Suppr超能文献

一组慢性疼痛患者中,阿片类药物剂量调整与疼痛评分变化之间缺乏相关性。

Lack of correlation between opioid dose adjustment and pain score change in a group of chronic pain patients.

机构信息

Massachusetts General Hospital Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.

出版信息

J Pain. 2013 Apr;14(4):384-92. doi: 10.1016/j.jpain.2012.12.012. Epub 2013 Feb 26.

Abstract

UNLABELLED

Despite the increasing use of opioid analgesics for chronic pain management, it is unclear whether opioid dose escalation leads to better pain relief during chronic opioid therapy. In this study, we retrospectively analyzed clinical data collected from the Massachusetts General Hospital Center for Pain Medicine over a 7-year period. We examined 1) the impact of opioid dose adjustment (increase or decrease) on clinical pain score; 2) gender and age differences in response to opioid therapy; and 3) the influence of clinical pain conditions on the opioid analgesic efficacy. A total of 109 subjects met the criteria for data collection. We found that neither opioid dose increase, nor decrease, correlated with point changes in clinical pain score in a subset of chronic pain patients over a prolonged course of opioid therapy (an average of 704 days). This lack of correlation was consistent regardless of the type of chronic pain including neuropathic, nociceptive, or mixed pain conditions. Neither gender nor age differences showed a significant influence on the clinical response to opioid therapy in these subjects. These results suggest that dose adjustment during opioid therapy may not necessarily alter long-term clinical pain score in a group of chronic pain patients and that individualized opioid therapy based on the clinical effectiveness should be considered to optimize the treatment outcome.

PERSPECTIVE

The study reports a relationship, or lack thereof, between opioid dose change and clinical pain score in a group of chronic pain patients. The study also calls for further investigation into the effectiveness of opioid therapy in the management of chronic nonmalignant pain conditions.

摘要

未加标签

尽管阿片类镇痛药在慢性疼痛管理中的应用日益增多,但阿片类药物剂量的增加是否能在慢性阿片类药物治疗期间更好地缓解疼痛仍不清楚。在这项研究中,我们回顾性分析了马萨诸塞州总医院疼痛医学中心在 7 年期间收集的临床数据。我们检查了 1)阿片类药物剂量调整(增加或减少)对临床疼痛评分的影响;2)性别和年龄对阿片类药物治疗反应的差异;3)临床疼痛状况对阿片类药物镇痛效果的影响。共有 109 名受试者符合数据收集标准。我们发现,在慢性疼痛患者中,无论是阿片类药物剂量增加还是减少,都与长期阿片类药物治疗过程中的临床疼痛评分的点变化无关(平均 704 天)。这种相关性缺失在包括神经病理性、伤害感受性或混合性疼痛状况在内的各种慢性疼痛类型中都是一致的。性别和年龄差异在这些受试者对阿片类药物治疗的临床反应中也没有显著影响。这些结果表明,在一组慢性疼痛患者中,阿片类药物治疗期间的剂量调整不一定会改变长期的临床疼痛评分,应考虑基于临床疗效的个体化阿片类药物治疗,以优化治疗效果。

观点

该研究报告了一组慢性疼痛患者中阿片类药物剂量变化与临床疼痛评分之间的关系,或缺乏这种关系。该研究还呼吁进一步研究阿片类药物治疗在管理慢性非恶性疼痛状况方面的有效性。

相似文献

1
Lack of correlation between opioid dose adjustment and pain score change in a group of chronic pain patients.
J Pain. 2013 Apr;14(4):384-92. doi: 10.1016/j.jpain.2012.12.012. Epub 2013 Feb 26.
2
Only modest long-term opioid dose escalation occurs over time in chronic nonmalignant pain management.
J Pain Palliat Care Pharmacother. 2013 Dec;27(4):370-7. doi: 10.3109/15360288.2013.846957. Epub 2013 Oct 21.
3
A randomized trial of 2 prescription strategies for opioid treatment of chronic nonmalignant pain.
J Pain. 2011 Feb;12(2):288-96. doi: 10.1016/j.jpain.2010.09.003. Epub 2010 Nov 26.
4
Prolonged-release oxycodone/naloxone in nonmalignant pain: single-center study in patients with constipation.
Adv Ther. 2013 Jan;30(1):41-59. doi: 10.1007/s12325-012-0074-0. Epub 2012 Dec 21.
5
Dose escalation during the first year of long-term opioid therapy for chronic pain.
Pain Med. 2015 Apr;16(4):733-44. doi: 10.1111/pme.12634. Epub 2014 Dec 19.
7
Combination of intrathecal opioids with bupivacaine attenuates opioid dose escalation in chronic noncancer pain patients.
Pain Med. 2011 Oct;12(10):1481-9. doi: 10.1111/j.1526-4637.2011.01232.x. Epub 2011 Sep 21.
9
Long-term treatment in chronic noncancer pain: Results of an observational study comparing opioid and nonopioid therapy.
Scand J Pain. 2017 Oct;17:87-98. doi: 10.1016/j.sjpain.2017.07.005. Epub 2017 Aug 7.
10
Age-dependent intrathecal opioid escalation in chronic noncancer pain patients.
Pain Med. 2011 Aug;12(8):1179-89. doi: 10.1111/j.1526-4637.2011.01188.x. Epub 2011 Aug 2.

引用本文的文献

1
Interprofessional Active Learning for Chronic Pain: Transforming Student Learning From Recall to Application.
J Med Educ Curric Dev. 2023 Dec 25;10:23821205231221950. doi: 10.1177/23821205231221950. eCollection 2023 Jan-Dec.
2
Pharmacological options for pain control in patients with vertebral fragility fractures.
Osteoporos Sarcopenia. 2022 Sep;8(3):93-97. doi: 10.1016/j.afos.2022.09.003. Epub 2022 Oct 3.
5
Determinants of long-term opioid prescribing in an urban population: A cross-sectional study.
Br J Clin Pharmacol. 2022 Jul;88(7):3172-3181. doi: 10.1111/bcp.15231. Epub 2022 Feb 7.
7
Multiple Sclerosis and the Endogenous Opioid System.
Front Neurosci. 2021 Sep 17;15:741503. doi: 10.3389/fnins.2021.741503. eCollection 2021.
10
Chronic neuropathic pain reduces opioid receptor availability with associated anhedonia in rat.
Pain. 2018 Sep;159(9):1856-1866. doi: 10.1097/j.pain.0000000000001282.

本文引用的文献

1
Primary care survey of the value and effectiveness of the Washington State Opioid Dosing Guideline.
J Opioid Manag. 2011 Nov-Dec;7(6):427-33. doi: 10.5055/jom.2011.0083.
2
Opioid rotation with extended-release opioids: where should we begin?
Int J Gen Med. 2012;5:11-7. doi: 10.2147/IJGM.S24287. Epub 2011 Dec 30.
3
Combination therapy for neuropathic pain: a review of current evidence.
CNS Drugs. 2011 Dec 1;25(12):1023-34. doi: 10.2165/11596280-000000000-00000.
4
Opioid use, misuse, and abuse in patients labeled as fibromyalgia.
Am J Med. 2011 Oct;124(10):955-60. doi: 10.1016/j.amjmed.2011.05.031.
5
Opioid therapy for chronic pain: physicians' attitude and current practice patterns.
J Opioid Manag. 2011 Jul-Aug;7(4):267-76. doi: 10.5055/jom.2011.0068.
6
The use of ketamine in severe cases of refractory pain syndromes in the palliative care setting: a case series.
J Palliat Med. 2011 Sep;14(9):1074-7. doi: 10.1089/jpm.2010.0424. Epub 2011 Aug 12.
7
Age-dependent intrathecal opioid escalation in chronic noncancer pain patients.
Pain Med. 2011 Aug;12(8):1179-89. doi: 10.1111/j.1526-4637.2011.01188.x. Epub 2011 Aug 2.
8
A comprehensive review of opioid-induced hyperalgesia.
Pain Physician. 2011 Mar-Apr;14(2):145-61.
9
Does pain intensity predict a poor opioid response in cancer patients?
Eur J Cancer. 2011 Mar;47(5):713-7. doi: 10.1016/j.ejca.2010.12.020. Epub 2011 Jan 20.
10
The course of opioid prescribing for a new episode of disabling low back pain: opioid features and dose escalation.
Pain. 2010 Oct;151(1):22-29. doi: 10.1016/j.pain.2010.04.012. Epub 2010 Aug 11.

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验