Clinical analgesia correlates with decline in temporal summation in response to remifentanil infusion in patients with chronic neuropathic (radicular) pain

Erica Suzan, PhD; Ayelet Midbari, MD; Dorit Pud, PhD; Salim Hadad, PhD; Elon Eisenberg, MD

doi:10.5055/jom.2016.0340

Authors

Erica Suzan, PhD
Ayelet Midbari, MD
Dorit Pud, PhD
Salim Hadad, PhD
Elon Eisenberg, MD

DOI:

https://doi.org/10.5055/jom.2016.0340

Keywords:

neuropathic pain, radicular pain, opioids, remifentanil, temporal summation

Abstract

Background: Animal studies have shown that in addition to their antinociceptive effects, opioids have attenuated the electrophysiological “wind-up” phenomenon. Although effects of opioids on clinical pain and on temporal summation (TS), the human correlatives of this phenomenon, have been tested repeatedly, correlations between these two parameters have not been reported so far.

Objectives: To search for possible correlations between the effects of remifentanil on clinical pain intensity and on the magnitude of TS in patients with chronic pain.

Design: A single-blinded prospective study.

Setting: A tertiary care pain clinic.

Patients: Thirty-one patients (24 men) with chronic lumbar (radicular) neuropathic pain.

Intervention: Intervenous administration of saline followed by remifentanil infusions.

Main Outcome Measures: Clinical pain intensity and thermal TS measured at baseline, during infusion of each drug and 20 minutes after termination of remifentnail infusion.

Results: Friedman test revealed statistically significant differences in the magnitudes of both clinical pain intensity and TS (χ2(3) = 73, p < 0.001 and χ2(3) = 11.38, p = 0.01, respectively). Post hoc analysis (Wilcoxon signed-rank test) showed significant differences between clinical pain intensities measured at all time points but significant reductions in the magnitudes of TS were found only during remifentanil compared to baseline (p = 0.014) and to saline (p = 0.019). The difference in clinical pain between saline and remifentanil positively correlated with the difference in TS measured at the same time points (Spearman's test; r = 0.444, p = 0.012).

Conclusions: These results point to a possible causative relationship between TS and opioid analgesia.

Author Biographies

Erica Suzan, PhD

The Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel

Ayelet Midbari, MD

Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel

Dorit Pud, PhD

Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.

Salim Hadad, PhD

Department of Pharmacy, Rambam Health Care Campus, Haifa, Israel

Elon Eisenberg, MD

The Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel

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