Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.
Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
J Pain. 2021 Nov;22(11):1477-1496. doi: 10.1016/j.jpain.2021.06.011. Epub 2021 Jul 3.
Moderate to severe pain is often treated with opioids, but central mechanisms underlying opioid analgesia are poorly understood. Findings thus far have been contradictory and none could infer opioid specific effects. This placebo-controlled, randomized, 2-way cross-over, double-blinded study aimed to explore opioid specific effects on central processing of external stimuli. Twenty healthy male volunteers were included and 3 sets of assessments were done at each of the 2 visits: 1) baseline, 2) during continuous morphine or placebo intravenous infusion and 3) during simultaneous morphine + naloxone or placebo infusion. Opioid antagonist naloxone was introduced in order to investigate opioid specific effects by observing which morphine effects are reversed by this intervention. Quantitative sensory testing, spinal nociceptive withdrawal reflexes (NWR), spinal electroencephalography (EEG), cortical EEG responses to external stimuli and resting EEG were measured and analyzed. Longer lasting pain (cold-pressor test - hand in 2° water for 2 minutes, tetanic electrical), deeper structure pain (bone pressure) and strong nociceptive (NWR) stimulations were the most sensitive quantitative sensory testing measures of opioid analgesia. In line with this, the principal opioid specific central changes were seen in NWRs, EEG responses to NWRs and cold-pressor EEG. The magnitude of NWRs together with amplitudes and insular source strengths of the corresponding EEG responses were attenuated. The decreases in EEG activity were correlated to subjective unpleasantness scores. Brain activity underlying slow cold-pressor EEG (1-4Hz) was decreased, whereas the brain activity underlying faster EEG (8-12Hz) was increased. These changes were strongly correlated to subjective pain relief. This study points to evidence of opioid specific effects on perception of external stimuli and the underlying central responses. The analgesic response to opioids is likely a synergy of opioids acting at both spinal and supra-spinal levels of the central nervous system. Due to the strong correlations with pain relief, the changes in EEG signals during cold-pressor test have the potential to serve as biomarkers of opioid analgesia. PERSPECTIVE: This exploratory study presents evidence of opioid specific effects on the pain system at peripheral and central levels. The findings give insights into which measures are the most sensitive for assessing opioid-specific effects.
中重度疼痛通常采用阿片类药物治疗,但阿片类药物镇痛的中枢机制仍不清楚。迄今为止的研究结果相互矛盾,没有一个能推断出阿片类药物的特定作用。这项安慰剂对照、随机、2 向交叉、双盲研究旨在探索阿片类药物对外部刺激的中枢处理的特定作用。纳入了 20 名健康男性志愿者,在 2 次就诊时分别进行了 3 组评估:1)基线,2)持续吗啡或安慰剂静脉输注期间,3)同时吗啡+纳洛酮或安慰剂输注期间。引入阿片类拮抗剂纳洛酮是为了通过观察这种干预逆转的吗啡作用来研究阿片类药物的特定作用。测量和分析了定量感觉测试、脊髓伤害性撤回反射(NWR)、脊髓脑电图(EEG)、外部刺激的皮质 EEG 反应和静息 EEG。持续时间较长的疼痛(冷压测试-手浸入 2°C 水中 2 分钟,强直电刺激)、深部结构疼痛(骨压)和强烈的伤害性刺激(NWR)是阿片类药物镇痛最敏感的定量感觉测试措施。与此一致的是,NWR、NWR 的 EEG 反应和冷压 EEG 的主要阿片类药物特定中枢变化最为明显。NWR 的幅度以及相应 EEG 反应的振幅和岛叶源强度减弱。EEG 活动的减少与主观不愉快评分相关。慢冷压 EEG(1-4Hz)的脑活动减少,而较快 EEG(8-12Hz)的脑活动增加。这些变化与主观疼痛缓解强烈相关。这项研究提供了阿片类药物对外部刺激的感知和潜在的中枢反应具有特定作用的证据。阿片类药物的镇痛反应可能是阿片类药物在中枢神经系统的脊髓和脊髓以上水平均发挥作用的协同作用。由于与疼痛缓解有很强的相关性,冷压测试期间 EEG 信号的变化有可能成为阿片类药物镇痛的生物标志物。观点:这项探索性研究提供了阿片类药物在周围和中枢水平对疼痛系统的特定作用的证据。研究结果深入了解了评估阿片类药物特定作用的最敏感措施。
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