematic review of experimental pain studies.
Opioid-induced analgesia among persons with opioid use disorder receiving methadone or buprenorphine: A systematic review of experimental pain studies.
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DOI：
10.1016/j.drugalcdep.2021.109097
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发表时间：
2021-11-01
影响因子：
4.2
通讯作者：
Sofuoglu M
中科院分区：
文献类型：
--
作者：
De Aquino JP;Parida S;Avila-Quintero VJ;Flores J;Compton P;Hickey T;Gómez O;Sofuoglu M
使用阿片激动剂疗法(OAT)治疗阿片使用障碍(OUD)患者的急性疼痛是复杂的，当考虑到阿片类药物的滥用潜力和呼吸抑制作用时，阿片类药物的治疗益处仍不清楚。我们对实验性疼痛研究进行了系统综述，考察了服用燕麦片的患者中阿片类药物诱导的镇痛作用。我们搜索了从成立到2021年7月30日的多个数据库。研究质量通过先前建立的效度来评估。共确定了9项研究，共有225名参与者，其中63%为男性，37%为女性。6项研究包括美沙酮维持治疗的OUD患者；4项研究包括丁丙诺啡维持治疗的OUD患者；3项研究包括健康人作为对照组。给予额外剂量的燕麦片或其他阿片类药物--吗啡、羟考酮、氢吗啡酮或瑞芬太尼。在七项研究中，服用OUD的人没有经历止痛，尽管接受的阿片类药物剂量比临床上用于治疗阿片类药物幼稚的严重疼痛的剂量高出20倍。相反，在两项研究中，高效力阿片类药物确实产生了镇痛作用，尽管有更大的滥用潜力。值得注意的是，服用燕麦片的人仍然容易受到呼吸抑制的影响。虽然服用OUD的人可以从阿片类药物中获得止痛效果，但可能需要高效力的化合物才能达到临床上显著的止痛效果。此外，服用燕麦片的人可能仍然容易受到阿片类药物导致的滥用潜力和呼吸抑制的影响。总而言之，这些发现对燕麦片治疗急性疼痛具有临床、方法学和机械学上的启示。
Treating acute pain among persons with opioid use disorder (OUD) on opioid agonist therapy (OAT) is complex, and the therapeutic benefits of opioids remain unclear when weighted against their abuse potential and respiratory depressant effects. We conducted a systematic review of experimental pain studies examining opioid-induced analgesia among persons with OUD on OAT. We searched multiple databases from inception to July 30, 2021. Study quality was assessed by previously established validity measures. Nine studies were identified, with a total of 225 participants, of whom 63% were male, and 37% were female. Six studies included methadone-maintained persons with OUD; four studies included buprenorphine-maintained persons with OUD; and three studies included healthy persons as comparison groups. Either additional doses of OAT or other opioids – morphine, oxycodone, hydromorphone, or remifentanil – were administered. In seven studies, persons with OUD on OAT did not experience analgesia, despite receiving opioid doses up to 20 times greater than those clinically used to treat severe pain among the opioid naïve. Conversely, in two studies, high-potency opioids did produce analgesia, albeit with greater abuse potential. Notably, persons with OUD on OAT remained vulnerable to respiratory depression. Although persons with OUD on OAT can derive analgesic effects from opioids, high-potency compounds may be required to achieve clinically significant pain relief. Further, persons with OUD on OAT may remain vulnerable to opioid-induced abuse potential and respiratory depression. Together, these finding have clinical, methodological, and mechanistic implications for the treatment of acute pain in the context of OAT.
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影响因子：
9.8
作者：
Comelon, M.;Raeder, J.;Lenz, H.
通讯作者：
Lenz, H.
影响因子：
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作者：
Agin-Liebes, Gabrielle;Huhn, Andrew S.;Strain, Eric C.;Bigelow, George E.;Smith, Michael T.;Edwards, Robert R.;Gruber, Valerie A.;Tompkins, D. Andrew
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Tompkins, D. Andrew
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Gallagher, E. John
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Aasvang, E;Kehlet, H
通讯作者：
Kehlet, H