Hines Susan, Theodorou Stan, Williamson Anna, Fong Damian, Curry Kenneth
Drug Health Services, Canterbury Hospital, SSWAHS, Campsie, NSW, Australia.
Drug Alcohol Rev. 2008 Sep;27(5):519-23. doi: 10.1080/09595230802245519.
Methadone maintained treatment (MMT) patients may be given less opioid analgesia for acute pain than the general patient, due to requests for analgesia being misinterpreted as craving for drugs. Pain studies have showed that MMT patients have hyperalgesic responses and that cross-tolerance to opioids may be present, suggesting that they may need more analgesia than the non-MMT patient. This study compares the pain management of MMT patients and controls during an acute hospital stay. It is a retrospective study of MMT in-patients and controls matched for medical condition, age and gender, comparing the analgesia given and pain stated in hospital notes. Patients with a chronic pain condition were excluded. MMT patients and controls did not differ in relation to median morphine dose received or average number of pain reports per day, and only a small proportion of both groups engaged in drug-seeking behaviour. Behavioural problems were significantly more common among MMT patients (39% versus 5%, p < 0.001). The fact that the opioid doses were not significantly different between subjects and controls seems to contradict the experimental evidence that patients on methadone tend to be hyperalgesic. Alternatively, MMT patients may be hyperalgesic, and statistically equal levels of opioid analgesia given to both groups may indicate an effective under-treatment of pain in the hyperalgesic MMT group. Inadequate analgesia may contribute to both behavioural problems and premature discharge. Resolving these uncertainties will require prospective studies.
美沙酮维持治疗（MMT）患者在急性疼痛时可能比普通患者接受更少的阿片类镇痛药物，因为对镇痛的需求可能被误解为对药物的渴望。疼痛研究表明，MMT患者有痛觉过敏反应，并且可能存在对阿片类药物的交叉耐受性，这表明他们可能比非MMT患者需要更多的镇痛药物。本研究比较了MMT患者和对照组在急性住院期间的疼痛管理情况。这是一项对MMT住院患者和对照组进行的回顾性研究，两组在病情、年龄和性别方面相匹配，比较了医院记录中给予的镇痛药物和所述疼痛情况。患有慢性疼痛疾病的患者被排除在外。MMT患者和对照组在接受的吗啡中位数剂量或每天疼痛报告的平均数量方面没有差异，两组中只有一小部分人有觅药行为。行为问题在MMT患者中明显更为常见（39%对5%，p<0.001）。受试者和对照组之间阿片类药物剂量没有显著差异这一事实似乎与实验证据相矛盾，即服用美沙酮的患者往往有痛觉过敏。或者，MMT患者可能有痛觉过敏，而两组给予的阿片类镇痛药物在统计学上的同等水平可能表明痛觉过敏的MMT组存在有效的镇痛不足情况。镇痛不足可能导致行为问题和过早出院。解决这些不确定性需要进行前瞻性研究。
