Kratom: a primer for pain physicians.

IF 2.3 3区 医学 Q2 ANESTHESIOLOGY
Current Opinion in Anesthesiology Pub Date : 2024-10-01 Epub Date: 2024-07-08 DOI:10.1097/ACO.0000000000001413
Trent Emerick, Shravani Durbhakula, Maria R Eibel, Lynn Kohan
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引用次数: 0

Abstract

Purpose of review: Kratom is used commonly in the United States, usually to mitigate pain, opioid withdrawal, or fatigue. A comprehensive discussion on kratom, tailored to pain management physicians, is needed, given its associated risks and potential interactions.

Recent findings: Kratom and its main metabolites, mitragynine and 7-OH-mitragynine, bind to a variety of receptors including mu opioid receptors. Still, kratom cannot be described as a classic opioid. Kratom has been utilized without FDA approval as an alternative to traditional medications for opioid use disorder and opioid withdrawal. Lower doses of kratom typically cause opioid-like effects while higher doses can have sedating effects. Tolerance, dependence and withdrawal still occur, although kratom withdrawal appears to be more moderate than opioid withdrawal. Contamination with heavy metals and biological toxins is concerning and there is potential for serious complications, including seizures and death.

Summary: The use of kratom as an opioid-sparing alternative as a part of a multimodal pain regimen is not without significant risks. It is of utmost importance for pain physicians to be aware of the risks and adverse effects associated with kratom use.

桔梗:疼痛科医生入门指南。
审查目的:Kratom 在美国很常用,通常用于减轻疼痛、阿片类药物戒断或疲劳。鉴于桔梗的相关风险和潜在相互作用,需要针对疼痛治疗医生对桔梗进行全面讨论:最近的研究发现:桔梗及其主要代谢物米曲宁和 7-OH-米曲宁可与多种受体结合,包括μ阿片受体。尽管如此,桔梗仍不能被称为典型的阿片类药物。Kratom 在未经美国食品及药物管理局批准的情况下被用作治疗阿片类药物使用障碍和阿片类药物戒断的传统药物替代品。较低剂量的 Kratom 通常会产生类似阿片类药物的效果,而较高剂量则会产生镇静效果。耐受性、依赖性和戒断性仍然会出现,但克瑞托姆的戒断性似乎比阿片类药物的戒断性更温和。重金属和生物毒素的污染令人担忧,而且有可能出现严重的并发症,包括癫痫发作和死亡。对于疼痛科医生来说,了解与使用 kratom 相关的风险和不良反应至关重要。
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来源期刊
CiteScore
4.90
自引率
8.00%
发文量
207
审稿时长
12 months
期刊介绍: ​​​​​​​​Published bimonthly and offering a unique and wide ranging perspective on the key developments in the field, each issue of Current Opinion in Anesthesiology features hand-picked review articles from our team of expert editors. With fifteen disciplines published across the year – including cardiovascular anesthesiology, neuroanesthesia and pain medicine – every issue also contains annotated references detailing the merits of the most important papers.
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