Mizera L, Gossrau G, Hummel T, Haehner A
Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany.
Comprehensive Pain Center, TU Dresden, Dresden, Germany.
Eur J Pain. 2017 Jan;21(1):92-100. doi: 10.1002/ejp.903. Epub 2016 Jun 20.
There is some evidence suggesting that analgesics have an impact on human chemosensory function, especially opioids and cannabinoids are known to interfere with olfactory function. However, largely unknown is the effect of a long-term use of analgesics on the intranasal trigeminal system so far. Here, we investigated olfactory function and the perception of intranasal trigeminal stimuli in pain patients with long-term use of analgesics compared to age-matched healthy controls.
For this purpose, a psychophysical approach was chosen to measure these sensory functions in 100 chronic pain patients and 95 controls. Olfactory testing was performed using the 'Sniffin' Sticks' test kit, which involves tests for odour threshold, odour discrimination and odour identification. Further, participants were asked to rate the intensity of trigeminal stimuli by using a visual analogue scale.
We observed that the chronic use of pain medication was associated with significantly reduced perception of intranasal trigeminal stimuli and olfactory function compared to age-matched controls without intake of analgesics. Results indicate that non-opioid and opioid drugs, or a combination of both did not differ in their effects on chemosensory function. Further, after eliminating the effect of a co-existing depression and the use of co-analgesics, the negative influence of analgesics on olfactory function and trigeminal perception was still evident.
The observed effect might be mediated due to interaction with opioid receptors in trigeminal ganglia and nuclei or due to trigeminal/olfactory interaction. As a practical consequence, patients should be made aware of a possible impairment of their olfactory and trigeminal function under long-term analgesic treatment. WHAT DOES THIS STUDY ADD?: We observed that the chronic use of pain medication was associated with significantly reduced olfactory function and perception of intranasal trigeminal stimuli compared to age-matched controls without intake of analgesics. Non-opioid and opioid drugs did not differ in their effects on chemosensory function.
有证据表明镇痛药会对人类化学感觉功能产生影响，尤其是阿片类药物和大麻素已知会干扰嗅觉功能。然而，长期使用镇痛药对鼻内三叉神经系统的影响目前很大程度上尚不清楚。在此，我们研究了长期使用镇痛药的疼痛患者与年龄匹配的健康对照者相比的嗅觉功能以及鼻内三叉神经刺激的感知。
为此，选择了一种心理物理学方法来测量100名慢性疼痛患者和95名对照者的这些感觉功能。使用“嗅棒”测试套件进行嗅觉测试，该测试包括气味阈值、气味辨别和气味识别测试。此外，要求参与者使用视觉模拟量表对三叉神经刺激的强度进行评分。
我们观察到，与未服用镇痛药的年龄匹配对照者相比，长期使用止痛药物与鼻内三叉神经刺激的感知和嗅觉功能显著降低有关。结果表明，非阿片类药物和阿片类药物或两者的组合对化学感觉功能的影响没有差异。此外，在消除并存抑郁症和使用辅助镇痛药的影响后，镇痛药对嗅觉功能和三叉神经感知的负面影响仍然明显。
观察到的效应可能是由于与三叉神经节和核中的阿片受体相互作用介导的，或者是由于三叉神经/嗅觉相互作用。实际的结果是，应该让患者意识到长期镇痛治疗可能会损害他们的嗅觉和三叉神经功能。本研究补充了什么？：我们观察到，与未服用镇痛药的年龄匹配对照者相比，长期使用止痛药物与嗅觉功能和鼻内三叉神经刺激的感知显著降低有关。非阿片类药物和阿片类药物对化学感觉功能的影响没有差异。
