Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands.
Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands.
Pain. 2022 May 1;163(5):955-963. doi: 10.1097/j.pain.0000000000002462.
Long-term opioid use in patients with chronic noncancer pain (CNCP) can lead to opioid use disorder (OUD) and has been associated with hyperalgesia and reduced quality of life (QoL). Studies suggest antihyperalgesic properties of buprenorphine, and buprenorphine or naloxone (BuNa) has shown beneficial effects on QoL in patients with OUD without CNCP. This study investigated the added value of BuNa in patients with CNCP with OUD on self-reported pain, pain thresholds, pain tolerance, and QoL. In the current study, 43 outpatients with CNCP and OUD were included for inpatient conversion from full μ-receptor agonist opioids to BuNa. Self-reported pain, pain thresholds, pain tolerance, and QoL were determined at baseline and after 2 months of follow-up, using, respectively, a Visual Analogue Scale (VAS-pain and VAS-QoL), quantitative sensory testing, and EuroQol-5 dimensions. In total, 37 participants completed the protocol, and their data were analyzed. The mean VAS-pain score decreased from 51.3 to 37.2 (27.5%, F = 3.3; P = 0.044), whereas the pressure pain threshold and electric pain threshold or tolerance increased after substitution (F = 7.8; P = 0.005 and F = 44.5; P < 0.001, respectively), as well as QoL (EuroQol-5 dimensions questionnaire: F = 10.4; P = 0.003 and VAS-QoL: F = 4.4; P = 0.043). We found that conversion of full μ-receptor agonists to BuNa, in patients with CNCP with OUD, was accompanied with lower self-reported pain, higher pain thresholds, higher pain tolerance, and improved QoL. Despite several study limitations, these data suggest that BuNa might be of value in patients with CNCP with OUD. Future studies should investigate long-term effects of BuNa in randomized trials.
慢性非癌痛（CNCP）患者长期使用阿片类药物可能导致阿片类药物使用障碍（OUD），并与痛觉过敏和生活质量（QoL）下降有关。研究表明丁丙诺啡具有抗痛觉过敏作用，丁丙诺啡或纳洛酮（BuNa）在没有 CNCP 的 OUD 患者中对 QoL 有有益影响。本研究调查了 BuNa 在伴有 OUD 的 CNCP 患者中的附加价值，评估了患者的自我报告疼痛、疼痛阈值、疼痛耐受力和生活质量。在当前研究中，43 名伴有 OUD 的 CNCP 门诊患者被纳入研究，进行从全 μ 受体激动剂阿片类药物转换为 BuNa 的住院治疗。分别使用视觉模拟量表（VAS-pain 和 VAS-QoL）、定量感觉测试和欧洲五维健康量表（EuroQol-5 dimensions）来评估自我报告的疼痛、疼痛阈值、疼痛耐受力和生活质量。共有 37 名参与者完成了方案，他们的数据被分析。VAS-pain 评分从 51.3 降至 37.2（27.5%，F = 3.3；P = 0.044），而压力疼痛阈值和电疼痛阈值或耐受力在替代治疗后增加（F = 7.8；P = 0.005 和 F = 44.5；P < 0.001），同时 QoL 也得到改善（欧洲五维健康量表问卷：F = 10.4；P = 0.003 和 VAS-QoL：F = 4.4；P = 0.043）。我们发现，在伴有 OUD 的 CNCP 患者中，从全 μ 受体激动剂转换为 BuNa 治疗与自我报告疼痛降低、疼痛阈值升高、疼痛耐受力升高和生活质量改善有关。尽管存在一些研究限制，但这些数据表明，BuNa 可能对伴有 OUD 的 CNCP 患者有价值。未来的研究应该在随机试验中调查 BuNa 的长期效果。
