Opioid Taper is Associated with Improved Experimental Pain Tolerance in Patients with Chronic Pain: An Observational Study.
Opioid Taper is Associated with Improved Experimental Pain Tolerance in Patients with Chronic Pain: An Observational Study.
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DOI：
10.1007/s40122-021-00348-8
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发表时间：
2022-03
期刊：
影响因子：
4
通讯作者：
Badiola I
中科院分区：
文献类型：
--
作者：
Compton P;Halabicky OM;Aryal S;Badiola I
阿片类药物引起的痛觉过敏对慢性疼痛患者的疼痛体验的影响程度仍未得到相对的描述。本初步研究的目的是确定实验性疼痛反应是否改善慢性疼痛患者，因为他们接受计划的阿片类药物逐渐减少。这是一项前瞻性观察性研究。7例慢性神经性疼痛患者接受至少120 mg吗啡当量/天的治疗。参与者在个体化阿片类药物逐渐减少到较低剂量的过程中被跟踪。实验疼痛敏感性的测量，包括中枢疼痛调节指标，每两周收集一次；此外，每月收集功能和生活质量的测量数据。使用纵向混合效应回归模型和一般线性回归模型，以基线剂量、终止剂量和逐渐减少的速率为正则化函数，研究了阿片类药物逐渐减少对疼痛反应和功能结局的影响。在这个接受高度个体化和可变阿片类药物逐渐减少的小样本患者中，阿片类药物逐渐减少与冷压试验疼痛反应的改善显著相关，疼痛阈值平均每6周增加1.14秒（p = 0.0084, 6周变化0.3039-2.0178的95%置信区间[CI]），疼痛耐受性平均每6周增加2.87秒（p = 0.0026, 6周变化1.02-4.7277的95% CI）。虽然条件调节倾向于阿片类药物逐渐减少而改善，但未观察到中枢性疼痛调节的逐渐减少相关变化。同样，阿片类药物逐渐减少也没有观察到功能和生活质量的下降，这表明尽管阿片类药物剂量减少，但仍保持稳定。阿片类药物逐渐减少与实验疼痛反应的改善有关，而不会导致功能和生活质量下降，这表明该临床样本中阿片类药物引起的痛觉过敏减轻了。ClinicalTrials.gov识别码，NCT03912298。在线版本包含补充材料，可在10.1007/s40122-021-00348-8获得。
The degree to which opioid-induced hyperalgesia contributes to the pain experience of patients with chronic pain remains relatively undescribed. The objective of this pilot study was to determine if experimental pain responses improve in patients with chronic pain as they undergo a planned opioid taper. This was a prospective observational study. Seven patients with chronic neuropathic pain on at least 120 mg morphine equivalents/day were enrolled. The participants were followed over the course of an individualized opioid taper to a lower dose. Measures of experimental pain sensitivity, including indicators of central pain modulation, were collected on a biweekly basis; in addition, measures of function and quality of life were collected monthly. The effect of opioid taper on pain responses and functional outcomes over time were examined using longitudinal mixed-effects regression modeling and general linear regression modeling with regularization as a function of baseline dose, end dose, and taper rate. In this small sample of patients undergoing highly individualized and variable opioid taper, the opioid taper was significantly associated with improved pain responses to the cold-pressor test, with the pain threshold on average increasing by 1.14 s every 6 weeks (p = 0.0084, 95% confidence interval [CI] for 6-week change 0.3039–2.0178) and pain tolerance on average increasing by 2.87 s every 6 weeks (p = 0.0026, 95% CI for 6-week change 1.02–4.7277). Taper-related changes in central pain modulation were not observed, although conditioned modulation trended toward improvement by the completion of opioid taper. Similarly, no declines in function and quality of life were observed with the opioid taper, suggesting stability despite decreased opioid dose. Opioid taper was associated with improvements in experimental pain responses without a decline in function and quality of life, suggestive of diminished opioid-induced hyperalgesia in this clinical sample. ClinicalTrials.gov identifier, NCT03912298. The online version contains supplementary material available at 10.1007/s40122-021-00348-8.
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