Hooten W Michael, Zheng Danielle, Canzanello Nicholas C, Moman Rajat N, Prokop Larry, Eberhart Nathan D, Benkli Barlas, Hirani Salman
Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
Anesthesiology Systematic Review Group, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
Pain Rep. 2025 May 20;10(3):e1294. doi: 10.1097/PR9.0000000000001294. eCollection 2025 Jun.
The availability of knowledge about the effects of buprenorphine on pain perception in healthy adults could help investigators select experimental tests with evidence of responsiveness to buprenorphine in nondiseased states. The purpose of this meta-narrative systematic review is to summarize the effects of buprenorphine on pain perception in healthy adults. Comprehensive database searches were conducted from inception dates through July 16, 2024. Inclusion criteria included all study designs involving healthy adults receiving buprenorphine and tests of pain perception. Risk of bias was assessed using a tool developed for randomized controlled trials (RCTs). A meta-narrative approach was used due to high levels of clinical heterogeneity. A total of 10 RCTs were included, and healthy adults comprised the comparator groups in all trials. Three RCTs had a low risk of bias, 6 had some concerns, and 1 had a high risk of bias. Six RCTs used intravenous buprenorphine, 3 used transdermal, and 1 study used intravenous and sublingual buprenorphine. The effects of buprenorphine on pain perception are influenced by the route of administration, dose, and pain stimulus modality. Considerable differences exist in the effects of intravenous and transdermal buprenorphine, but only 1 study used sublingual buprenorphine, which limited comparison with the other drug formulations. Based on these findings, recommendations for clinical trials are proposed. These recommendations should be cautiously interpreted due to the clinical heterogeneity, but they provide a framework for advancing the use of experimental pain tests in trials of buprenorphine involving comparator groups of healthy adults.
了解丁丙诺啡对健康成年人疼痛感知影响的相关知识，有助于研究人员选择在非疾病状态下对丁丙诺啡有反应证据的实验测试。本元叙事系统评价的目的是总结丁丙诺啡对健康成年人疼痛感知的影响。从起始日期到2024年7月16日进行了全面的数据库检索。纳入标准包括所有涉及接受丁丙诺啡的健康成年人的研究设计和疼痛感知测试。使用为随机对照试验（RCT）开发的工具评估偏倚风险。由于临床异质性水平较高，采用了元叙事方法。共纳入10项RCT，所有试验中的健康成年人作为对照人群。3项RCT的偏倚风险较低，6项存在一些问题，1项偏倚风险较高。6项RCT使用静脉注射丁丙诺啡，3项使用透皮给药，1项研究使用静脉注射和舌下含服丁丙诺啡。丁丙诺啡对疼痛感知的影响受给药途径、剂量和疼痛刺激方式的影响。静脉注射和透皮丁丙诺啡的效果存在相当大的差异，但只有1项研究使用舌下含服丁丙诺啡，这限制了与其他药物剂型的比较。基于这些发现，提出了临床试验的建议。由于临床异质性，这些建议应谨慎解读，但它们为在涉及健康成年人对照人群的丁丙诺啡试验中推进实验性疼痛测试的应用提供了一个框架。
