Rieb Launette Marie, Norman Wendy V, Martin Ruth Elwood, Berkowitz Jonathan, Wood Evan, Milloy Michael John, McNeil Ryan
Department of Family Practice, University of British Columbia, Vancouver, BC, Canada.
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
Pain Rep. 2018 Apr 5;3(3):e648. doi: 10.1097/PR9.0000000000000648. eCollection 2018 May.
Understanding the details of one individual's experience with pain, opioid use and withdrawal may generate insights into possible relationships between opioid-induced hyperalgesia and withdrawal-associated injury site pain (WISP).
This case study was extracted from a mixed methods study that characterized WISP. In 2014, the individual was recruited from a primary care clinic that prescribes opioid agonist therapy. In an interview, she completed a 35-item survey and elaborated on her own experience. Follow-up contact was made in June of 2017.
This 34-year-old white woman had several twisting injuries of her right knee between ages 13 and 15. The pain resolved each time in a few days, and she was pain free for 15 years. Around age 30, she initiated illicit oxycodone recreationally (not for pain) and developed an opioid use disorder. On detoxification, she experienced severe knee pain for 6 weeks that resolved postdetoxification but returned after subsequent oxycodone use and withdrawal episodes along with generalized skin sensitivity. This experience of WISP became a barrier to opioid cessation. Although nonsteroidal anti-inflammatories and gabapentin relieved WISP and methadone therapy assisted her opioid use disorder, an eventual change to sublingual buprenorphine/naloxone provided superior control of both.
This case report illustrates that both opioid use and withdrawal can reactivate injury site pain, which can increase with dose escalation and repeated withdrawal events. The timing, trajectory, and neuropathic features of WISP reported here are consistent with those previously reported for the development of opioid-induced hyperalgesia, possibly linking these phenomena.
了解个体疼痛、阿片类药物使用及戒断经历的细节，可能有助于深入了解阿片类药物诱导的痛觉过敏与戒断相关损伤部位疼痛（WISP）之间的潜在关系。
本案例研究摘自一项对WISP进行特征描述的混合方法研究。2014年，该个体从一家开具阿片类激动剂疗法的初级保健诊所招募而来。在一次访谈中，她完成了一项35项的调查问卷，并详细阐述了自己的经历。2017年6月进行了随访。
这位34岁的白人女性在13至15岁期间右膝有几次扭伤。每次疼痛在几天内就会缓解，她有15年没有疼痛。30岁左右，她开始非医疗目的（并非因疼痛）使用非法的羟考酮，并患上了阿片类药物使用障碍。在戒毒期间，她经历了6周的严重膝关节疼痛，戒毒后疼痛缓解，但在随后使用羟考酮及戒断发作后又复发，同时伴有全身皮肤敏感。这种WISP经历成为了她戒除阿片类药物的障碍。尽管非甾体抗炎药和加巴喷丁缓解了WISP，美沙酮疗法有助于治疗她的阿片类药物使用障碍，但最终改用舌下含服丁丙诺啡/纳洛酮能更好地控制这两种情况。
本病例报告表明，阿片类药物的使用和戒断均可重新激活损伤部位疼痛，且这种疼痛会随着剂量增加和反复戒断事件而加剧。此处报告的WISP的发生时间、发展轨迹和神经病理性特征与先前报道的阿片类药物诱导的痛觉过敏的特征一致，可能将这些现象联系起来。
