Opioid Taper is Associated with Improved Experimental Pain Tolerance in Patients with Chronic Pain: An Observational Study.
Chronic pain
Cold-pressor test
Opioid
Quantitative sensory testing
Taper
Journal
Pain and therapy
ISSN: 2193-8237
Titre abrégé: Pain Ther
Pays: New Zealand
ID NLM: 101634491
Informations de publication
Date de publication:
Mar 2022
Mar 2022
Historique:
received:
05
11
2021
accepted:
10
12
2021
pubmed:
13
1
2022
medline:
13
1
2022
entrez:
12
1
2022
Statut:
ppublish
Résumé
The degree to which opioid-induced hyperalgesia contributes to the pain experience of patients with chronic pain remains relatively undescribed. The objective of this pilot study was to determine if experimental pain responses improve in patients with chronic pain as they undergo a planned opioid taper. This was a prospective observational study. Seven patients with chronic neuropathic pain on at least 120 mg morphine equivalents/day were enrolled. The participants were followed over the course of an individualized opioid taper to a lower dose. Measures of experimental pain sensitivity, including indicators of central pain modulation, were collected on a biweekly basis; in addition, measures of function and quality of life were collected monthly. The effect of opioid taper on pain responses and functional outcomes over time were examined using longitudinal mixed-effects regression modeling and general linear regression modeling with regularization as a function of baseline dose, end dose, and taper rate. In this small sample of patients undergoing highly individualized and variable opioid taper, the opioid taper was significantly associated with improved pain responses to the cold-pressor test, with the pain threshold on average increasing by 1.14 s every 6 weeks (p = 0.0084, 95% confidence interval [CI] for 6-week change 0.3039-2.0178) and pain tolerance on average increasing by 2.87 s every 6 weeks (p = 0.0026, 95% CI for 6-week change 1.02-4.7277). Taper-related changes in central pain modulation were not observed, although conditioned modulation trended toward improvement by the completion of opioid taper. Similarly, no declines in function and quality of life were observed with the opioid taper, suggesting stability despite decreased opioid dose. Opioid taper was associated with improvements in experimental pain responses without a decline in function and quality of life, suggestive of diminished opioid-induced hyperalgesia in this clinical sample. ClinicalTrials.gov identifier, NCT03912298.
Identifiants
pubmed: 35020185
doi: 10.1007/s40122-021-00348-8
pii: 10.1007/s40122-021-00348-8
pmc: PMC8753938
doi:
Banques de données
ClinicalTrials.gov
['NCT03912298']
Types de publication
Journal Article
Langues
eng
Pagination
303-313Subventions
Organisme : NINR NIH HHS
ID : F31 NR019527
Pays : United States
Organisme : NIDA NIH HHS
ID : R21 DA046364
Pays : United States
Organisme : NINR NIH HHS
ID : R21 NR019047
Pays : United States
Organisme : NIEHS NIH HHS
ID : T32 ES007062
Pays : United States
Informations de copyright
© 2022. The Author(s).
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