Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY, USA.
Headache. 2018 May;58(5):750-754. doi: 10.1111/head.13292. Epub 2018 Mar 8.
Parenteral opioids are used in more than 50% of emergency department (ED) visits for migraine. Use of opioids for migraine has been associated with subsequent ED visits, perhaps because of opioid-induced euphoria. In this study, we quantify the extent to which nontherapeutic effects of opioids influence migraine outcomes. We hypothesized that "feeling good" and medication likeability would in fact be associated with receipt of opioids (rather than relief of migraine pain) and that receipt of opioids (rather than relief of migraine pain) would be associated with return visits to the ED.
During an ED-based clinical trial, migraine patients were randomized to receive hydromorphone 1 mg or prochlorperazine 10 mg + diphenhydramine 25 mg IV. Thirty minutes after medication administration, we asked, (1) How much did you like the medication you received? and (2) How good did the medication make you feel? Participants were asked to provide answers on a 0-10 scale. We also determined 0-10 pain scores at baseline and 1 hour and number of return visits for headache during the subsequent month.
Sixty-three patients received prochlorperazine and 64 hydromorphone. Prochlorperazine pain scores improved by 6.8 (SD: 2.6), hydromorphone by 4.7 (SD: 3.3) (95%CI for difference of 2.1: 1.0, 3.2). On the 0-10 likeability scale, prochlorperazine patients reported a mean of 7.2 (SD: 2.8), hydromorphone 6.9 (SD: 2.9) (95% CI for difference of 0.3: -0.7, 1.3). On the 0-10 feeling good scale, prochlorperazine patients reported a mean of 7.5 (SD: 2.3), hydromorphone 6.8 (SD: 2.8) (95%CI: for difference of 0.7: -0.2, 1.6). In the hydromorphone group, 8/57 (14%, 95%CI: 7, 26%) returned to the ED vs 5/63 (8%, 95%CI: 3,18%) in the prochlorperazine group. In regression modeling, feeling good was independently associated with pain relief (P < .01) but not with medication received (P = .67) or return visits (P = .12). Similarly, medication likeability was independently associated with pain relief (P < .01) but not medication received (P = .12) or return visits (P = .16).
We did not detect an association between hydromorphone and medication likeability, feeling good, or return visits to the ED. Headache relief was associated with medication likeability and feeling good.
在超过 50%的因偏头痛而就诊的急诊部（ED）患者中使用了肠外阿片类药物。阿片类药物用于偏头痛与随后的 ED 就诊有关，可能是因为阿片类药物引起的欣快感。在这项研究中，我们定量评估了阿片类药物的非治疗作用对偏头痛结果的影响。我们假设“感觉良好”和药物的可接受性实际上与接受阿片类药物（而不是缓解偏头痛疼痛）有关，而接受阿片类药物（而不是缓解偏头痛疼痛）与返回 ED 就诊有关。
在一项基于 ED 的临床试验中，偏头痛患者被随机分配接受氢吗啡酮 1 毫克或丙氯拉嗪 10 毫克+苯海拉明 25 毫克 IV。在药物给药后 30 分钟，我们询问：（1）您对接受的药物的喜欢程度如何？（2）药物使您感觉如何？参与者被要求在 0-10 的范围内回答。我们还在基线、1 小时和随后一个月头痛的返回就诊时确定了 0-10 的疼痛评分。
63 名患者接受了丙氯拉嗪，64 名患者接受了氢吗啡酮。丙氯拉嗪的疼痛评分改善了 6.8（SD：2.6），氢吗啡酮为 4.7（SD：3.3）（95%CI 差值为 2.1：1.0，3.2）。在 0-10 的可接受性量表上，丙氯拉嗪患者报告的平均得分为 7.2（SD：2.8），氢吗啡酮为 6.9（SD：2.9）（95%CI 差值为 0.3：-0.7，1.3）。在 0-10 的感觉良好量表上，丙氯拉嗪患者报告的平均得分为 7.5（SD：2.3），氢吗啡酮为 6.8（SD：2.8）（95%CI：差值为 0.7：-0.2，1.6）。在氢吗啡酮组中，8/57（14%，95%CI：7，26%）返回 ED，而丙氯拉嗪组中 5/63（8%，95%CI：3，18%）。在回归模型中，感觉良好与疼痛缓解独立相关（P<0.01），但与接受的药物（P=0.67）或返回就诊（P=0.12）无关。同样，药物的可接受性与疼痛缓解独立相关（P<0.01），但与接受的药物（P=0.12）或返回就诊（P=0.16）无关。
我们没有发现氢吗啡酮与药物的可接受性、感觉良好或返回 ED 就诊之间存在关联。头痛缓解与药物的可接受性和感觉良好有关。
