PAIN ANALGESIC RESPONSE IN OPIATE DEPENDENCE

描述：（申请人摘要） 越来越多的人长期接受鸦片剂， 用于治疗阿片依赖性或用于治疗慢性疼痛。 管理阿片类药物维持个体的疼痛是一个具有挑战性的问题。的 阿片耐受性和依赖性的发展可能导致疼痛改变 敏感性和随后对额外阿片类药物的反应。许多临床医生 我相信成瘾者不能从进一步的阿片类药物管理中获益，因为他们 对镇痛效果有耐受性。另一些人认为，如果一个瘾君子 维持在阿片激动剂，药物提供足够的镇痛 治疗急性疼痛患者不愿意提供准确的病史， 临床医生经常对有以下病史的患者停用阿片类镇痛药： 吸毒那些抱怨的人被怀疑，他们的抱怨 忽视目前，很少有指导方针，以帮助临床医生和那些 是基于经验和共识，而不是基于证据 research. 本研究旨在探讨：1）阿片类药物维持治疗的患者（ 丁丙诺啡或美沙酮）经历疼痛（耐受性和阈值），以及如何 他们与非阿片类药物依赖者不同，2）患者如何 维持美沙酮和丁丙诺啡与正常对照不同， 对添加的阿片类和非阿片类镇痛剂的反应和3）如何治疗 用于镇痛的吗啡的血浆浓度水平在美沙酮中不同， 与正常对照组相比，丁丙诺啡维持患者。 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维持的个人疼痛的管理。

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.