Opioide bei chronischem Kreuzschmerz

详细信息    查看全文

• 作者：F. Petzke ; P. Welsch ; P. Klose ; R. Schaefert ; C. Sommer ; PD Dr. W. H?user
• 关键词：Systematische übersichtsarbeit ; Metaanalyse ; Opioide ; Chronischer Rückenschmerz ; Systematic review ; Meta ; analysis ; Opioids ; Chronic low back pain
• 刊名：Der Schmerz
• 出版年：2015
• 出版时间：February 2015
• 年：2015
• 卷：29
• 期：1
• 页码：60-72
• 全文大小：840 KB
• 参考文献：1. Altman DG, Bland JM (2003) Interaction revisited: the difference between two estimates. BMJ 326(7382):219 CrossRef
  2. Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088-101 CrossRef
  3. Bundes?rztekammer (B?K), Kassen?rztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) (2010) Nationale VersorgungsLeitlinie Kreuzschmerz -Langfassung. Version?1.X. http://www.versorgungsleitlinien.de/themen/kreuzschmerz. Zugegriffen: 15.?August 2013
  4. Chaparro LE, Furlan AD, Deshpande A et?al (2013) Opioids compared to placebo or other treatments for chronic low-back pain. Cochrane Database Syst Rev 8:CD004959
  5. Chou R, Huffman LH (2007) Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med 147(7):505-14 CrossRef
  6. Chu LF, D’Arcy N, Brady C et?al (2012) Analgesic tolerance without demonstrable opioid-induced hyperalgesia: a double-blinded, randomized, placebo-controlled trial of sustained-release morphine for treatment of chronic nonradicular low-back pain. Pain 153(8):1583-592 CrossRef
  7. Cohen J (1988) Statistical power analysis for the behavioral sciences. Lawrence Erlbaum Associates, Hillsdale
  8. Egger M, Smith GD, Schneider M (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629-34 CrossRef
  9. Fayers PM, Hays RD (2014) Don’t middle your MIDs: regression to the mean shrinks estimates of minimally important differences. Qual Life Res 23(1):1- CrossRef
  10. Gordon A, Rashiq S, Moulin DE et?al (2010) Buprenorphine transdermal system for opioid therapy in patients with chronic low back pain. Pain Res Manag 15(3):169-78
  11. Guyatt GH, Oxman AD, Kunz R et?al (2008) Going from evidence to recommendations. BMJ 336(7652):1049-051 CrossRef
  12. H?user W, Bernardy K, Maier C (2014) Langzeitopioidtherapie bei chronischem nicht-tumorbedingtem Schmerz. Systematische übersicht und Metaanalyse der Wirksamkeit und Risiken in offenen Langzeitanschlussstudien über mindestens 26?Wochen. Schmerz. dx.doi.org/10.1007/s00482-014-1452-0
  13. Higgins JPT, Green S (o?J) Cochrane Handbook for systematic reviews of intervention. Version?5.1.0. http://handbook.cochrane.org/
  14. Kissin I (2013) Long-term opioid treatment of chronic nonmalignant pain: unproven efficacy and neglected safety? J?Pain Res 6:513-29
  15. Moher D, Liberati A, Teztlaff J et?al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 51:1-
  16. Moore AR, Eccleston C, Derry S et?al (2010) ?Evidence-in chronic pain—establishing best practice in the reporting of systematic reviews. Pain 150(3):386-89 CrossRef
  17. Moore RA, Derry S, Wiffen PJ (2013) Challenges in design and interpretation of chronic pain trials. Br J Anaesth 111(1):38-5 CrossRef
  18. Moulin DE, Lezzi A, Amireh R et?al (1996) Randomised trial of oral morphine for chronic non-cancer pain. Lancet 347(8995):143-47 CrossRef
  19. Noble M, Treadwell JR, Tregear SJ et?al (2010) Long-term opioid management for chronic noncancer pain. Cochrane Database Syst Rev 1:CD006605
  20. O’Donnell JB, Ekman EF, Spalding WM et?al (2009) The effectiveness of a weak opioid medication versus a cyclo-oxygenase-2 (COX-2) selective non-steroidal anti-inflammatory drug in treating flare-up of chronic low-back pain: results from two randomized, double-blind, 6-week studies. J?Int Med Res 37(6):1789-802
  21. Pillastrini P, Gardenghi I, Bonetti F et?al (2012) An updated overview of clinical guidelines for ch
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Pain Medicine
  Anesthesiology
  Chiropractic Medicine
  Psychotherapy
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1432-2129

文摘

Background The efficacy and safety of opioid therapy in chronic low back pain (CLBP) is under debate. We updated a recent systematic review on the efficacy and safety of opioids in CLBP. Methods We screened MEDLINE, Scopus and the Cochrane Central Register of Controlled Trials (CENTRAL) up until October?2013, as well as reference sections of original studies and systematic reviews of randomized controlled trials (RCTs) of opioids in CLBP. We included double-blind randomized placebo-controlled studies of at least 4?weeks duration. Using a random effects model, absolute risk differences (RD) were calculated for categorical data and standardized mean differences (SMD) for continuous variables. Results We included 12?RCTs with 17?treatment arms and 4375?participants. Median study duration was 12?(4-6)?weeks. Of the 17?treatment arms, seven?(41.2-) used oxycodone; four?(23.6-) tramadol; buprenorphine and oxymorphone were each used in two?(11.8-) and hydromorphone and tapentadol each in one?(5.8-). The results for studies with parallel/cross-over design were as follows (with 95- confidence interval, CI): opioids were superior to placebo in reducing pain intensity (SMD??-.29 [?-.37,??-.21], p--.0001; six studies with 2896?participants). Opioids were superior to placebo in 50- pain reduction (RD?0.05 [0.01,?0.10], p--.01; two studies with 1492?participants; number needed to benefit (NNTB)?19 [95-?CI?10-07]). Opioids were not superior to placebo in reports of much or very much improved pain (RD?0.16 [?-.01,?0.34], p--.07; two studies with 1153?participants). Opioids were superior to placebo in improving physical functioning (SMD??-.22 [?-.31,??-.12], p--.0001; four studies with 1895?participants). Patients dropped out less frequently with opioids than with placebo due to lack of efficacy (RD??-.10 [?-.16,??-.04], p--.001; five studies with 3168?participants; NNTB?10?[8-3]). Patients dropped out more frequently with opioids than with placebo due to adverse events (RD?0.12 [0.05,?0.19], p--.0007; six studies with 2910?participants; number needed to harm (NNTH)?7?[95-?CI?6-]). There was no significant difference between opioids and placebo in terms of the frequency of serious adverse events or deaths. Conclusion Opioids were superior to placebo in terms of efficacy and inferior in terms of tolerability. Opioids and placebo did not differ in terms of safety during the study period. The conclusion on the safety of opioids compared to placebo is limited by the low number of serious adverse events and deaths. Short-term and intermediate-term opioid therapy may be considered in selected CLBP patients. The English full-text version of this article is freely available at SpringerLink (under “Supplemental-.