Arnér S, Meyerson B A
Departments of Anaesthesiology and Neurosurgery, Karolinska Hospital, S-104 01 StockholmSweden.
Pain. 1988 Apr;33(1):11-23. doi: 10.1016/0304-3959(88)90198-4.
The aim of the present study has been to assess the responsiveness of various types of chronic pain to opioids given i.v. and tested against placebo in a double-blind, randomized fashion. Pain classified as primary nociceptive was effectively alleviated (P greater than 0.001) while neuropathic deafferentation pain was not significantly influenced by morphine or equivalent doses of other opioids. Also 'idiopathic' pain, defined as chronic pain with no or little demonstrable pathology, failed to respond. The results were not related to whether the patients were regular users of narcotic analgesics or not. The outcome of our double-blind opioid test has proved useful to justify a continued, or discontinued, use of narcotic medication in individual patients. It may also support the indication and choice of invasive stimulation procedures (spinal cord or brain). The results of the study illustrate the misconception of chronic pain as an entity and highlight the importance of recognizing different neurobiological mechanisms and differences in responsiveness to analgesic drugs as well as to non-pharmacological modes of treatment. The opioid test has thus become a valuable tool in pain analysis and helpful as a guide for further treatment.
本研究的目的是评估静脉注射阿片类药物对各类慢性疼痛的反应，并以双盲、随机方式与安慰剂进行对照测试。分类为原发性伤害感受性疼痛得到有效缓解（P>0.001），而神经病理性去传入性疼痛未受到吗啡或等效剂量其他阿片类药物的显著影响。同样，被定义为无明显或仅有少量可证实病理改变的慢性疼痛的“特发性”疼痛也无反应。结果与患者是否为麻醉性镇痛药的常规使用者无关。我们双盲阿片类药物测试的结果已证明有助于判断在个体患者中继续或停止使用麻醉药物是否合理。它也可能支持侵入性刺激程序（脊髓或脑）的适应证和选择。该研究结果说明了将慢性疼痛视为一个整体的误解，并强调了认识不同神经生物学机制以及对镇痛药和非药物治疗方式反应差异的重要性。因此，阿片类药物测试已成为疼痛分析中的一个有价值的工具，并有助于指导进一步治疗。
