Department of Anesthesiology, Pain Medicine and Critical Care, La Sapienza University, Rome, Italy.
Minerva Anestesiol. 2013 Aug;79(8):871-83. Epub 2013 Apr 5.
Multifactor neuropathic pain is one of the most frequent symptoms in AIDS patients and analgesic treatment is primarily based on the use of drug combination of opioids, tricyclic antidepressants and antiepileptics. However, the chronic use of opioids in AIDS patients presents a risk due to the immunosuppressive action of these drugs. Until now, buprenorphine has been regarded as one of the safest opioid analgesics for the treatment of patients with compromised immune systems. To assess the suitability of transdermal fentanyl for the treatment of neuropathic pain in AIDS patients, the present study compares the efficacy, tolerability and the immunosuppressive effects of transdermal buprenorphine vs. fentanyl.
Forty advanced AIDS patients (28 male and 12 female) with chronic peripheral neuropathic pain were enrolled onto this clinical trial. Neuropathic pain was assessed for its constituent types of pain (burning, stabbing and shooting), its overall intensity and allodynia; scores were awarded using the Neuropathic Pain Scale, expressed as 10 item VAS scores.
Both treatment groups showed statistically significant reductions in each of the individual types of neuropathic pain and allodynia (P<0.05; 95% CI: -14.7, -3.1) and significant improvements in Karnofsky Performance Status (P<0.05; mean value, 69; range: 40-90). Both buprenorphine and fentanyl were well tolerated. Neither buprenorphine nor fentanyl affected CD4+ or CD8+levels and both treatments, but particularly buprenorphine group, resulted in more stable CD4+ concentrations.
The high efficacy, tolerability and patient compliance of both buprenorphine and fentanyl make both these two opioids valid therapeutic options for the treatment of neuropathic pain in patients with AIDS.
多发性神经病理性疼痛是艾滋病患者最常见的症状之一，其镇痛治疗主要基于阿片类药物、三环类抗抑郁药和抗癫痫药的联合应用。然而，由于这些药物具有免疫抑制作用，艾滋病患者长期使用阿片类药物存在风险。到目前为止，丁丙诺啡一直被认为是治疗免疫系统受损患者的最安全的阿片类镇痛药之一。为了评估经皮芬太尼治疗艾滋病患者神经性疼痛的适用性，本研究比较了经皮丁丙诺啡与芬太尼的疗效、耐受性和免疫抑制作用。
本临床试验纳入了 40 例患有慢性周围神经性疼痛的晚期艾滋病患者（28 名男性和 12 名女性）。使用神经性疼痛量表评估神经性疼痛的组成类型（烧灼感、刺痛感和枪击感）、总体强度和感觉异常；采用 10 项视觉模拟评分（VAS 评分）进行评分。
两组患者的每种神经性疼痛和感觉异常类型（P<0.05；95%置信区间：-14.7，-3.1）以及卡诺夫斯基表现状态（P<0.05；平均值为 69；范围：40-90）均有显著降低。丁丙诺啡和芬太尼均具有良好的耐受性。丁丙诺啡和芬太尼均未影响 CD4+或 CD8+水平，且两种治疗方法，尤其是丁丙诺啡组，导致 CD4+浓度更稳定。
丁丙诺啡和芬太尼均具有较高的疗效、耐受性和患者依从性，是治疗艾滋病患者神经性疼痛的有效治疗选择。
