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Opioids for Chronic Noncancer Pain: A Systematic Review and Meta-analysis.


ABSTRACT:

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, -0.82 to -0.56 cm] on a 10-cm visual analog scale for pain; modeled risk difference for achieving the MID, 11.9% [95% CI, 9.7% to 14.1%]), improved physical functioning (WMD, 2.04 points [95% CI, 1.41 to 2.68 points] on the 100-point SF-36 PCS; modeled risk difference for achieving the MID, 8.5% [95% CI, 5.9% to 11.2%]), and increased vomiting (5.9% with opioids vs 2.3% with placebo for trials that excluded patients with adverse events during a run-in period). Low- to moderate-quality evidence suggested similar associations of opioids with improvements in pain and physical functioning compared with nonsteroidal anti-inflammatory drugs (pain: WMD, -0.60 cm [95% CI, -1.54 to 0.34 cm]; physical functioning: WMD, -0.90 points [95% CI, -2.69 to 0.89 points]), tricyclic antidepressants (pain: WMD, -0.13 cm [95% CI, -0.99 to 0.74 cm]; physical functioning: WMD, -5.31 points [95% CI, -13.77 to 3.14 points]), and anticonvulsants (pain: WMD, -0.90 cm [95% CI, -1.65 to -0.14 cm]; physical functioning: WMD, 0.45 points [95% CI, -5.77 to 6.66 points]).

Conclusions and relevance

In this meta-analysis of RCTs of patients with chronic noncancer pain, evidence from high-quality studies showed that opioid use was associated with statistically significant but small improvements in pain and physical functioning, and increased risk of vomiting compared with placebo. Comparisons of opioids with nonopioid alternatives suggested that the benefit for pain and functioning may be similar, although the evidence was from studies of only low to moderate quality.

SUBMITTER: Busse JW 

PROVIDER: S-EPMC6583638 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Publications

Opioids for Chronic Noncancer Pain: A Systematic Review and Meta-analysis.

Busse Jason W JW   Wang Li L   Kamaleldin Mostafa M   Craigie Samantha S   Riva John J JJ   Montoya Luis L   Mulla Sohail M SM   Lopes Luciane C LC   Vogel Nicole N   Chen Eric E   Kirmayr Karin K   De Oliveira Kyle K   Olivieri Lori L   Kaushal Alka A   Chaparro Luis E LE   Oyberman Inna I   Agarwal Arnav A   Couban Rachel R   Tsoi Ludwig L   Lam Tommy T   Vandvik Per Olav PO   Hsu Sandy S   Bala Malgorzata M MM   Schandelmaier Stefan S   Scheidecker Anne A   Ebrahim Shanil S   Ashoorion Vahid V   Rehman Yasir Y   Hong Patrick J PJ   Ross Stephanie S   Johnston Bradley C BC   Kunz Regina R   Sun Xin X   Buckley Norman N   Sessler Daniel I DI   Guyatt Gordon H GH  

JAMA 20181201 23


<h4>Importance</h4>Harms and benefits of opioids for chronic noncancer pain remain unclear.<h4>Objective</h4>To systematically review randomized clinical trials (RCTs) of opioids for chronic noncancer pain.<h4>Data sources and study selection</h4>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.<h4>Data extraction and synthesis</h4>Paired reviewers independently  ...[more]

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