Opioids in chronic non-cancer pain: systematic review of efficacy and safety
Opioids in chronic non-cancer pain: systematic review of efficacy and safety
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DOI：
10.1016/j.pain.2004.09.019
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发表时间：
2004-12-01
期刊：
影响因子：
7.4
通讯作者：
McQuay, HJ
中科院分区：
文献类型：
--
作者：
Kalso, E;Edwards, JE;McQuay, HJ
阿片类药物越来越多地用于治疗慢性非癌症疼痛。其长期使用的有效性和安全性存在争议。我们分析了可用的关于WHO Step 3阿片类药物治疗慢性非癌性疼痛的随机、安慰剂对照试验。检索牛津疼痛缓解数据库(1950-1994)、Medline、EMBASE和Cochrane图书馆，直到2003年9月。纳入标准为世界卫生组织第三步阿片类药物与安慰剂在慢性非癌症疼痛中的随机比较。使用有效的疼痛等级报告疼痛强度结果的双盲研究包括在内。15个随机的安慰剂对照试验包括在内。4项研究对120名患者进行了静脉阿片试验。11项研究(1025名患者)将口服阿片类药物与安慰剂进行了四天至八周的比较。在15项纳入试验中，有6项进行了6-24个月的开放式标签随访。在大多数研究中，使用阿片类药物后疼痛强度平均下降至少30%，在神经性和肌肉骨骼疼痛方面类似。大约80%的患者至少经历过一次不良事件，其中便秘(41%)、恶心(32%)和嗜睡(29%)最为常见。接受开放标签治疗的388名患者中，只有44%在治疗7至24个月后仍在服用阿片类药物。阿片类药物在神经病理性和肌肉骨骼疼痛方面的短期疗效都很好。然而，在这些研究中，只有少数患者继续使用阿片类药物进行长期治疗。选定的患者数量较少，随访时间较短，因此无法就耐受性和成瘾等问题得出结论。(C)2004年国际疼痛研究协会。爱思唯尔出版，版权所有。
Opioids are used increasingly for chronic non-cancer pain. Controversy exists about their effectiveness and safety with long-term use. We analysed available randomised, placebo-controlled trials of WHO step 3 opioids for efficacy and safety in chronic non-cancer pain. The Oxford Pain Relief Database (1950-1994) and Medline, EMBASE and the Cochrane Library were searched until September 2003. Inclusion criteria were randomised comparisons of WHO step 3 opioids with placebo in chronic non-cancer pain. Double-blind studies reporting on pain intensity outcomes using validated pain scales were included. Fifteen randomised placebo-controlled trials were included. Four investigations with 120 patients studied intravenous opioid testing. Eleven studies (1025 patients) compared oral opioids with placebo for four days to eight weeks. Six of the 15 included trials had an open label follow-up of 6-24 months. The mean decrease in pain intensity in most studies was at least 30% with opioids and was comparable in neuropathic and musculoskeletal pain. About 80% of patients experienced at least one adverse event, with constipation (41%), nausea (32%) and somnolence (29%) being most common. Only 44% of 388 patients on open label treatments were still on opioids after therapy for between 7 and 24 months. The short-term efficacy of opioids was good in both neuropathic and musculoskeletal pain conditions. However, only a minority of patients in these studies went on to long-term management with opioids. The small number of selected patients and the short follow-ups do not allow conclusions concerning problems such as tolerance and addiction. (C) 2004 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.