Barrachina Jordi, Margarit Cesar, Muriel Javier, López-Gil Vicente, López-Gil Santiago, Ballester Pura, Mira-Lorente Laura, Agulló Laura, Peiró Ana M
Neuropharmacology on Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), c/Pintor Baeza, 12, 03010 Alicante, Spain.
Pain Unit, Department of Health of Alicante-General Hospital, c/Pintor Baeza, 12, 03010 Alicante, Spain.
Biomedicines. 2022 Oct 2;10(10):2468. doi: 10.3390/biomedicines10102468.
Despite the large body of research on sex differences in pain, there is a lack of translation to real-world pain management. Our aim was to analyse the sex differences in the analgesic response to oxycodone/naloxone (OXN) and tapentadol (TAP), in comparison with other opioids (OPO) commonly prescribed for chronic non-cancer pain (CNCP). An observational and cross-sectional study was conducted on ambulatory CNCP patients (n = 571). Sociodemographic, clinical (pain intensity, relief, and quality of life), safety (adverse events (AEs), adverse drug reactions), hospital frequentations and pharmacological (morphine equivalent daily dose (MEDD)) variables were collected. Multiple linear regressions were carried out to assess the association between sex and outcomes. Sex differences were observed, with lower female tolerability and higher hospital frequentation, especially in the OXN group (OR AEs report = 2.8 [1.8−4.4], p < 0.001). Here, females showed higher hospital use (23% hospital admission, 30% prescription change, p < 0.05), requiring a higher MEDD (127 ± 103 mg/day, p < 0.05), compared to OXN men. Regardless of the opioid group, CNCP women were significantly older than men (three years), with significantly higher benzodiazepine use (OR = 1.6 [1.1−2.3]), more constipation (OR = 1.34 [0.93−1.90]) and headache (OR = 1.45 [0.99−2.13]) AEs, than men who were more likely to refer sexual dysfunction (OR = 2.77 [1.53−5.01]), and loss of libido (OR = 1.93 [1.22−3.04]). Sex-differences were found related to poorer female drug tolerability and higher hospital resources, even worst in OXN female users. Other differences related to older female ages and benzodiazepine prescription, need to be further analysed from a gender perspective.
尽管关于疼痛方面的性别差异已有大量研究，但这些研究成果在现实世界的疼痛管理中却缺乏应用。我们的目的是分析与常用于慢性非癌性疼痛（CNCP）的其他阿片类药物（OPO）相比，羟考酮/纳洛酮（OXN）和曲马多（TAP）镇痛反应中的性别差异。对门诊CNCP患者（n = 571）进行了一项观察性横断面研究。收集了社会人口统计学、临床（疼痛强度、缓解情况和生活质量）、安全性（不良事件（AE）、药物不良反应）、住院频次和药理学（吗啡等效日剂量（MEDD））等变量。进行了多元线性回归以评估性别与结果之间的关联。观察到了性别差异，女性的耐受性较低且住院频次较高，尤其是在OXN组（不良事件报告的比值比 = 2.8 [1.8 - 4.4]，p < 0.001）。在此，与OXN组男性相比，女性的住院使用率更高（23%住院，30%处方变更，p < 0.05），需要更高的MEDD（127 ± 103毫克/天，p < 0.05）。无论阿片类药物组如何，CNCP女性的年龄均显著大于男性（相差三岁），使用苯二氮䓬类药物的比例显著更高（比值比 = 1.6 [1.1 - 2.3]），便秘（比值比 = 1.34 [0.93 - 1.90]）和头痛（比值比 = 1.45 [0.99 - 2.13]）等不良事件比男性更多，而男性更易出现性功能障碍（比值比 = 2.77 [1.53 - 5.01]）和性欲减退（比值比 = 1.93 [1.22 - 3.04]）。发现性别差异与女性较差的药物耐受性和更高的医院资源利用有关，在OXN女性使用者中情况更糟。与女性年龄较大和苯二氮䓬类药物处方相关的其他差异，需要从性别角度进一步分析。
