Department of Orthopaedic Surgery and Traumatology, Heidelberg University Hospital, Heidelberg, Germany.
Pain Physician. 2012 Jul;15(3 Suppl):ES135-43.
Long-term opioid treatment has been used extensively in treatment of chronic low back pain (cLBP) in the last decades. However, there are serious limitations to the long-term efficacy of opioids and related side effects.
In this study we investigated whether long-term opioid treatment changes pain sensitivity of patients with cLBP.
A prospective, nonrandomized, cross-sectional study.
Multidisciplinary pain management clinic, specialty referral center, university hospital in Germany.
Using quantitative sensory testing (QST), we compared the pain sensitivity of the low back bilaterally among 3 groups: 35 patients with cLBP undergoing a long-term opioid therapy (OP); 35 patients with cLBP administered no opioids (ON), and 28 subjects with neither pain nor opioid intake (HC).
OP patients showed significantly higher bilateral thermal detection thresholds to warm stimuli on the back as compared to both ON (P = 0.009 for left low back, P = 0.008 for right low back) and HC subjects (P = 0.004 for left low back, P = 0.003 for right low back). Pain thresholds for cold and heat on the hand were similar in OP and ON groups; both showed, however, significantly reduced heat pain thresholds in comparison with HC participants (P = 0.012 for OP, P = 0.001 for ON). Factors such as age, sex, duration and dose of opioid intake, and self-reported pain intensity, but not depression and pain duration, correlated significantly with QST results.
Limitations include small numbers of patients with heterogeneous opioid therapy and the nonrandomized observational nature of the study.
The current study demonstrated that chronic opioid intake may only reduce the temperature sensitivity but not pain sensitivity measured by QST which is a useful tool in detecting characteristic changes in pain perception of patients with chronic low back pain after long-term opioid intake.
在过去的几十年中，长期使用阿片类药物治疗慢性下腰痛（cLBP）。然而，阿片类药物的长期疗效和相关副作用存在严重限制。
本研究旨在探讨长期阿片类药物治疗是否会改变慢性下腰痛患者的疼痛敏感性。
前瞻性、非随机、横断面研究。
德国多学科疼痛管理诊所、专业转诊中心、大学医院。
使用定量感觉测试（QST），我们比较了 3 组患者的双侧下腰痛的疼痛敏感性：35 例接受长期阿片类药物治疗（OP）的慢性下腰痛患者；35 例未接受阿片类药物治疗（ON）的慢性下腰痛患者；28 例无疼痛且未服用阿片类药物的健康对照者（HC）。
OP 患者双侧背部的温热感觉检测阈值明显高于 ON 组（左低背 P = 0.009，右低背 P = 0.008）和 HC 组（左低背 P = 0.004，右低背 P = 0.003）。OP 和 ON 组手部冷觉和热觉痛阈相似；但与 HC 组相比，两组的热痛阈均显著降低（OP 组 P = 0.012，ON 组 P = 0.001）。年龄、性别、阿片类药物摄入的持续时间和剂量、自我报告的疼痛强度等因素与 QST 结果显著相关，但抑郁和疼痛持续时间与 QST 结果无显著相关性。
本研究的局限性包括接受异质性阿片类药物治疗的患者数量较少，以及研究的非随机观察性质。
本研究表明，慢性阿片类药物摄入可能仅降低 QST 测量的温度敏感性，而不降低疼痛敏感性，QST 是一种有用的工具，可以检测慢性下腰痛患者在长期阿片类药物摄入后疼痛感知的特征性变化。
