Gastroenterology, Salford Royal NHS Foundation Trust, Salford, UK.
Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK.
Aliment Pharmacol Ther. 2019 May;49(10):1282-1292. doi: 10.1111/apt.15241. Epub 2019 Apr 4.
Chronic continuous abdominal pain (CCAP) is characteristic of centrally mediated gastrointestinal pain disorders. It consumes significant healthcare resources yet is poorly understood, with minimal cohort-specific data in the literature.
To examine in a large cohort of CCAP patients, (a) diagnostic features, (b) iatrogenic impact of opioids and surgery, (c) drug treatment effects and tolerance.
Consecutive tertiary CCAP referrals to a neurogastroenterology clinic (2009-2016) were reviewed for Rome IV and neuropathic pain criteria. Medical, surgical and drug histories, interventions and outcomes were correlated with clinical diagnosis and associated opioid use.
Of 103 CCAP patients (mean age 40 ± 14, 85% female), 50% had physiological exacerbations precluding full Rome IV Centrally Mediated Abdominal Pain Syndrome criteria. However, there were no significant differences between patients who satisfied Rome IV criteria and those who did not. Overall, 81% had allodynia (a nonpainful stimulus evoking pain sensation). Opioid use was associated with allodynia (P = 0.003). Prior surgery was associated with further operations post CCAP onset (P < 0.001). Although 68% had undergone surgical interventions, surgery did not resolve pain in any patient and worsened pain in 35%. Whilst duloxetine was the most effective neuromodulator (P = 0.003), combination therapy was superior to monotherapy (P = 0.007).
This is currently the largest cohort CCAP dataset that supports eliciting neuropathic features, including allodynia, for a positive clinical diagnosis, to guide treatment. Physiological exacerbation of CCAP may represent visceral allodynia, and need not preclude central origin. Use of centrally acting neuromodulators, and avoidance of detrimental opioids and surgical interventions appear to predict favourable outcomes.
慢性持续性腹痛（CCAP）是一种以中枢介导的胃肠道疼痛障碍为特征的疾病。它消耗了大量的医疗资源，但人们对此了解甚少，文献中也几乎没有针对特定人群的具体数据。
在一个大型 CCAP 患者队列中，（a）检查诊断特征，（b）阿片类药物和手术的医源性影响，（c）药物治疗效果和耐受性。
回顾性分析 2009 年至 2016 年间连续就诊于神经胃肠病学诊所的 CCAP 患者，评估罗马 IV 标准和神经病理性疼痛标准。将患者的医疗、手术和药物史、干预措施和结果与临床诊断及相关阿片类药物使用相关联。
103 例 CCAP 患者（平均年龄 40±14 岁，85%为女性）中，50%存在生理恶化，无法完全满足罗马 IV 正中介导的腹痛综合征标准。然而，满足罗马 IV 标准的患者与不满足的患者之间没有显著差异。总体而言，81%的患者存在触诱发痛（非疼痛刺激引发疼痛感觉）。阿片类药物的使用与触诱发痛相关（P=0.003）。先前的手术与 CCAP 发病后进一步手术相关（P<0.001）。尽管 68%的患者接受了手术干预，但手术并未缓解任何患者的疼痛，反而使 35%的患者疼痛加重。度洛西汀是最有效的神经调节剂（P=0.003），但联合治疗优于单一治疗（P=0.007）。
这是目前 CCAP 患者最大的队列数据集，支持引出包括触诱发痛在内的神经病理性特征，以进行阳性临床诊断，从而指导治疗。CCAP 的生理恶化可能代表内脏触诱发痛，且不一定排除中枢起源。使用中枢作用的神经调节剂，避免使用有害的阿片类药物和手术干预，似乎可以预测良好的结果。
