Hooten W Michael, Lamer Tim J, Twyner Channing
Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN, USA Mayo Graduate School of Medicine, Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN, USA.
Pain. 2015 Jun;156(6):1145-1152. doi: 10.1097/j.pain.0000000000000170.
The hyperalgesic effects of long-term opioid use in community-dwelling adults with chronic pain have not been widely reported. Therefore, the primary aim of this study was to determine the associations between opioid use and heat pain (HP) perception in a sample of community-dwelling adults with chronic pain. The study cohort involved 187 adults (85 opioid and 102 nonopioid) with chronic pain consecutively admitted to an outpatient interdisciplinary pain treatment program. Heat pain perception was assessed using a validated quantitative sensory test method of levels. An effect of opioid use was observed for nonstandardized (P = 0.004) and standardized (P = 0.005) values of HP 5-0.5 in which values of the opioid group were lower (more hyperalgesic) compared with those of the nonopioid group. HP 5-0.5 is a measure of the slope of the line connecting HP 0.5 (HP threshold) and HP 5 (intermediate measure of HP tolerance). In univariable (P = 0.019) and multiple variable (P = 0.003) linear regression analyses (adjusted for age, sex, body mass index, work status, pain diagnosis, pain severity, depression, and pain catastrophizing), opioid use was associated with lower (more hyperalgesic) nonstandardized values of HP 5-0.5. Similarly, in univariable (P = 0.004) and multiple variable (P = 0.011) linear regression analyses (adjusted for work status, pain diagnosis, pain severity, depression, and pain catastrophizing), opioid use was associated with lower standardized values of HP 5-0.5. In this sample of community-dwelling adults, these observations suggest that long-term opioid use was associated with hyperalgesia independent of other clinical factors known to influence HP perception.
长期使用阿片类药物对社区居住的慢性疼痛成年人的痛觉过敏影响尚未得到广泛报道。因此，本研究的主要目的是确定在社区居住的慢性疼痛成年人样本中，阿片类药物使用与热痛（HP）感知之间的关联。研究队列包括187名患有慢性疼痛的成年人（85名使用阿片类药物者和102名未使用阿片类药物者），他们连续入住门诊跨学科疼痛治疗项目。使用经过验证的定量感觉测试方法评估热痛感知水平。观察到阿片类药物使用对HP 5-0.5的非标准化值（P = 0.004）和标准化值（P = 0.005）有影响，其中阿片类药物组的值低于非阿片类药物组（痛觉过敏更严重）。HP 5-0.5是连接HP 0.5（HP阈值）和HP 5（HP耐受性的中间测量值）的直线斜率的度量。在单变量（P = 0.019）和多变量（P = 0.003）线性回归分析中（对年龄、性别、体重指数、工作状态、疼痛诊断、疼痛严重程度、抑郁和疼痛灾难化进行了调整），阿片类药物使用与较低的（痛觉过敏更严重）HP 5-0.5非标准化值相关。同样，在单变量（P = 0.004）和多变量（P = 0.011）线性回归分析中（对工作状态、疼痛诊断、疼痛严重程度、抑郁和疼痛灾难化进行了调整），阿片类药物使用与较低的HP 5-0.5标准化值相关。在这个社区居住的成年人样本中，这些观察结果表明，长期使用阿片类药物与痛觉过敏相关，且独立于其他已知影响HP感知的临床因素。
