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