在干预性疼痛试验中量化同时使用止痛药的影响:一项超流行病学研究
Balaji V Sridhar1, Andrew Humbert2,3, Adam Babitts2
1Department of Occupational and Environmental Medicine, University of Washington, Seattle, WA 98105, United States.
Pain medicine (Malden, Mass.)
|May 26, 2025
概括
大多数疼痛治疗试验报告同时使用止痛药,但很少考虑它. 为止痛药使用的调整显著增加了对疼痛强度的预计治疗效果.
科学领域:
- 疼痛管理研究 疼痛管理研究
- 临床试验方法论 临床试验方法论
- 基于证据的医学是基于证据的医学.
背景情况:
- 疼痛治疗中适度的效果大小需要强大的随机对照试验 (RCT) 方法.
- 在疼痛研究中,定义治疗效果和对并发治疗的解释至关重要.
研究的目的:
- 评估干预性疼痛RCT中同时使用止痛药的报告频率.
- 评估计算止痛药使用对疼痛强度结果估计的影响.
主要方法:
- 对37个非手术性干预性疼痛RCT进行了超流行病学研究.
- 同时使用止痛药的分析报告方法.
- 用QPAC1.5结果比较治疗效果的元分析,并未对止痛药进行调整.
主要成果:
- 大约50%的RCT报告了同时使用止痛药;只有一个试验在结果中考虑了它.
- 通过QPAC1.5分析计算并发止痛药,估计干预对疼痛强度的影响平均增加了-0.45分 (数值评分表).
- 这种调整显著影响了治疗效果大小 (95% CI -0.76至 -0.14; P < 0.001).
结论:
- 同时使用止痛药的报道不一致,并且很少被纳入RCT的疼痛强度结果分析中.
- 考虑到同时使用止痛药在疼痛中的RCT,可以大大改变估计的治疗效果.
- 这种调整可能会减轻止痛药的混作用,从而导致更准确的治疗效果大小.
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