Hall O Trent, Teater Julie, Rood Kara M, Phan K Luan, Clauw Daniel J
Departments of Psychiatry and Behavioral Health.
Obstetrics and Gynecology, Ohio State University Wexner Medical Center, Columbus, OH, USA.
Pain Rep. 2022 Jul 7;7(4):e1016. doi: 10.1097/PR9.0000000000001016. eCollection 2022 Jul-Aug.
Central sensitization (CS) involves dysfunctional central nervous system pain modulation resulting in heightened pain perception. Central sensitization is not commonly assessed among patients with opioid use disorder (OUD), despite the fact that pain has been implicated in the development, maintenance, and relapse of OUD and chronic opioid use may produce opioid-induced hyperalgesia. Central sensitization is a plausibly important mechanism underlying the complex relationship between OUD and chronic pain. However, this premise is largely untested.
Participants with OUD (n = 141) were recruited from an academic addiction treatment center in Columbus, Ohio. An established surrogate measure of CS, the American College of Rheumatology 2011 Fibromyalgia Survey Criteria, was administered using electronic survey. Participants also responded to questions about pain interference (Brief Pain Inventory), quality of life (RAND-36), and items regarding pain beliefs and expectations of pain and addiction treatment. Descriptive analyses, Spearman rho correlations, and Mann-Whitney tests were performed.
Hypothesized relationships were confirmed between degree of CS, pain interference, and health-related quality of life. Degree of CS was also positively correlated with greater endorsement of pain as a reason for the onset, maintenance, and escalation of OUD; treatment delay; and OUD relapse. Participants with the American College of Rheumatology 2011 Fibromyalgia Survey Criteria ≥13 had significantly greater endorsement of pain as a reason for delaying OUD treatment, continuing and increasing opioid use, and precipitating OUD relapse.
This study provides early evidence CS may underlie previously observed connections between clinically salient features of chronic pain and OUD, potentially informing future mechanistic research and precision treatment.
中枢敏化（CS）涉及中枢神经系统疼痛调节功能失调，导致疼痛感知增强。尽管疼痛与阿片类物质使用障碍（OUD）的发生、维持和复发有关，且长期使用阿片类药物可能会产生阿片类药物诱导的痛觉过敏，但在患有OUD的患者中，中枢敏化并不常被评估。中枢敏化可能是OUD与慢性疼痛之间复杂关系的一个重要潜在机制。然而，这一假设在很大程度上尚未得到验证。
从俄亥俄州哥伦布市的一个学术性成瘾治疗中心招募了患有OUD的参与者（n = 141）。使用电子调查问卷，采用已确立的中枢敏化替代指标——美国风湿病学会2011年纤维肌痛调查标准。参与者还回答了有关疼痛干扰（简明疼痛量表）、生活质量（兰德36项健康调查量表）以及关于疼痛信念和对疼痛及成瘾治疗期望的问题。进行了描述性分析、斯皮尔曼等级相关分析和曼-惠特尼检验。
证实了中枢敏化程度、疼痛干扰和健康相关生活质量之间的假设关系。中枢敏化程度还与更强烈地认可疼痛是OUD发作、维持和加重的原因、治疗延迟以及OUD复发呈正相关。符合美国风湿病学会2011年纤维肌痛调查标准≥13的参与者更强烈地认可疼痛是延迟OUD治疗、持续和增加阿片类药物使用以及促使OUD复发的原因。
本研究提供了早期证据，表明中枢敏化可能是慢性疼痛和OUD临床显著特征之间先前观察到的联系的基础，这可能为未来的机制研究和精准治疗提供信息。
