Anesthesiology, University of California San Diego, La Jolla, California, USA
Emergency Medicine, University of California Irvine, Irvine, California, USA.
BMJ Case Rep. 2021 Feb 19;14(2):e237009. doi: 10.1136/bcr-2020-237009.
Neuropathic opioid refractory phantom limb pain (PLP) following amputation can be a life long debilitating chronic pain syndrome capable of completely destroying a patient's life. The pain, its associated depression and sleep deprivation can make many patients suicidal. Ever changing and relentless, it is notoriously unresponsive to traditional cocktails of strong opioids, adjuvant pain medications, antidepressants, local anaesthetics, nerve stimulators, hypnotics and psychotropics. Drug effects are seldom more effective than placebo. We describe a successful sustained rescue of a difficult 2-year-long PLP case with sublingual buprenorphine/naloxone using the drug's potent multimodal mechanisms of action: potent long-acting mu agonist/antagonist, kapa receptor antagonist, delta receptor antagonist and novel opioid receptor-like 1 (OR-L1) agonist effects. Traditional escalating pure mu-opioid receptor agonists and adjuvant neuropathic pain cocktails often have disappointing efficacy in the treatment of resistant PLP. We suggest introducing buprenorphine/naloxone as an early effective opioid choice in PLP management.
神经病理性阿片类药物难治性幻肢痛（PLP）是截肢后一种终身致残的慢性疼痛综合征，能够彻底摧毁患者的生活。疼痛、相关的抑郁和睡眠剥夺会使许多患者产生自杀念头。这种疼痛变化无常、无情，对传统的强效阿片类药物、辅助止痛药、抗抑郁药、局部麻醉剂、神经刺激器、催眠药和精神药物组合治疗反应不佳，这是出了名的。药物的疗效很少比安慰剂更有效。我们描述了一种使用舌下给予丁丙诺啡/纳洛酮成功持续缓解一例长达 2 年的难治性 PLP 病例的方法，该方法利用了该药的强大多模式作用机制：强效长效 μ 阿片受体激动剂/拮抗剂、κ 受体拮抗剂、δ 受体拮抗剂和新型阿片受体样 1（OR-L1）激动剂作用。传统的逐渐递增的纯 μ 阿片受体激动剂和辅助神经病理性疼痛鸡尾酒疗法在治疗难治性 PLP 时往往效果不佳。我们建议将丁丙诺啡/纳洛酮作为 PLP 管理中早期有效的阿片类药物选择。
