Opioids for Chronic Noncancer Pain

作者：Jason Walter Busse, Li Wang, Mostafa Kamaleldin, Samantha Craigie, John J. Riva, Luis Montoya, Sohail M. Mulla, Luciane Cruz Lopes, Nicole Vogel, Eric Yu Hai Chen, Karin Kirmayr, Kyle De Oliveira, Lori Olivieri, Alka Kaushal, Luis Enrique Chaparro, Inna Oyberman, Arnav Agarwal, Rachel Couban, Ludwig Tsoi, Tommy Tsz‐On Lam, Per Olav Vandvik, Sandy Chan Hsu, Małgorzata Maria Bała, Stefan Schandelmaier, Anne Scheidecker, Shanil Ebrahim, Vahid Ashoorion, Yasir Rehman, Patrick Jiho Hong, Stephanie A. Ross, Bradley C. Johnston, Regina Kunz, Xin Sun, Norman Buckley, Daniel I. Sessler, Gordon Henry Guyatt · 发表于：JAMA · 年份：2018 · DOI：10.1001/jama.2018.18472 · 被引用次数：735 · 研究领域：Opioid Use Disorder Treatment、Pain Management and Opioid Use、Pediatric Pain Management Techniques

Importance: Harms and benefits of opioids for chronic noncancer pain remain unclear. Objective: To systematically review randomized clinical trials (RCTs) of opioids for chronic noncancer pain. Data Sources and Study Selection: The databases of CENTRAL, CINAHL, EMBASE, MEDLINE, AMED, and PsycINFO were searched from inception to April 2018 for RCTs of opioids for chronic noncancer pain vs any nonopioid control. Data Extraction and Synthesis: Paired reviewers independently extracted data. The analyses used random-effects models and the Grading of Recommendations Assessment, Development and Evaluation to rate the quality of the evidence. Main Outcomes and Measures: The primary outcomes were pain intensity (score range, 0-10 cm on a visual analog scale for pain; lower is better and the minimally important difference [MID] is 1 cm), physical functioning (score range, 0-100 points on the 36-item Short Form physical component score [SF-36 PCS]; higher is better and the MID is 5 points), and incidence of vomiting. Results: Ninety-six RCTs including 26 169 participants (61% female; median age, 58 years [interquartile range, 51-61 years]) were included. Of the included studies, there were 25 trials of neuropathic pain, 32 trials of nociceptive pain, 33 trials of central sensitization (pain present in the absence of tissue damage), and 6 trials of mixed types of pain. Compared with placebo, opioid use was associated with reduced pain (weighted mean difference [WMD], -0.69 cm [95% CI, -0...