治疗慢性非癌症疼痛的阿片类药物:系统性审查和元分析
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
概括
在慢性非癌症疼痛中,阿片类药物可缓解疼痛和改善身体功能,但会增加吐的风险. 益处可能与非阿片类止痛药相似,但证据质量不同.
科学领域:
- 治疗疼痛
- 药理学
- 临床试验
背景情况:
- 治疗慢性非癌症疼痛的阿片类止痛药的有效性和安全性尚未得到充分证实.
- 了解阿片类药物与非阿片类药物的有效性对临床决策至关重要.
研究的目的:
- 系统地审查随机临床试验 (RCT),评估阿片类药物对慢性非癌症疼痛的有效性和危害.
- 将阿片类药物与安慰剂和各种非阿片类药物的作用进行比较.
主要方法:
- 在多个数据库 (CENTRAL,CINAHL,EMBASE,MEDLINE,AMED,PsycINFO) 进行了对RCT的全面搜索.
- 数据由配对审查者独立提取,分析采用随机效应模型.
- 使用推评估,开发和评估 (GRADE) 框架来评估证据的质量.
主要成果:
- 包括包括26169名参与者的96个RCT,涵盖神经性疼痛,感觉性疼痛和中央敏感性.
- 与安慰剂相比,阿片类药物对疼痛强度 (WMD: - 0. 69厘米) 和身体功能 (WMD: 2. 04分) 的改善具有统计学意义,尽管很小.
- 与安慰剂相比,阿片类药物的使用与吐的发生率更高 (5. 9% 与 2. 3% 相比).
结论:
- 高质量的证据表明,阿片类药物对慢性非癌症疼痛和身体功能提供了适度的益处,但增加了吐的风险.
- 低到中等质量的证据表明,阿片类药物对疼痛和功能的益处可能与非类固醇抗炎药物,三环抗抑郁药物和抗药物相比较.
- 需要进一步进行高质量的研究,以澄清阿片类药物的长期比较有效性和安全性.
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