PDF(Pubmed)
Abstract：
BACKGROUND: The opiate epidemic has severe medical and social consequences. Opioids are commonly prescribed in patients with chronic pain, and are a main contributor to the opiate epidemic. The adverse effects of long-term opioid usage have been studied primarily in dependence/addiction disorders, but not in chronic pain. Here, we examine the added iatrogenic effects, psychology, and brain morphology of long-term opioid use in matched patients with chronic pain with and without opioid use (case-controlled design).
METHODS: We compared psychosocial, functional, and psychological measures between patients with chronic back pain (CBP) who were managing their pain with or without opioids, thereby controlling for the effect of pain on these outcomes. In addition, we investigated brain morphological differences associated with long-term opioid usage. We recruited 58 patients with CBP, 29 of them on long-term opioids and 29 who did not use opioids, and who were matched in terms of age, sex, pain intensity, and pain duration. Questionnaires were used to assess pain quality, pain psychology, negative and positive emotions, physical, cognitive, sensory, and motor functions, quality of life, and personality traits.
RESULTS: Patients with CBP on opioids displayed more negative emotion, poorer physical function, and more pain interference (p < 0.001), whereas there were no statistical differences in cognitive and motor functions and personality traits. Voxel-based morphometry using structural brain imaging data identified decreased gray matter density of the dorsal paracingulate cortex (family-wise error-corrected p < 0.05) in patients with opioids, which was associated with negative emotion (p = 0.03). Finally, a volumetric analysis of hippocampal subfields identified lower volume of the left presubiculum in patients on opioids (p < 0.001).
CONCLUSIONS: Long-term opioid use in chronic pain is associated with adverse negative emotion and disabilities, as well as decreased gray matter volumes of specific brain regions.
METHODS: We compared psychosocial, functional, and psychological measures between patients with chronic back pain (CBP) who were managing their pain with or without opioids, thereby controlling for the effect of pain on these outcomes. In addition, we investigated brain morphological differences associated with long-term opioid usage. We recruited 58 patients with CBP, 29 of them on long-term opioids and 29 who did not use opioids, and who were matched in terms of age, sex, pain intensity, and pain duration. Questionnaires were used to assess pain quality, pain psychology, negative and positive emotions, physical, cognitive, sensory, and motor functions, quality of life, and personality traits.
RESULTS: Patients with CBP on opioids displayed more negative emotion, poorer physical function, and more pain interference (p < 0.001), whereas there were no statistical differences in cognitive and motor functions and personality traits. Voxel-based morphometry using structural brain imaging data identified decreased gray matter density of the dorsal paracingulate cortex (family-wise error-corrected p < 0.05) in patients with opioids, which was associated with negative emotion (p = 0.03). Finally, a volumetric analysis of hippocampal subfields identified lower volume of the left presubiculum in patients on opioids (p < 0.001).
CONCLUSIONS: Long-term opioid use in chronic pain is associated with adverse negative emotion and disabilities, as well as decreased gray matter volumes of specific brain regions.
摘要：
背景：阿片类药物流行具有严重的医疗和社会后果。阿片类药物通常用于慢性疼痛患者，是鸦片流行的主要原因。长期使用阿片类药物的不良反应主要在依赖性/成瘾性疾病中进行了研究，但不是慢性疼痛。这里,我们检查了额外的医源性效应，心理学,长期使用阿片类药物的慢性疼痛患者和不使用阿片类药物的大脑形态（病例对照设计）。
方法：我们比较了社会心理，功能，以及在有或没有阿片类药物的情况下处理疼痛的慢性背痛（CBP）患者之间的心理措施，从而控制疼痛对这些结果的影响。此外,我们调查了与长期使用阿片类药物相关的大脑形态差异.我们招募了58名CBP患者，其中29人长期服用阿片类药物，29人没有使用阿片类药物，在年龄方面是匹配的，性别,疼痛强度，和疼痛持续时间。问卷调查用于评估疼痛质量，疼痛心理学，消极和积极的情绪，物理，认知，感官,和电机功能，生活质量,和人格特质。
结果：服用阿片类药物的CBP患者表现出更多的负面情绪，较差的身体机能，和更多的疼痛干扰（p<0.001），而认知和运动功能以及人格特质没有统计学差异。使用结构性脑成像数据的基于体素的形态计量学确定阿片类药物患者的背侧旁皮层的灰质密度降低（家庭误差校正p<0.05），与负性情绪相关(p=0.03)。最后,一项对海马亚区的体积分析发现,阿片类药物患者的左前下丘体积较低(p<0.001).
结论：长期使用阿片类药物治疗慢性疼痛与不良负面情绪和残疾有关，以及特定大脑区域的灰质体积减少。
方法：我们比较了社会心理，功能，以及在有或没有阿片类药物的情况下处理疼痛的慢性背痛（CBP）患者之间的心理措施，从而控制疼痛对这些结果的影响。此外,我们调查了与长期使用阿片类药物相关的大脑形态差异.我们招募了58名CBP患者，其中29人长期服用阿片类药物，29人没有使用阿片类药物，在年龄方面是匹配的，性别,疼痛强度，和疼痛持续时间。问卷调查用于评估疼痛质量，疼痛心理学，消极和积极的情绪，物理，认知，感官,和电机功能，生活质量,和人格特质。
结果：服用阿片类药物的CBP患者表现出更多的负面情绪，较差的身体机能，和更多的疼痛干扰（p<0.001），而认知和运动功能以及人格特质没有统计学差异。使用结构性脑成像数据的基于体素的形态计量学确定阿片类药物患者的背侧旁皮层的灰质密度降低（家庭误差校正p<0.05），与负性情绪相关(p=0.03)。最后,一项对海马亚区的体积分析发现,阿片类药物患者的左前下丘体积较低(p<0.001).
结论：长期使用阿片类药物治疗慢性疼痛与不良负面情绪和残疾有关，以及特定大脑区域的灰质体积减少。
