治疗急性疼痛的新型阿片类药物/普拉克索联合疗法:一项试点研究。

IF 2.5 Q2 CLINICAL NEUROLOGY Frontiers in pain research (Lausanne, Switzerland) Pub Date : 2024-09-24 eCollection Date: 2024-01-01 DOI:10.3389/fpain.2024.1422298
Cara Girardi, Joseph Duronio, Ryan Patton, Kevin O'Brien, Stefan Clemens, Kori L Brewer
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引用次数: 0

摘要

目的:尽管阿片类药物具有危险的副作用,但它仍然是治疗中度至重度疼痛的标准药物,几乎没有替代药物。我们需要一种既能保持阿片类药物镇痛效果,又能将相关风险降至最低的策略。临床前研究表明,使用多巴胺 3 受体(D3R)激动剂作为吗啡的辅助药物,可提供比单独使用吗啡更优越的疼痛刺激镇痛效果。我们的目的是测试 D3R 受体激动剂的辅助治疗能否在保持有效镇痛的同时减少阿片类药物的使用:本研究为双盲、安慰剂对照随机试验。研究对象包括急诊科的急性肾绞痛患者,患者被随机分配到 "对照组 "或 "研究组"。对照组接受标准治疗(吗啡,0.1 毫克/千克;静脉注射)和口服安慰剂。实验组接受半剂量吗啡和口服普拉克索丸(0.25 毫克)。在基线和随后每隔 15 分钟对参加者进行疼痛测量,包括疼痛数字量表和视觉模拟量表:共有 19 名患者完成了研究,其中实验组 10 人,对照组 9 人。在研究期间,80% 的实验组患者实现了有效镇痛(比基线下降 50%),而对照组仅为 33.3%:我们的试点临床试验证明,D3R招募可作为低剂量吗啡的有效辅助药物,用于控制肾绞痛以及其他潜在的急性疼痛:临床试验注册:ClinicalTrials.gov,标识符(NCT04160520)。
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A novel opioid/pramipexole combination treatment for the management of acute pain: a pilot study.

Purpose: Despite their dangerous side effects, opioid drugs remain a standard of care for moderate to severe pain with few alternatives. Strategies to maintain the analgesic effects of opioids while minimizing the associated risks are needed. Pre-clinical studies have shown using a dopamine 3 receptor (D3R) agonist as an adjuvant to morphine provides superior analgesia against painful stimuli compared to morphine alone. Our objective was to test if adjunct treatment with a D3R agonist can lead to a reduction in opioid use while maintaining effective analgesia.

Patients and methods: This study was set up as a double-blinded, placebo-controlled randomized trial. Enrollment included acute renal colic patients presenting to the emergency department, from which patients were randomized to either the "control" or "study arm". The control group received standard treatment of care (morphine, 0.1 mg/kg; i.v.) and an oral placebo pill. The experimental group received half-dosed morphine and oral pramipexole pill (0.25 mg). Pain measurements including a numerical pain scale and visual analog scale were collected from enrollees at baseline and every subsequent 15 min.

Results: A total of 19 patients completed the study, 10 in the experimental arm and 9 in the control arm. During the study period, effective analgesia (50% decrease from baseline) was achieved in 80% of patients in the experimental arm vs. 33.3% in the control arm.

Conclusion: Our pilot clinical trial demonstrated that D3R recruitment can serve as an effective adjuvant to low-dose morphine for control of renal colic pain and potentially other acute pain conditions.

Clinical trial registration: ClinicalTrials.gov, identifier, (NCT04160520).

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