Wasan Ajay D, Davar Gudarz, Jamison Robert
Brigham and Women's Hospital/Harvard Medical School, Departments of Anesthesiology, Perioperative and Pain Medicine; and Psychiatry, Pain Mangement Center, 850 Boylston Street, Chestnut Hill, MA 02467, USA Amgen Corporation, Thousand Oaks, CA, USA.
Pain. 2005 Oct;117(3):450-461. doi: 10.1016/j.pain.2005.08.006.
Comprised mainly of depression, anxiety, and high neuroticism, psychopathology diminishes the effectiveness of many chronic pain treatments. But, it is not known if it is associated with diminished opioid analgesia in patients with chronic, noncancer pain. We tested the hypothesis that psychopathology diminishes opioid analgesia in patients with discogenic low back pain in 60 patients not on opioids in a double blind, placebo controlled, random crossover designed trial. Patients were stratified into three groups of psychological symptom severity (LOW, MOD, and HIGH), based on composite scores on depression, anxiety for pain, and neuroticism scales. Subjects were given intravenous morphine (4-6mg dosed by ideal body weight) and placebo in random order on separate visits, and completed serial pain ratings over three hours at each session. With 20 subjects per group, there were nonsignificant differences between groups in the distribution of age, gender, baseline pain (avg. 6.1/10), radicular pain, and morphine dose (5.0mg). For morphine analgesia, using a total pain relief calculation (TOTPAR), the LOW group had 65.1% TOTPAR vs. 41.0% in the HIGH group, P=.026. For placebo analgesia the LOW group had 7.7% TOTPAR vs. 23.5% in the HIGH group, P=.03. A morphine minus placebo analgesia calculation revealed 59.2% TOTPAR in the LOW group vs. 21.7% in the HIGH group, P=.0001. High levels of psychopathology are associated with diminished opioid analgesia in patients with discogenic low back pain. These results have implications for the prescription of oral opioids to patients with chronic low back pain and psychopathology.
精神病理学主要由抑郁、焦虑和高神经质组成，它会降低许多慢性疼痛治疗的效果。但是，尚不清楚它是否与慢性非癌性疼痛患者阿片类药物镇痛效果降低有关。在一项双盲、安慰剂对照、随机交叉设计试验中，我们对60名未使用阿片类药物的椎间盘源性下腰痛患者进行了测试，以验证精神病理学是否会降低阿片类药物镇痛效果这一假设。根据抑郁、疼痛焦虑和神经质量表的综合评分，将患者分为心理症状严重程度的三组（低、中、高）。受试者在不同的就诊时随机接受静脉注射吗啡（根据理想体重给予4 - 6毫克剂量）和安慰剂，并在每次疗程中完成三个小时的连续疼痛评分。每组有20名受试者，在年龄、性别、基线疼痛（平均6.1/10）、神经根性疼痛和吗啡剂量（5.0毫克）的分布上，组间无显著差异。对于吗啡镇痛，采用总疼痛缓解计算（TOTPAR），低分组的TOTPAR为65.1%，而高分组为41.0%，P = 0.026。对于安慰剂镇痛，低分组的TOTPAR为7.7%，而高分组为23.5%，P = 0.03。吗啡减去安慰剂镇痛计算显示，低分组的TOTPAR为59.2%，而高分组为21.7%，P = 0.0001。高水平的精神病理学与椎间盘源性下腰痛患者阿片类药物镇痛效果降低有关。这些结果对慢性下腰痛和精神病理学患者口服阿片类药物的处方具有启示意义。
