PDF(Pubmed)
Abstract：
UNASSIGNED: In chronic pain conditions such as fibromyalgia (FM), pain amplification within the central nervous system, or \"central sensitization,\" may contribute to the development and maintenance of chronic pain. Chronic pain treatments include opioid therapy, and opioid therapy may maladaptively increase central sensitization, particularly in patients who take opioids long-term. However, it has remained unknown how central sensitization is impacted in patients who use opioids long-term.
UNASSIGNED: To investigate how long-term opioid therapy affects central sensitization, we used the validated measure of temporal summation. The temporal summation measurement consists of applying a series of noxious stimuli to a patient\'s skin and then calculating changes in the patient\'s pain rating to each stimulus. Using this measurement, we evaluated temporal summation in study participants with fibromyalgia who take opioids long-term (i.e., greater than 90 days duration; n = 24, opioid-FM). We compared opioid-FM responses to 2 control groups: participants with fibromyalgia who do not take opioids (n = 33, non-opioid FM), and healthy controls (n = 31). For the temporal summation measurement, we applied a series of 10 noxious heat stimuli (sensitivity-adjusted temperatures) to the ventral forearm (2s duration of each stimulus, applied once every 3 s). Additionally, we collected responses to standard pain and cognitive-affective questionnaires to assess pain severity and other factors.
UNASSIGNED: Group differences in sensitivity-adjusted stimulus temperatures were observed, with only the non-opioid FM group requiring significantly lower stimulus temperatures (The opioid-FM group also required lower temperatures, but not significantly different from the control group). However, all 3 groups exhibited similar magnitudes of temporal summation. Across combined FM groups, temporal summation negatively correlated with pain severity (r = -0.31, p = 0.021). Within the opioid-FM group, higher pain sensitivity to heat (i.e., lower sensitivity-adjusted temperatures) showed a trend relationship with higher opioid dosage (r = -0.45, p = 0.036), potentially reflective of opioid-related hyperalgesia. Our findings also indicated that heightened pain severity may skew sensitivity-adjusted temporal summation, thereby limiting its utility for measuring central sensitization. Overall, in participants taking opioids, temporal summation may be influenced by hypersensitivity to heat pain, which appeared to vary with opioid dosage.
UNASSIGNED: To investigate how long-term opioid therapy affects central sensitization, we used the validated measure of temporal summation. The temporal summation measurement consists of applying a series of noxious stimuli to a patient\'s skin and then calculating changes in the patient\'s pain rating to each stimulus. Using this measurement, we evaluated temporal summation in study participants with fibromyalgia who take opioids long-term (i.e., greater than 90 days duration; n = 24, opioid-FM). We compared opioid-FM responses to 2 control groups: participants with fibromyalgia who do not take opioids (n = 33, non-opioid FM), and healthy controls (n = 31). For the temporal summation measurement, we applied a series of 10 noxious heat stimuli (sensitivity-adjusted temperatures) to the ventral forearm (2s duration of each stimulus, applied once every 3 s). Additionally, we collected responses to standard pain and cognitive-affective questionnaires to assess pain severity and other factors.
UNASSIGNED: Group differences in sensitivity-adjusted stimulus temperatures were observed, with only the non-opioid FM group requiring significantly lower stimulus temperatures (The opioid-FM group also required lower temperatures, but not significantly different from the control group). However, all 3 groups exhibited similar magnitudes of temporal summation. Across combined FM groups, temporal summation negatively correlated with pain severity (r = -0.31, p = 0.021). Within the opioid-FM group, higher pain sensitivity to heat (i.e., lower sensitivity-adjusted temperatures) showed a trend relationship with higher opioid dosage (r = -0.45, p = 0.036), potentially reflective of opioid-related hyperalgesia. Our findings also indicated that heightened pain severity may skew sensitivity-adjusted temporal summation, thereby limiting its utility for measuring central sensitization. Overall, in participants taking opioids, temporal summation may be influenced by hypersensitivity to heat pain, which appeared to vary with opioid dosage.
摘要：
■在纤维肌痛（FM）等慢性疼痛情况下，中枢神经系统内的疼痛放大，或“中央敏化，“可能有助于慢性疼痛的发展和维持。慢性疼痛治疗包括阿片类药物治疗，阿片类药物治疗可能会不适应地增加中枢敏化，特别是长期服用阿片类药物的患者。然而,对于长期使用阿片类药物的患者,中枢致敏作用如何受到影响仍不得而知.
■为了研究长期阿片类药物治疗如何影响中枢致敏，我们使用了经过验证的时间总和度量。时间总和测量包括对患者的皮肤施加一系列有害刺激,然后计算患者对每个刺激的疼痛等级的变化。使用这个测量，我们评估了长期服用阿片类药物的纤维肌痛研究参与者的时间总和(即，持续时间大于90天；n=24，阿片类药物-FM)。我们将阿片类药物-FM反应与2个对照组进行了比较：不服用阿片类药物的纤维肌痛患者（n=33，非阿片类药物FM），和健康对照（n=31）。对于时间求和测量，我们对前臂腹侧施加了一系列10个有害的热刺激（敏感性调节温度）（每个刺激的持续时间为2s，每3秒应用一次)。此外,我们收集了对标准疼痛和认知-情感问卷的回答,以评估疼痛严重程度和其他因素.
■观察到灵敏度调节刺激温度的组差异，只有非阿片类FM组需要显著较低的刺激温度（阿片类FM组也需要较低的温度，但与对照组没有显着差异）。然而,所有3组表现出相似的时间总和。跨组合FM组，时间总和与疼痛严重程度呈负相关(r=-0.31,p=0.021)。在阿片类药物FM组中，对热的疼痛敏感性更高(即较低的灵敏度调节温度）与较高的阿片类药物剂量呈趋势关系（r=-0.45，p=0.036），可能反映阿片类药物相关的痛觉过敏。我们的发现还表明，疼痛严重程度升高可能会使敏感性调整后的时间总和产生偏差，从而限制了其用于测量中央敏化的用途。总的来说,在服用阿片类药物的参与者中，时间总和可能受到对热痛的超敏反应的影响，这似乎随阿片类药物剂量而变化。
■为了研究长期阿片类药物治疗如何影响中枢致敏，我们使用了经过验证的时间总和度量。时间总和测量包括对患者的皮肤施加一系列有害刺激,然后计算患者对每个刺激的疼痛等级的变化。使用这个测量，我们评估了长期服用阿片类药物的纤维肌痛研究参与者的时间总和(即，持续时间大于90天；n=24，阿片类药物-FM)。我们将阿片类药物-FM反应与2个对照组进行了比较：不服用阿片类药物的纤维肌痛患者（n=33，非阿片类药物FM），和健康对照（n=31）。对于时间求和测量，我们对前臂腹侧施加了一系列10个有害的热刺激（敏感性调节温度）（每个刺激的持续时间为2s，每3秒应用一次)。此外,我们收集了对标准疼痛和认知-情感问卷的回答,以评估疼痛严重程度和其他因素.
■观察到灵敏度调节刺激温度的组差异，只有非阿片类FM组需要显著较低的刺激温度（阿片类FM组也需要较低的温度，但与对照组没有显着差异）。然而,所有3组表现出相似的时间总和。跨组合FM组，时间总和与疼痛严重程度呈负相关(r=-0.31,p=0.021)。在阿片类药物FM组中，对热的疼痛敏感性更高(即较低的灵敏度调节温度）与较高的阿片类药物剂量呈趋势关系（r=-0.45，p=0.036），可能反映阿片类药物相关的痛觉过敏。我们的发现还表明，疼痛严重程度升高可能会使敏感性调整后的时间总和产生偏差，从而限制了其用于测量中央敏化的用途。总的来说,在服用阿片类药物的参与者中，时间总和可能受到对热痛的超敏反应的影响，这似乎随阿片类药物剂量而变化。
