Department of Anesthesiology, Division of Pain Medicine, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio 44106, USA.
Pain Med. 2011 Aug;12(8):1179-89. doi: 10.1111/j.1526-4637.2011.01188.x. Epub 2011 Aug 2.
Age and gender may exert important influences on opioid responsiveness and chronic pain. These effects have not been explored in the setting of chronic intrathecal (IT) opioid therapy. The objective of this study was to evaluate the effect of age and sex on IT opioid requirements during the first year after implantation of an intrathecal drug delivery system (IDDS) in chronic noncancer pain patients.
Retrospective study. METHODS AND PATIENT POPULATION: In this retrospective study, 135 chronic noncancer pain patients consecutively implanted with IDDSs for opioid therapy had their first year postimplant records examined.
Similar pain relief was achieved at 12 months after implant in both age groups. Relative to the dose at implant, younger patients had significantly higher rates of IT opioid dose escalation compared with older patients at 12 months (750 ± 450% in patients ≤50 years old vs 195 ± 120% in patients >50 years old, P < 0.001). Oral opioid consumption was significantly decreased at 12 months in the older patient population (140 ± 89 to 62 ± 35 mg/day at 12 months, P < 0.001, n = 85), while in the younger patient group, there was no change in oral opioid consumption (128 ± 81 mg/day to 105 ± 140 mg/day at 12 months, P = 0.65, n = 50). Gender-based analysis (55% males and 45% females) revealed similar reductions in pain scores during the first year postimplant. Oral opioid consumption was significantly higher in females (126 ± 138 mg) vs males (79 ± 89 mg) at 12 months postimplant; however, IT opioid dose escalation at 12 months postimplant was not statistically different between males and females.
IT opioid dose escalation occurs more steeply in the younger (under 50 years old) IDDS patient population without a concomitant significant decrease in oral consumption of opioids. Age-dependent changes may have important clinical implications on the effectiveness of IT opioid therapy in noncancer pain and its potential complications.
年龄和性别可能对阿片类药物的反应性和慢性疼痛产生重要影响。这些影响在慢性鞘内（IT）阿片类药物治疗中尚未得到探索。本研究的目的是评估年龄和性别对慢性非癌痛患者植入鞘内药物输送系统（IDDS）后第一年 IT 阿片类药物需求的影响。
回顾性研究。
在这项回顾性研究中，对 135 例连续接受 IDDS 治疗阿片类药物的慢性非癌痛患者的植入后第一年记录进行了检查。
两组患者在植入后 12 个月时均获得相似的疼痛缓解。与植入时相比，年轻患者在 12 个月时 IT 阿片类药物剂量升级的比例明显高于老年患者（≤50 岁患者为 750±450%，>50 岁患者为 195±120%，P<0.001）。老年患者人群在 12 个月时口服阿片类药物的消耗量显著减少（140±89 至 62±35mg/天，P<0.001，n=85），而在年轻患者组，口服阿片类药物的消耗量没有变化（128±81mg/天至 105±140mg/天，P=0.65，n=50）。基于性别的分析（55%为男性，45%为女性）显示，植入后第一年的疼痛评分也有类似的降低。女性（126±138mg）在植入后 12 个月时的口服阿片类药物消耗量明显高于男性（79±89mg）；然而，植入后 12 个月时男性和女性的 IT 阿片类药物剂量升级没有统计学差异。
年轻（<50 岁）IDDS 患者人群中，IT 阿片类药物剂量升级更为陡峭，而口服阿片类药物的消耗量没有相应显著减少。年龄相关的变化可能对非癌痛患者的 IT 阿片类药物治疗的有效性及其潜在并发症具有重要的临床意义。
