Ezeh Ebubechukwu, Singh Davinder, Dobariya Varun, Akhigbe Esiemoghie J, Gilkerson Christine
Internal Medicine, Marshall University, Joan C. Edwards School of Medicine, Huntington, USA.
Cureus. 2020 Dec 28;12(12):e12345. doi: 10.7759/cureus.12345.
As opioid use disorder (OUD) reaches epidemic levels in the United States, medication-assisted treatment (MAT) plays a central role in its treatment. Methadone, a long-acting mu-opioid receptor agonist has been shown to be effective in managing OUD. It is also known that chronic opioid therapy may have the paradoxical effect of increased sensitivity to pain, a phenomenon called opioid-induced hyperalgesia (OIH). This presents a conundrum when a patient such as ours, on MAT presents with acute pain and OIH. This case report illustrates the current challenges health care providers encounter when treating patients on chronic MAT for non-opioid-related conditions. As this patient population ages, these encounters will become more common. These patients will need appropriate health care screening and chronic care management. This case serves two purposes; to highlight the difficulty in treating acute pain in patients on long-term high-dose methadone coupled with the missed opportunity for primary care for OUD patient population, and proposes that education reforms in this area be implemented now.
随着阿片类药物使用障碍（OUD）在美国达到流行程度，药物辅助治疗（MAT）在其治疗中发挥着核心作用。美沙酮，一种长效μ-阿片受体激动剂，已被证明在管理OUD方面有效。人们还知道，慢性阿片类药物治疗可能会产生矛盾的效果，即对疼痛的敏感性增加，这种现象称为阿片类药物诱导的痛觉过敏（OIH）。当像我们这样接受MAT治疗的患者出现急性疼痛和OIH时，这就带来了一个难题。本病例报告说明了医疗保健提供者在为患有非阿片类药物相关疾病的慢性MAT患者提供治疗时目前遇到的挑战。随着这一患者群体的老龄化，这些情况将变得更加普遍。这些患者将需要适当的医疗保健筛查和慢性病管理。本病例有两个目的；强调在长期大剂量服用美沙酮的患者中治疗急性疼痛的困难，以及OUD患者群体初级保健的机会错失，并建议现在就实施该领域的教育改革。
