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BMJ:减少阿片类药物剂量治疗对慢性非癌症疼痛的干预效果

2022-04-06 MedSci原创 MedSci原创

减少长期阿片类药物治疗慢性疼痛的证据仍然受到研究方法学的限制。特别令人关注的是,缺乏与可能危害相关的证据。迫切需要制订和报告关于减少阿片类药物治疗研究的商定标准。

在阿片类药物治疗的危害大于益处的情况下,为慢性非癌症疼痛患者开出了阿片类药物的过量处方,导致最近颁布了建议减少或停止长期阿片类药物治疗的指南

近日,顶级杂志BMJ上发表了一篇研究文章,研究人员旨在评估减少慢性非癌性疼痛患者长期阿片类药物治疗的干预措施,同时考虑了剂量减少和停药、疼痛、功能、生活质量、戒断症状、药物使用和不良事件的疗效。研究人员对干预措施的随机对照试验和非随机研究进行了系统回顾和荟萃分析。数据来源于Medline、Embase、PsycINFO、CINAHL和Cochrane图书馆,检索时间从数据库成立到2021年7月。研究人员还检索了参考文献和以往的评论。研究人员选择了英文原创研究。病例报告和横断面研究被排除在外。

两名研究者独立选择研究,提取数据,并在随机和非随机研究中使用Cochrane偏倚风险工具(RoB2和ROBINS-I)。研究者将干预措施分为五类(疼痛自我管理、补充和替代医学、药理学和生物医学设备和干预措施、阿片类药物替代治疗和减压方法),使用随机效应荟萃分析模型估计汇总效应,并使用GRADE(建议分级、评估、发展和评价)评估证据的确定性。

在166项符合纳入标准的研究中,130项(78%)被认为存在严重偏倚风险,并被排除在证据综合之外。在纳入的36项研究中,很少有对照的治疗组,样本量通常较小。因此,证据的确定性都很低或极低。尽管存在这些局限性,但适度确定性的证据表明,支持处方者遵守指南的干预措施增加了患者停用阿片类药物治疗的可能性(调整后的比值比为1.5,95%置信区间为1.0至2.1),这些处方者干预以及疼痛自我管理项目比对照组减少阿片类药物的剂量更多(干预 vs 对照组,平均差异为-6.8mg(标准误差为1.6)每日口服吗啡当量,P<0.001;疼痛方案 vs. 对照者,−14.31mg每日口服吗啡当量,95%置信区间为−21.57至−7.05)。

由此可见,减少长期阿片类药物治疗慢性疼痛的证据仍然受到研究方法学的限制。特别令人关注的是,缺乏与可能危害相关的证据。迫切需要制订和报告关于减少阿片类药物治疗研究的商定标准。

原始出处:

Nicholas Avery,et al.Efficacy of interventions to reduce long term opioid treatment for chronic non-cancer pain: systematic review and meta-analysis.BMJ.2022;https://www.bmj.com/content/377/bmj-2021-066375

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    2023-03-08 gaoxiaoe
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    2022-12-23 sunyl07
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    2022-04-07 lhlxtx
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JMCP:酒精滥用或患有慢性非癌症疼痛的长期阿片样物质使用者的疾病负担

慢性非癌症患者(CNCP)患者的药物滥用增加了临床治疗挑战和经济负担。尽管有潜在的风险,一些具有酒精滥用或依赖史(AAD)和非阿片类药物治疗难治的CNCP患者仍然可能需要阿片类药物进行疼痛管理。然而,缺乏CNCP长期阿片类药物使用者的不良后果资料,以及药物滥用或AAD史。将长期服用阿片类药物治疗的CNCP患者不良事件和全因医疗费用与是否之前有过AAD比较。

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