School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Anesth Prog. 2023 Mar 1;70(1):9-16. doi: 10.2344/anpr-69-03-03.
Opioid-induced hyperalgesia, a paradoxical increase in pain sensitivity associated with ongoing opioid use, may worsen the postoperative pain experience. This pilot study examined the effect of chronic opioid use on pain responses in patients undergoing a standardized dental surgery.
Experimental and subjective pain responses were compared prior to and immediately following planned multiple tooth extractions between patients with chronic pain on opioid therapy (≥30 mg morphine equivalents/d) and opioid-naïve patients without chronic pain matched on sex, race, age, and degree of surgical trauma.
Preoperatively, chronic opioid users rated experimental pain as more severe and appreciated less central modulation of that pain than did opioid-naïve participants. Postoperatively, chronic opioid-using patients rated their pain as more severe during the first 48 hours and used almost twice as many postoperative analgesic doses during the first 72 hours as the opioid-naïve controls.
These data suggest that patients with chronic pain taking opioids approach surgical interventions with heightened pain sensitivity and have a more severe postoperative pain experience, providing evidence that their complaints of postoperative pain should be taken seriously and managed appropriately.
阿片类药物诱发的痛觉过敏是一种与持续使用阿片类药物相关的痛觉敏感性增加的矛盾现象，可能会使术后疼痛体验恶化。本初步研究调查了慢性阿片类药物使用对接受标准化牙科手术患者疼痛反应的影响。
在计划进行多颗牙齿拔除术之前和之后，比较慢性疼痛接受阿片类药物治疗（≥30 毫克吗啡当量/天）的患者和无慢性疼痛且在性别、种族、年龄和手术创伤程度上相匹配的阿片类药物未使用者的实验和主观疼痛反应。
术前，慢性阿片类药物使用者比阿片类药物未使用者报告的实验性疼痛更严重，对疼痛的中枢调节作用也更小。术后，慢性阿片类药物使用者在前 48 小时内将疼痛评为更严重，并在前 72 小时内使用了近两倍的术后镇痛剂量，而阿片类药物未使用者对照组则更少。
这些数据表明，接受阿片类药物治疗的慢性疼痛患者在接受手术干预时具有更高的疼痛敏感性，并且术后疼痛体验更严重，这表明他们对术后疼痛的抱怨应认真对待并进行适当管理。
