OPIATE PHARMACOTHERAPY PAIN TOLERANCE AND ANALGESIC RESPONSE

拟议的研究试图评估疼痛耐受性和止痛反应。 在接受阿片维持治疗的吸毒者中， 哪种疼痛管理是一个常见且具有临床挑战性的问题。 尽管负责疼痛和疼痛的大脑系统之间存在重叠 阿片类药物依赖日益受到重视，人们对阿片类药物依赖知之甚少 长期摄入外源性阿片类药物者的疼痛体验。 因此，我们建议描述阿片类药物维持的疼痛耐受性。 并评估他们对止痛药的反应。一个 维持美沙酮(n=54)、维持丁丙诺啡(n=54)和 将招募LAAM维护的(n=54)样本，他们对 标准化冷加压试验(CPT)将在入院时进行评估 治疗，一旦他们在阿片类药物维持上稳定下来 了解阿片类药物治疗过程中疼痛耐受性是否以及如何发生变化 维持治疗。这些药物的CPT镇痛反应稳定 受试者将通过双盲口服阿片类药物进行评估 (地劳得，3毫克)，非阿片类(托拉多，10毫克)，安慰剂，使用拉丁语 正方形设计，并与匹配对照样本中注意到的进行比较。 建议的分析将提供有关1)疼痛耐受性的信息 寻求治疗的阿片成瘾者，2)对三种阿片类药物的疼痛耐受性- 保存的标本，3)对阿片类药物有效的止痛药- 被维持者，以及4)疼痛反应的潜在差异 服用美沙酮、丁丙诺啡和拉美沙星的人。它是 预计拟议研究的结果将具有重要的 本病疼痛评估和治疗的临床意义 这是一种容易引起痛苦的发病率的人群。

The proposed study seeks to evaluate pain tolerance and analgesic response in drug abusers receiving opiate maintenance treatment, a population for which pain management is a frequent and clinically challenging issue. Although overlap between brain systems responsible for both pain and opiate dependence is increasingly appreciated, little is known about the experience of pain for persons chronically ingesting exogenous opiates. Thus we propose to describe pain tolerance in opiate-maintained individuals and evaluate their response to analgesic medications. A methadone-maintained (n = 54), a buprenorphine-maintained (n = 54) and a LAAM-maintained (n = 54) sample will be recruited, and their tolerance to a standardized cold-pressor test (CPT) will be evaluated upon admission to treatment and again once they have stabilized on opiate maintenance to learn if and how pain tolerance changes over the course of opiate maintenance treatment. The CPT analgesic response of these stabilized subjects will be evaluated by double blind administration of oral opiate (Dilaudid, 3 mg.), non-opiate (Toradol, 10 mg.), and placebo using a Latin square design, and compared to that noted in a sample of matched controls. Proposed analyses will provide information on 1) pain tolerance for treatment-seeking opiate addicts, 2) pain tolerance for three opiate- maintained samples, 3) analgesic agents which are effective for opiate- maintained persons, and 4) potential differences in pain response between persons maintained on methadone, buprenorphine and LAAM. It is anticipated that the findings from the proposed study will have important clinical implications for the assessment and treatment of pain in this population which is prone to painful morbidity.