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Does mutual compensation of the cognitive effects induced by pain and opioids exist? An experimental study

Abstract

Rationale

Studies have demonstrated that both pain and opioids have actions on the central nervous system that may interfere with cognitive function, but their effects have mainly been analysed separately and not as an integrated process.

Objective

The objective of this study is to test two hypotheses: (1) the analgesic effect of opioids improves cognitive function by decreasing pain, and (2) pain antagonizes cognitive effects of opioids.

Methods

Randomized, placebo-controlled, crossover study. Three experiments were conducted with 22 healthy males. Sustained attention, memory and motor function/attention/mental flexibility were evaluated by continuous reaction time (CRT), verbal fluency test (VFT) and trail making test-B (TMT-B), respectively. In the 1st experiment, the cognitive effects of experimental tonic pain of mild and moderate intensities produced by a computer-controlled pneumatic tourniquet cuff were assessed; in the 2nd, the effects of saline solution and remifentanil were assessed in the absence of pain; and in the 3rd experiment, the cognitive effects of moderate pain intensity relieved by remifentanil infusion were assessed followed by increasing pain to moderate intensity during a constant remifentanil infusion.

Results

The first two experiments demonstrated that pain and remifentanil impaired CRT. In the 3rd experiment, remifentanil infusion relieving pain significantly impaired CRT and further deterioration was noted following increasing pain intensity.

Conclusion

Pain and remifentanil seemed to have additive deleterious cognitive effects. This study represents an initial step to enhance our basic understanding of some of the cognitive effects following a painful stimulus and an opioid infusion separately and combined in a sequence comparable to clinical settings.

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Acknowledgments

The study was supported by The Danish Cancer Society and The Danish Council for Strategic Research. The authors worked independently at all stages of the study, including the design, data collection, analysis, data interpretation, preparation and revision of the manuscript. In addition, the authors have full control of all primary data and agree to allow the journal to review their data if requested.

Conflict of interest

The authors declare no conflicts of interest related to this study.

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Correspondence to Geana Paula Kurita.

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Kurita, G.P., Malver, L.P., Andresen, T. et al. Does mutual compensation of the cognitive effects induced by pain and opioids exist? An experimental study. Psychopharmacology 232, 1373–1381 (2015). https://doi.org/10.1007/s00213-014-3768-y

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  • DOI: https://doi.org/10.1007/s00213-014-3768-y

Keywords

  • Analgesics
  • Opioid
  • Pain
  • Cognition
  • Attention
  • Experimental model