Methadone maintenance patients lack analgesic response to a cumulative intravenous dose of 32 mg of hydromorphone.
Methadone maintenance patients lack analgesic response to a cumulative intravenous dose of 32 mg of hydromorphone.
复制标题
美沙酮维持治疗患者对累积静脉注射32 mg氢吗啡酮缺乏镇痛反应。
DOI：
10.1016/j.drugalcdep.2021.108869
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发表时间：
2021-09-01
影响因子：
4.2
通讯作者：
Tompkins, D. Andrew
中科院分区：
文献类型：
--
作者：
Agin-Liebes, Gabrielle;Huhn, Andrew S.;Strain, Eric C.;Bigelow, George E.;Smith, Michael T.;Edwards, Robert R.;Gruber, Valerie A.;Tompkins, D. Andrew
由于阿片类药物耐受性较高，维持美沙酮治疗的阿片类药物使用障碍患者的急性疼痛管理面临着独特的挑战。这项随机对照研究利用经过验证的实验疼痛范例、定量感觉测试 (QST)，评估了急性静脉注射 (IV) 氢吗啡酮与安慰剂剂量递增的镇痛和滥用倾向效果。无慢性疼痛的个体 (N = 8) 维持每天 80-100 毫克的口服美沙酮。参与者在 270 分钟内接受四次静脉注射，逐渐增加/增量剂量的氢吗啡酮（总计 32 毫克）或在测试日内接受四剂安慰剂。测试时间至少间隔一周。在基线和每次注射后进行 QST 和滥用倾向测量。在任何 QST 结果的镇痛指数上，氢吗啡酮和安慰剂对照条件之间均未检测到显着差异。同样，尽管使用了高剂量的氢吗啡酮，但没有检测到安全性或滥用倾向指数的差异。几乎没有检测到不良事件，并且报告的不良事件严重程度较轻。研究结果表明，使用美沙酮维持治疗的个体对高剂量静脉注射氢吗啡酮的镇痛作用高度不敏感，可能需要非常高剂量的阿片类药物、更有效的阿片类药物或联合非阿片类镇痛策略才能达到充分的镇痛效果。
Acute pain management in patients with opioid use disorder who are maintained on methadone presents unique challenges due to high levels of opioid tolerance in this population. This randomized controlled study assessed the analgesic and abuse liability effects of escalating doses of acute intravenous (IV) hydromorphone versus placebo utilizing a validated experimental pain paradigm, quantitative sensory testing (QST). Individuals (N = 8) without chronic pain were maintained on 80-100 mg/day of oral methadone. Participants received four IV, escalating/incremental doses of hydromorphone over 270 minutes (32 mg total) or four placebo doses within a session test day. Test sessions were scheduled at least one week apart. QST and abuse liability measures were administered at baseline and after each injection. No significant differences between the hydromorphone and placebo control conditions on analgesic indices on any QST outcomes were detected. Similarly, no differences on safety or abuse liability indices were detected despite the high doses of hydromorphone utilized. Few adverse events were detected, and those reported were mild in severity. The findings demonstrate that methadone-maintained individuals are highly insensitive to the analgesic effects of high-dose IV hydromorphone and may require very high doses of opioids, more efficacious opioids, or combined non-opioid analgesic strategies to achieve adequate analgesia.
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