TY - JOUR

T1 - A Double-blind, Placebo-controlled Study on the Effect of Buprenorphine and Fentanyl on Descending Pain Modulation: A Human Experimental Study

AU - Arendt-Nielsen, Lars

AU - Andresen, Trine

AU - Paludan Malver, Lasse

AU - Oksche, Alexander

AU - Mansikka, Heikki

AU - Drewes, Asbjørn M

PY - 2012

Y1 - 2012

N2 - OBJECTIVES:: The descending pain inhibitory system is impaired in chronic pain and it is important to know how analgesics interact with this system. The aim of this human experimental pain, double-blind, randomized, placebo-controlled, 3 way cross-over study was to investigate the effect of 2 different opioids on descending pain inhibition using conditioning pain modulation (CPM) as a screening tool. METHODS:: Twenty-two healthy male volunteers were randomized to 72 hours of treatment with transdermal patches of fentanyl (25 μg/h), buprenorphine (20 μg/h), or placebo. The CPM was induced by immersing the hand into cold (3.0±0.3°C) water and the evoked pain was continuously rated on a visual analogue scale (VAS). The test stimulus [pressure pain tolerance threshold (PPTol)] was applied to the contra-lateral arm. The CPM test was performed at baseline, 24, 48, and 72 hours after application of the patches. RESULTS:: The opioid treatments did not significantly (F=2.249; P=0.07) modulate the PPTol over the treatment period compared with placebo. The CPM-evoked PPTol increases (percentage increase from what was obtained at the baseline before patch application) were significantly enhanced by buprenorphine (P=0.004) and fentanyl (P=0.005) compared with placebo, with no differences between the 2 active drugs. Fentanyl significantly attenuated the time to cold water-evoked VAS peak compared with placebo (P=0.005), and the same trend was observed for buprenorphine (P=0.06). The VAS pain intensity was not affected. DISCUSSION:: The opioids buprenorphine and fentanyl significantly potentiate the effect of descending pain inhibition in healthy volunteers.

AB - OBJECTIVES:: The descending pain inhibitory system is impaired in chronic pain and it is important to know how analgesics interact with this system. The aim of this human experimental pain, double-blind, randomized, placebo-controlled, 3 way cross-over study was to investigate the effect of 2 different opioids on descending pain inhibition using conditioning pain modulation (CPM) as a screening tool. METHODS:: Twenty-two healthy male volunteers were randomized to 72 hours of treatment with transdermal patches of fentanyl (25 μg/h), buprenorphine (20 μg/h), or placebo. The CPM was induced by immersing the hand into cold (3.0±0.3°C) water and the evoked pain was continuously rated on a visual analogue scale (VAS). The test stimulus [pressure pain tolerance threshold (PPTol)] was applied to the contra-lateral arm. The CPM test was performed at baseline, 24, 48, and 72 hours after application of the patches. RESULTS:: The opioid treatments did not significantly (F=2.249; P=0.07) modulate the PPTol over the treatment period compared with placebo. The CPM-evoked PPTol increases (percentage increase from what was obtained at the baseline before patch application) were significantly enhanced by buprenorphine (P=0.004) and fentanyl (P=0.005) compared with placebo, with no differences between the 2 active drugs. Fentanyl significantly attenuated the time to cold water-evoked VAS peak compared with placebo (P=0.005), and the same trend was observed for buprenorphine (P=0.06). The VAS pain intensity was not affected. DISCUSSION:: The opioids buprenorphine and fentanyl significantly potentiate the effect of descending pain inhibition in healthy volunteers.

U2 - 10.1097/AJP.0b013e31823e15cb

DO - 10.1097/AJP.0b013e31823e15cb

M3 - Journal article

C2 - 22156892

VL - 28

SP - 623

EP - 627

JO - The Clinical Journal of Pain

JF - The Clinical Journal of Pain

SN - 0749-8047

IS - 7

ER -