Jackson Daniel, Singh Sunita, Zhang-James Yanli, Faraone Stephen, Johnson Brian
Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, United States.
College of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States.
Front Psychiatry. 2021 Feb 16;12:593842. doi: 10.3389/fpsyt.2021.593842. eCollection 2021.
While opioids temporarily alleviate pain, the overshoot of balancing pain drivers may increase pain, leading to opioid induced hyperalgesia (OIH). Our goal was to find out what chronic opioid treatment does to pain tolerance as measured by the cold pressor test (CPT), an objective measure of pain tolerance, and to find an alternative effective treatment for chronic pain and FM. The setting was an academic addiction medicine service that has an embedded pain service. Patients had routine clinical care starting with an evaluation that included assessment of medical and psychiatric conditions. Participants were 55 patients with OIH and 21 patients with fibromyalgia; all had at least two CPTs. Treatment included a single dose of buprenorphine for detoxification. In this open-label case series, patients were treated with low dose naltrexone (LDN), a pure opioid receptor antagonist that, we hypothesize, treats OIH and FM by restoring endogenous opioid tone. Comparing initial and last CPT times, those with OIH more than quadrupled their pain tolerance, and those with FM doubled theirs. This improved pain tolerance for OIH and FM was statistically significant ( < 0.0001 and = 0.003, respectively) and had a large effect size ( = 0.82 and = 0.63, respectively). Results suggest that patients on chronic opioid therapy should have pain tolerance measured by CPT with detoxification and LDN provided to correct opioid induced hyperalgesia if found. FM may also be treated with LDN. The main limitation of the findings was lack of a randomized control group treated with placebo.
虽然阿片类药物可暂时缓解疼痛，但平衡疼痛驱动因素的过度反应可能会加剧疼痛，导致阿片类药物诱导的痛觉过敏（OIH）。我们的目标是通过冷加压试验（CPT）这一客观的疼痛耐受性测量方法，来探究慢性阿片类药物治疗对疼痛耐受性的影响，并找到一种针对慢性疼痛和纤维肌痛的替代有效治疗方法。研究背景是一家设有嵌入式疼痛服务的学术性成瘾医学机构。患者接受常规临床护理，起始评估包括对医疗和精神状况的评估。参与者为55名患有OIH的患者和21名患有纤维肌痛的患者；所有人至少接受了两次CPT测试。治疗包括单剂量丁丙诺啡用于戒毒。在这个开放标签的病例系列中，患者接受低剂量纳曲酮（LDN）治疗，我们推测这是一种纯阿片受体拮抗剂，通过恢复内源性阿片类物质张力来治疗OIH和纤维肌痛。比较初始和末次CPT测试时间，患有OIH的患者疼痛耐受性提高了四倍多，患有纤维肌痛的患者疼痛耐受性提高了一倍。OIH和纤维肌痛患者疼痛耐受性的这种改善具有统计学意义（分别为P<0.0001和P = 0.003），且效应量较大（分别为ES = 0.82和ES = 0.63）。结果表明，接受慢性阿片类药物治疗的患者应通过CPT测量疼痛耐受性，若发现阿片类药物诱导的痛觉过敏，则进行戒毒并给予LDN治疗。纤维肌痛也可用LDN治疗。研究结果的主要局限性是缺乏接受安慰剂治疗的随机对照组。
