Opioid reduction for patients with chronic pain in primary care: systematic review.
Opioid reduction for patients with chronic pain in primary care: systematic review.
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DOI：
10.3399/bjgp.2021.0537
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发表时间：
2022-04
期刊：
影响因子：
--
通讯作者：
Koes B
中科院分区：
文献类型：
--
作者：
de Kleijn L;Pedersen JR;Rijkels-Otters H;Chiarotto A;Koes B
长期阿片类药物治疗慢性疼痛患者往往是无效的，并可能有害。这些患者通常由全科医生管理，他们呼吁对初级保健的有效阿片类药物减少策略进行明确概述。评估长期阿片类药物治疗对慢性疼痛患者初级保健中阿片类药物减少策略的有效性。对从开办之日至2021年1月15日在初级保健领域开展的对照试验和队列研究进行系统评价。文献检索：EMBASE， MEDLINE, Web of Science, Cochrane Central Register of Controlled Trials， CINAHL，谷歌Scholar， PsycINFO。包括评估阿片类药物减少干预措施适用于成人长期阿片类药物治疗慢性非癌性疼痛的初级保健的研究。使用Cochrane风险-偏倚工具（版本2）（RoB 2）或非随机干预研究的偏倚风险（ROBINS-I）工具评估偏倚风险。由于研究设计和干预类型的临床异质性，进行了叙事综合。共纳入5项随机对照试验（rct）和5项队列研究（N = 1717，范围N = 35至N = 985），探索各种阿片类药物减少策略。其中，6项研究有高/临界RoB， 3项研究有中度RoB， 1项研究有低RoB。三个队列研究：调查gp监督的阿片类药物减少（临界ROBINS-I），综合疼痛治疗（中度ROBINS-I）和团体医疗就诊（临界ROBINS-I）显示组间阿片类药物显著减少。结果谨慎地指出了GP监督逐渐减少和多学科小组治疗会议的方向，以减少长期阿片类药物治疗。然而，由于偏倚风险高，样本量小，没有明确的结论可以证明需要更多的高质量研究。
Long-term opioid treatment in patients with chronic pain is often ineffective and possibly harmful. These patients are often managed by GPs who are calling for a clear overview of effective opioid reduction strategies for primary care. To evaluate effectiveness of opioid reduction strategies applicable in primary care for patients with chronic pain on long-term opioid treatment. Systematic review of controlled trials and cohort studies performed in primary care from inception date to 15 January 2021. Literature search conducted in EMBASE, MEDLINE, Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, Google Scholar, and PsycINFO. Studies evaluating opioid reduction interventions applicable in primary care among adults on long-term opioid treatment for chronic non-cancer pain were included. Risk of bias was assessed using the Cochrane risk-of-bias tool (version 2) (RoB 2) or the Risk of bias in non-randomized studies — of interventions (ROBINS-I) tool. Narrative synthesis was performed because of clinical heterogeneity in study designs and types of interventions. In total, five randomised controlled trials (RCTs) and five cohort studies were included (N = 1717, range n = 35 to n = 985) exploring various opioid reduction strategies. Of these, six studies had high/critical RoB, three moderate RoB, and one low RoB. Three cohort studies: investigating a GP-supervised opioid taper (critical ROBINS-I), an integrative pain treatment (moderate ROBINS-I), and group medical visits (critical ROBINS-I) demonstrated significant between-group opioid reduction. Results carefully point in the direction of a GP supervised tapering and multidisciplinary group therapeutic sessions to reduce long-term opioid treatment. However, because of high risk of bias and small sample sizes, no firm conclusions can be made demonstrating the need for more high-quality research.
影响因子：
2.9
作者：
Manchira Krishnan S;Gc VS;Sandhu HK;Underwood M;Eldabe S;Manca A;Iglesias Urrutia CP;I-WOTCH team
通讯作者：
I-WOTCH team