Wakaizumi Kenta, Vigotsky Andrew D, Jabakhanji Rami, Abdallah Maryam, Barroso Joana, Schnitzer Thomas J, Apkarian Apkar Vania, Baliki Marwan N
Shirley Ryan AbilityLab, Chicago, IL, USA.
Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 355 East Erie St, Chicago, IL, 60611, USA.
Pain Ther. 2021 Jun;10(1):691-709. doi: 10.1007/s40122-021-00257-w. Epub 2021 Apr 12.
The opiate epidemic has severe medical and social consequences. Opioids are commonly prescribed in patients with chronic pain, and are a main contributor to the opiate epidemic. The adverse effects of long-term opioid usage have been studied primarily in dependence/addiction disorders, but not in chronic pain. Here, we examine the added iatrogenic effects, psychology, and brain morphology of long-term opioid use in matched patients with chronic pain with and without opioid use (case-controlled design).
We compared psychosocial, functional, and psychological measures between patients with chronic back pain (CBP) who were managing their pain with or without opioids, thereby controlling for the effect of pain on these outcomes. In addition, we investigated brain morphological differences associated with long-term opioid usage. We recruited 58 patients with CBP, 29 of them on long-term opioids and 29 who did not use opioids, and who were matched in terms of age, sex, pain intensity, and pain duration. Questionnaires were used to assess pain quality, pain psychology, negative and positive emotions, physical, cognitive, sensory, and motor functions, quality of life, and personality traits.
Patients with CBP on opioids displayed more negative emotion, poorer physical function, and more pain interference (p < 0.001), whereas there were no statistical differences in cognitive and motor functions and personality traits. Voxel-based morphometry using structural brain imaging data identified decreased gray matter density of the dorsal paracingulate cortex (family-wise error-corrected p < 0.05) in patients with opioids, which was associated with negative emotion (p = 0.03). Finally, a volumetric analysis of hippocampal subfields identified lower volume of the left presubiculum in patients on opioids (p < 0.001).
Long-term opioid use in chronic pain is associated with adverse negative emotion and disabilities, as well as decreased gray matter volumes of specific brain regions.
阿片类药物泛滥造成了严重的医学和社会后果。阿片类药物常用于慢性疼痛患者，是导致阿片类药物泛滥的主要因素。长期使用阿片类药物的不良反应主要在依赖/成瘾性疾病中进行了研究，而在慢性疼痛中尚未开展。在此，我们采用病例对照设计，研究了长期使用阿片类药物和未使用阿片类药物的匹配慢性疼痛患者中，长期使用阿片类药物所带来的医源性影响、心理状况和脑形态学变化。
我们比较了使用或未使用阿片类药物来控制慢性背痛（CBP）的患者之间的社会心理、功能和心理指标，从而控制疼痛对这些结果的影响。此外，我们研究了与长期使用阿片类药物相关的脑形态学差异。我们招募了58例CBP患者，其中29例长期使用阿片类药物，29例未使用阿片类药物，两组在年龄、性别、疼痛强度和疼痛持续时间方面相匹配。采用问卷调查评估疼痛性质、疼痛心理、负面和正面情绪、身体、认知、感觉和运动功能、生活质量以及人格特质。
使用阿片类药物的CBP患者表现出更多负面情绪、身体功能更差以及疼痛干扰更大（p<0.001），而认知和运动功能以及人格特质方面无统计学差异。使用基于体素的形态学分析方法，利用脑结构成像数据发现，使用阿片类药物的患者背侧扣带旁皮质灰质密度降低（家族性错误校正p<0.05），这与负面情绪相关（p=0.03）。最后，对海马亚区进行体积分析发现，使用阿片类药物的患者左侧前下托体积较小（p<0.001）。
慢性疼痛患者长期使用阿片类药物与不良负面情绪和功能障碍有关，同时特定脑区的灰质体积减少。
