Emerick Trent, Durbhakula Shravani, Eibel Maria R, Kohan Lynn
UPMC Department of Anesthesiology and Perioperative Medicine, Pittsburgh, Pennsylvania.
VUMC Department of Anesthesiology, Nashville, Tennessee.
Curr Opin Anaesthesiol. 2024 Oct 1;37(5):575-580. doi: 10.1097/ACO.0000000000001413. Epub 2024 Jul 8.
Kratom is used commonly in the United States, usually to mitigate pain, opioid withdrawal, or fatigue. A comprehensive discussion on kratom, tailored to pain management physicians, is needed, given its associated risks and potential interactions.
Kratom and its main metabolites, mitragynine and 7-OH-mitragynine, bind to a variety of receptors including mu opioid receptors. Still, kratom cannot be described as a classic opioid. Kratom has been utilized without FDA approval as an alternative to traditional medications for opioid use disorder and opioid withdrawal. Lower doses of kratom typically cause opioid-like effects while higher doses can have sedating effects. Tolerance, dependence and withdrawal still occur, although kratom withdrawal appears to be more moderate than opioid withdrawal. Contamination with heavy metals and biological toxins is concerning and there is potential for serious complications, including seizures and death.
The use of kratom as an opioid-sparing alternative as a part of a multimodal pain regimen is not without significant risks. It is of utmost importance for pain physicians to be aware of the risks and adverse effects associated with kratom use.
在美国，人们普遍使用 kratom，通常用于缓解疼痛、减轻阿片类药物戒断症状或疲劳。鉴于其相关风险和潜在相互作用，需要针对疼痛管理医生进行一次关于 kratom 的全面讨论。
Kratom 及其主要代谢产物——帽柱木碱和 7-羟基帽柱木碱，可与多种受体结合，包括 μ 阿片受体。不过，kratom 不能被描述为典型的阿片类药物。Kratom 在未经美国食品药品监督管理局（FDA）批准的情况下，被用作治疗阿片类药物使用障碍和阿片类药物戒断的传统药物替代品。较低剂量的 kratom 通常会产生类阿片样作用，而较高剂量则可能有镇静作用。尽管 kratom 戒断似乎比阿片类药物戒断更为缓和，但耐受性、依赖性和戒断反应仍然会出现。重金属和生物毒素污染令人担忧，且存在严重并发症的可能性，包括癫痫发作和死亡。
将 kratom 作为多模式疼痛治疗方案的一部分，用作阿片类药物节省替代品并非没有重大风险。疼痛医生必须了解与使用 kratom 相关的风险和不良反应，这至关重要。
