Cognitive, Behavioral and Aging Effects of Opioids in Alcohol Users

阿片类药物对酒精使用者的认知、行为和衰老影响

• 批准号: 9476525
• 负责人: MONIQUE CHERRIER
• 金额: $ 37.08万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-05-01 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9476525
• 关键词: Absence of pain sensation; Acute; Adult; Adverse effects; Age; Aging; Alcohol consumption; Alcohols; American; Analgesics; Automobile Driving; Behavioral; Chronic; Clinical; Clinical Management; Cognitive; Communities; Dose; Drug Kinetics; Elderly; Equilibrium; Gender; Goals; Health Care Costs; Heavy Drinking; Human; Impaired cognition; Independent Living; Ink; Institute of Medicine (U.S.); Laboratory Study; Lead; Mediating; Metabolic; Opioid; Opioid Analgesics; Opioid Receptor; Oral; Oxycodone; Pain; Pain management; Participant; Patient Self-Report; Patients; Persistent pain; Persons; Pharmaceutical Preparations; Pharmacodynamics; Population; Prevalence; Process; Reporting; Safety; Stimulus; Testing; Therapeutic Uses; age effect; alcohol measurement; alcohol misuse; alcohol use disorder; chronic alcohol ingestion; chronic pain; cytochrome P450 3A; desensitization; disability; experience; fall risk; functional disability; innovation; middle age; opioid abuse; opioid use; pharmacodynamic model; psychosocial; public health relevance; receptor function; response

 DESCRIPTION (provided by applicant): An Institute of Medicine (IOM) report indicates that millions of Americans suffer from chronic pain conditions and that annual health care costs related to chronic pain are estimated at over half a trillion dollars. The prevalence of pain is greatest amongst older adults and is often associated with significant physical and psychosocial disability. Estimates of the prevalence of persistent pain problems among community-dwelling elderly persons range from 30-80%. Increasing evidence suggests an association between chronic pain and alcohol use disorder that is of great concern in older adults. Chronic unhealthy alcohol use has the potential of altering the subjective experience of pain and response to pain medications, which could complicate or compromise the effective clinical management of pain. In particular, unhealthy alcohol use in older adults may exacerbate debilitating side effects from opioid use, such as impaired cognition, diminished coordination and balance, and enhanced risk for falls that can threaten independent living. In addition, unhealthy alcohol use could increase the abuse potential of pain medications. However, the influence of unhealthy alcohol use on the pharmacokinetics and pharmacodynamics of opioid analgesics has not been studied in the elderly population. Our overall goal is to investigate the impact of aging and alcohol use on response to opioid analgesics in a controlled human laboratory study. We will compare pain relief as well as subjective, cognitive, and reinforcing side effects after an acute oral test doseof oxycodone in the following groups of subjects with mild to moderate recurring pain: 1) older adults (> 65 yrs) with unhealthy levels of alcohol use; 2) older adults with healthy levels of alcohol use; 3) middle-aged adults (35-55 yrs) with unhealthy levels of alcohol use; 4) middle-aged adults with healthy levels of alcohol use. "PA-13-058 Pain in Aging" calls for studies that examine the mechanisms and processes by which factors impact the experience and treatment of pain in older adults, including the interaction of alcohol use and pain. The proposed controlled laboratory study is innovative in that it may provide the first demonstration in humans of a highly plausible, but heretofore unproven interaction between chronic alcohol use and opioid response in the clinical context of therapeutic use and abuse liability of opioid analgesics. If proven true it would likely lead to in-depth studies on the confounding effects of excessive alcohol consumption on the efficacy, tolerability and safety of long-term opioid therapy in pain patients.

 描述（由适用提供）：医学研究所（IOM）报告表明，数百万美国人患有慢性疼痛状况，与慢性疼痛有关的年度医疗保健费用估计为超过半万亿美元。在老年人中，疼痛的患病率最高，通常与严重的身体和社会心理残疾有关。估计居住在社区老年人中持续性疼痛问题的患病率范围为30-80％。越来越多的证据表明，慢性疼痛与饮酒障碍之间存在关联，这在老年人中引起了极大关注。慢性不健康的饮酒可能会改变疼痛和对止痛药的反应的主题经验，这可能会使疼痛的有效临床管理变得复杂或损害。特别是，老年人的不健康饮酒可能会加剧阿片类药物使用的副作用，例如认知受损，协调和平衡减少，并增加了可能威胁独立生活的跌倒风险。此外，不健康的饮酒可能会增加止痛药的滥用潜力。但是，不健康的饮酒对阿片类镇痛药的药代动力学和药效学的影响尚未在古老的人群中研究。我们的总体目标是研究在受控的人类实验室研究中衰老和饮酒对阿片类镇痛药反应的影响。我们将在以下急性口服测试剂量的氧气剂量剂量的急性到中度重复疼痛的受试者组中进行急性口服测试剂量后的疼痛缓解以及主观，认知和增强副作用：1）老年人（> 65年）（> 65年），患有不健康的酒精饮酒； 2）健康饮酒水平的老年人； 3）中年成年人（35-55岁），饮酒水平不健康； 4）具有健康饮酒水平的中年成年人。 “衰老中的PA-13-058疼痛”呼吁进行研究，以检查因素影响老年人疼痛的经验和治疗的机制和过程，包括酒精使用和疼痛的相互作用。拟议的控制 实验室研究具有创新性，因为它可能会在人类中提供第一次演示 在治疗使用和滥用阿片类镇痛药的临床背景下，慢性酒精使用与阿片类药物反应之间的合理，但迄今未经证实的相互作用。如果被证明是正确的，它可能会导致对过量酒精消耗对疼痛患者长期阿片类药物治疗的有效性，耐受性和安全性的混杂影响的深入研究。