慢性非がん性疼痛に対するオピオイド: 系統的レビューとメタ解析
Jason W Busse1,2,3,4, Li Wang1,2,5, Mostafa Kamaleldin6
1Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada.
JAMA
|December 19, 2018
まとめ
オピオイドは慢性的な非がん性疼痛の痛みや身体機能に わずかな改善をもたらしますが 嘔吐のリスクを高めます 効果は非オピオイドの鎮痛剤と似ているが,証拠の質は異なる.
科学分野:
- 痛みの管理
- 薬理学について
- 臨床試験
背景:
- 慢性非がん性疼痛に対するオピオイド鎮痛剤の有効性と安全性は十分に確立されていません.
- オピオイドと非オピオイドの代替品の比較効果を理解することは,臨床的意思決定において極めて重要です.
研究 の 目的:
- 慢性非がん性疼痛に対するオピオイドの効果と害を評価するランダム化臨床試験 (RCT) を体系的に検討する.
- オピオイドの効果とプラセボの効果を比較する
主な方法:
- 多数のデータベース (CENTRAL,CINAHL,EMBASE,MEDLINE,AMED,PsycINFO) で,RCTに関する包括的な検索が行われました.
- データはペアリングされたレビュー者によって独立に抽出され,分析はランダム効果モデルを使用した.
- 証拠の質を評価するために,勧告の評価,開発,評価の格付け (GRADE) フレームワークが使用されました.
主要な成果:
- 26, 169人の参加者を含む96のRCTが含まれており,神経疾患の痛み,痛覚性疼痛,および中枢感受性に関するものであった.
- オピオイドは,プラセボと比較して,痛みの強度 (WMD: - 0. 69cm) と身体機能 (WMD: 2. 04ポイント) の統計的に有意な改善を示した.
- オピオイドの使用は,プラセボと比較して嘔吐の発生率が高かった (5. 9% 対 2. 3%).
結論:
- オピオイドは慢性的な非癌性痛の痛みや身体機能に わずかな効果があることを示していますが 嘔吐のリスクを高めています
- オピオイドの痛みと機能に対する効果は,非ステロイド性抗炎症薬,三輪性抗うつ薬,抗発作薬に匹敵する可能性があると,低から中程度の品質の証拠が示唆しています.
- この患者集団におけるオピオイドの長期的な比較効果と安全性を明らかにするために,さらに質の高い研究が必要である.
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