Impact of opioid rescue medication for breakthrough pain on the efficacy and tolerability of long-acting opioids in patients with chronic non-malignant pain.
Impact of opioid rescue medication for breakthrough pain on the efficacy and tolerability of long-acting opioids in patients with chronic non-malignant pain.
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DOI：
10.1093/bja/aep253
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发表时间：
2009-10
影响因子：
9.8
通讯作者：
Wiggett H
中科院分区：
文献类型：
--
作者：
Devulder J;Jacobs A;Richarz U;Wiggett H
几乎没有证据表明短效阿片类药物作为突破性疼痛的救援药物是慢性非恶性疼痛的最佳长期治疗策略。我们比较了允许短效阿片类药物救援的长效阿片类药物与不允许短效阿片类药物救援的长效阿片类药物的临床研究，以确定阿片类药物救援使用对慢性非恶性疼痛患者慢性阿片类药物治疗的镇痛疗效和耐受性的影响。我们检索MEDLINE（1950年至2006年7月）和EMBASE（1974年至2006年7月），使用慢性非恶性疼痛和长效阿片类药物的术语。对检索结果的独立审查确定了48项符合研究选择标准的研究。采用meta回归分析阿片类药物抢救用药对镇痛疗效和常见阿片类药物副作用发生率的影响。在调整了潜在的混杂变量（研究设计和阿片类药物类型）后，“抢救”和“无抢救”研究之间的镇痛疗效差异不显著，回归系数接近0和95%置信区间，排除了每种情况在0 - 100量表上超过18分的影响。在未调整和调整的分析中，“抢救”和“无抢救”研究中恶心、便秘或嗜睡的发生率也没有显著差异。我们没有发现短效阿片类药物用于突破性疼痛的救援药物会影响长效阿片类药物的镇痛效果或慢性非恶性疼痛患者常见阿片类药物相关副作用的发生率。
There is little evidence that short-acting opioids as rescue medication for breakthrough pain is an optimal long-term treatment strategy in chronic non-malignant pain. We compared clinical studies of long-acting opioids that allowed short-acting opioid rescue medication with those that did not, to determine the impact of opioid rescue medication use on the analgesic efficacy and tolerability of chronic opioid therapy in patients with chronic non-malignant pain. We searched MEDLINE (1950 to July 2006) and EMBASE (1974 to July 2006) using terms for chronic non-malignant pain and long-acting opioids. Independent review of the search results identified 48 studies that met the study selection criteria. The effect of opioid rescue medication on analgesic efficacy and the incidence of common opioid-related side-effects were analysed using meta-regression. After adjusting for potentially confounding variables (study design and type of opioid), the difference in analgesic efficacy between the ‘rescue’ and the ‘no rescue’ studies was not significant, with regression coefficients close to 0 and 95% confidence intervals that excluded an effect of more than 18 points on a 0–100 scale in each case. There was also no significant difference between the ‘rescue’ and the ‘no rescue’ studies for the incidence of nausea, constipation, or somnolence in both the unadjusted and the adjusted analyses. We found no evidence that rescue medication with short-acting opioids for breakthrough pain affects analgesic efficacy of long-acting opioids or the incidence of common opioid-related side-effects among chronic non-malignant pain patients.
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影响因子：
7.4
作者：
Kalso, E;Edwards, JE;McQuay, HJ
通讯作者：
McQuay, HJ
影响因子：
3
作者：
Jamison, RN;Raymond, SA;Katz, NP
通讯作者：
Katz, NP
影响因子：
7.4
作者：
ARKINSTALL, W;SANDLER, A;DARKE, AC
通讯作者：
DARKE, AC
影响因子：
3.6
作者：
Jage, J
通讯作者：
Jage, J
影响因子：
4.7
作者：
Babul, N;Noveck, R;Albert, K
通讯作者：
Albert, K