Antinociceptive effects of high dose remifentanil in male methadone-maintained patients
Date
2008
Authors
Hay, J.
White, J.
Bochner, F.
Somogyi, A.
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Journal Title
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Volume Title
Type:
Journal article
Citation
European Journal of Pain, 2008; 12(7):926-933
Statement of Responsibility
Justin L. Hay, Jason M. White, Felix Bochner and Andrew A. Somogyi
Conference Name
Abstract
The treatment of acute pain in patients maintained on methadone is difficult due to increased pain sensitivity (hyperalgesia) and cross-tolerance to other opioids. This study aimed to investigate whether remifentanil elicits antinociception in methadone-maintained subjects in a dose-dependent manner. Eight chronic methadone-maintained subjects attended the testing session approximately 20h after their normal methadone dose (range 50-110mgday−1). Following a 20min saline infusion, subjects were administered intravenous remifentanil in seven increasing doses ranging from 0.5 to 3.5μgkg−1min−1, each for 20min. Testing was performed in the last 10 min of each infusion. The testing measures included nociception, as measured by the cold pressor test, withdrawal using the subjective opiate withdrawal scale (SOWS), and subjective opioid effects using the morphine-benzedrine group scale (MBG). Results showed dose-dependent increase in cold pressor tolerance time from baseline of 15.6±3.5 (mean±SEM)s up to 77.3±24.7s during this dosing protocol. During the infusion typical μ-opioid receptor agonist side effects were observed, but with no withdrawal. Methadone-maintained patients demonstrate significant tolerance to remifentanil and may require opioid doses 20-30 higher than required for the treatment of acute pain in opioid-naïve patients.
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Dissertation Note
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Copyright © 2008 European Federation of Chapters of the International Association for the Study of Pain Published by Elsevier Ltd.
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Copyright 2008 Elsevier