PAIN TOLERANCE AND ANALGESIC RESPONSE IN OPIATE ADDICTS

NIDA最近发布的(6/94)计划公告(#94-070) 处方药的使用、滥用和转移反映出越来越多的人意识到 在疼痛和成瘾领域的临床医生和研究人员中 开出阿片类止痛药所涉及的复杂性， 明确的治疗适应症，适用于有已知吸毒史的患者 虐待。建议的R03应用程序，具有相对较新的研究人员 作为首席调查员，描述了必要的第一步 评估阿片类成瘾者在疼痛中滥用止痛剂的风险，以及 为止痛药制定适当的实践和监管指南 已知的药物滥用者的处方。 疼痛耐受性和止痛反应将在两个样本中描述 阿片类药物维持吸毒者(54名美沙酮维持吸毒者和54名吸毒者 丁丙诺啡维持的男性和女性受试者)与 按种族和性别匹配的非依赖对照样本(n=54)。疼痛 公差是指对标准冷压机的公差 审判。止痛反应作为冷加压的改变而运作。 阿片类止痛药双盲挑战后的试验耐受性 (地劳得，3 mg，PO)，一种非类固醇抗炎止痛药 (Toradol，10 mg，PO)和安慰剂，采用拉丁方设计。这个 阿片类维持剂和镇痛剂对心脏功能的不同影响 疼痛耐受性将是分析的主要主题。 预计拟议研究的结果将提供 阿片类药物的止痛需求和反应的初步信息- 持续吸毒者，并导致后续发展较大 对老年性痴呆患者合适的止痛处方的评价 有吸毒史。大鼠疼痛耐受性和镇痛反应的研究 未接受治疗的鸦片成瘾者和其他吸毒者的样本；以及 在临床环境中经历急性或慢性疼痛是合乎逻辑的 拟议工作的延伸，以增加普遍性和 调查结果在实践和监管背景下的实用性。

NIDA's recently released (6/94) Program Announcement (#94-070) on Prescription Drug Use, Abuse and Diversion reflects a growing appreciation among clinicians and researchers in both the areas of pain and addiction of the complexities involved in prescribing opioid analgesics, which have clear therapeutic indications, to patients with a known history of drug abuse. The proposed RO3 application, with a relatively new researcher serving as principal investigator, describes a necessary first step to estimating the risk of analgesic abuse by opiate addicts in pain, and developing appropriate practice and regulatory guidelines for analgesic prescription to known drug abusers. Pain tolerance and analgesic response will be described in two samples of opiate-maintained drug abusers (54 methadone-maintained and 54 buprenorphine-maintained male and female subjects) in comparison to a sample (n=54) of non-dependent controls matched on race and gender. Pain tolerance is operationalized as tolerance to a standard cold-pressor trial. Analgesic response is operationalized as change in cold-pressor trial tolerance following double-blind challenges to an opioid analgesic (Dilaudid, 3 mg., PO), a nonsteroidal anti-inflammatory analgesic (Toradol, 10 mg., PO), and placebo, using a Latin Square design. The differential effects of opiate maintenance agent and analgesic agent on pain tolerance will be the primary subjects of analyses. It is anticipated that the findings from the proposed study will provide preliminary information on analgesic need and response in opiate- maintained drug abusers, and lead to the subsequent development of larger evaluations of appropriate analgesic prescription to individuals with a history of drug abuse. Studies of pain tolerance and analgesic response in samples of opiate addicts and other drug abusers, not in treatment, and experiencing acute or chronic pain in clinical settings, are logical extensions of the proposed work to increase the generalizability and utility of the findings in practice and regulatory contexts.