PAIN ANALGESIC RESPONSE IN OPIATE DEPENDENCE

描述：(申请人摘要) 有越来越多的人长期服用鸦片类药物， 用于治疗阿片依赖或治疗慢性疼痛。 管理阿片类药物维持者的疼痛是一个具有挑战性的问题。这个 阿片类药物耐受和依赖的发展可能导致疼痛改变 对额外的阿片类药物的敏感性和随后的反应。许多临床医生 相信吸毒者不能从进一步的阿片类药物管理中受益，因为他们 对止痛作用有耐受性。其他人认为，如果一个瘾君子 维持在阿片类激动剂上，该药物可提供足够的止痛 治疗剧烈疼痛。患者不愿提供准确的病史，因为 临床医生经常对有阿片类止痛药病史的患者不予给予 吸毒。那些投诉的人会被怀疑，他们的投诉 已被忽略。目前，几乎没有指导方针来帮助临床医生和那些 确实存在是基于经验和共识，而不是基于证据 研究。 这项研究建议检查：1)接受阿片类药物维持的患者(或 丁丙诺啡或美沙酮)经历疼痛(耐受性和阈值)以及如何 他们不同于非阿片依赖者，2)患者如何 维持使用美沙酮和丁丙诺啡与正常对照组不同 对添加的阿片类和非阿片类镇痛剂的反应以及3)如何治疗 用于镇痛的吗啡的血药浓度水平在美沙酮和 丁丙诺啡维持患者与正常对照组相比。 这项拟议研究的结果将有助于制定系统的指导方针 临床医生在阿片类药物的疼痛管理中维持个体。

DESCRIPTION: (Applicant's Abstract) There is an increasingly large population receiving opiates on a chronic basis, either for treatment of opiate dependence or for treatment of chronic pain. Managing pain in opiate maintained individuals is a challenging problem. The development of opioid tolerance and dependence may result in altered pain sensitivity and subsequent response to additional opioids. Many clinicians believe addicts cannot benefit from further opiate administration because they are tolerant to the analgesic effects. Others believe that if an addict is maintained on an opiate agonist, that medication provides adequate analgesia for acute pain. Patients are reluctant to give accurate histories because clinicians often withhold opioid analgesics from patients with a history of drug abuse. Those who do complain are viewed suspiciously and their complaints ignored. Currently there are few guidelines to assist clinicians and those that do exist are based on experience and consensus rather than evidence-based research. This study proposes to examine: 1) how patients on opiate maintenance (either buprenorphine or methadone) experience pain (tolerance and threshold) and how they are different from non-opiate dependent individuals, 2) how patients maintained on methadone and buprenorphine differ from normal controls in response to added opiate and non-opiate analgesics and 3) how therapeutic plasma concentration levels of morphine for analgesia differ in methadone and buprenorphine maintained patients compared to normal controls. The results of this proposed study will help develop systematic guidelines for clinicians in the management of pain in opiate maintained individuals.