Scott J Ryan, Hassett Afton L, Brummett Chad M, Harris Richard E, Clauw Daniel J, Harte Steven E
Chronic Pain and Fatigue Research Center, Department of Anesthesiology.
Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA.
J Pain Res. 2017 Jul 28;10:1801-1809. doi: 10.2147/JPR.S134421. eCollection 2017.
Caffeine's properties as an analgesic adjuvant with nonsteroidal anti-inflammatory drugs/acetaminophen are well documented. However, little clinical research has explored caffeine's effects on opioid analgesia. This study assessed the effects of caffeine consumption on pain and other symptoms in opioid-using and nonusing chronic pain patients meeting the survey criteria for fibromyalgia.
Patients presenting to a university-based pain clinic completed validated self-report questionnaires assessing symptoms. Patients (N=962) meeting the fibromyalgia survey criteria were stratified by opioid use and further split into groups based on caffeine amount consumed per day (no caffeine, or low, moderate, high caffeine). Analysis of covariance with Dunnett's post hoc testing compared pain and symptom severity between the no caffeine group and the caffeine consuming groups.
In opioid users, caffeine consumption had modest but significant effects on pain, catastrophizing, and physical function. Lower levels of pain interference were associated with low and moderate caffeine use compared to no caffeine intake. Lower pain catastrophizing and higher physical function were observed in all caffeine dose groups, relative to the no caffeine group. Lower pain severity and depression were observed only in the moderate caffeine group. In opioid nonusers, low caffeine intake was associated with higher physical function; however, no other significant effects were observed.
Caffeine consumption was associated with decreased pain and symptom severity in opioid users, but not in opioid nonusers, indicating caffeine may act as an opioid adjuvant in fibromyalgia-like chronic pain patients. These data suggest that caffeine consumption concomitant with opioid analgesics could provide therapeutic benefits not seen with opioids or caffeine alone.
咖啡因作为非甾体抗炎药/对乙酰氨基酚的镇痛佐剂的特性已有充分记载。然而，很少有临床研究探讨咖啡因对阿片类镇痛的影响。本研究评估了摄入咖啡因对符合纤维肌痛调查标准的使用阿片类药物和未使用阿片类药物的慢性疼痛患者的疼痛及其他症状的影响。
到一家大学疼痛诊所就诊的患者完成了经过验证的自我报告问卷以评估症状。符合纤维肌痛调查标准的患者（N = 962）按阿片类药物使用情况分层，并根据每日咖啡因摄入量进一步分为几组（无咖啡因、低、中、高咖啡因）。采用协方差分析及Dunnett事后检验比较无咖啡因组与摄入咖啡因组之间的疼痛和症状严重程度。
在使用阿片类药物的患者中，摄入咖啡因对疼痛、灾难化思维和身体功能有适度但显著的影响。与不摄入咖啡因相比，低剂量和中等剂量咖啡因摄入与较低的疼痛干扰水平相关。相对于无咖啡因组，在所有咖啡因剂量组中均观察到较低的疼痛灾难化思维和较高的身体功能。仅在中等咖啡因剂量组中观察到较低的疼痛严重程度和抑郁情绪。在未使用阿片类药物的患者中，低咖啡因摄入量与较高的身体功能相关；然而，未观察到其他显著影响。
摄入咖啡因与使用阿片类药物患者的疼痛和症状严重程度降低相关，但与未使用阿片类药物的患者无关，这表明咖啡因可能在纤维肌痛样慢性疼痛患者中作为阿片类佐剂发挥作用。这些数据表明，与阿片类镇痛药同时摄入咖啡因可能提供单独使用阿片类药物或咖啡因时未见到的治疗益处。
