Comparative benefits and harms of individual opioids for chronic non-cancer pain: a systematic review and network meta-analysis of randomised trials,British Journal of Anaesthesia

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Comparative benefits and harms of individual opioids for chronic non-cancer pain: a systematic review and network meta-analysis of randomised trials
British Journal of Anaesthesia ( IF 9.8 ) Pub Date : 2022-07-09 , DOI: 10.1016/j.bja.2022.05.031
Atefeh Noori ₁ , Behnam Sadeghirad ₂ , Li Wang ₂ , Reed A C Siemieniuk ₃ , Mostafa Shokoohi ₄ , Elena Kum ₃ , Mark Jeddi ₃ , Luis Montoya ₅ , Patrick J Hong ₆ , Edward Zhou ₇ , Rachel J Couban ₃ , David N Juurlink ₈ , Lehana Thabane ₃ , Mohit Bhandari ₃ , Gordon H Guyatt ₃ , Jason W Busse ₉

Affiliation

Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada; The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada.
Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada; The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada; Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Krembil Research Institute-University Health Network-Orthopaedic Surgery Arthritis Program, Toronto, Ontario, Canada.
Department of Anesthesia, University of Toronto, Toronto, ON, Canada.
Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
Department of Medicine, University of Toronto, Toronto, ON, Canada.
Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada; The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada; Department of Anesthesia, McMaster University, Hamilton, ON, Canada; The Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, ON, Canada.

Background

Most systematic reviews of opioids for chronic pain have pooled treatment effects across individual opioids under the assumption they provide similar benefits and harms. We examined the comparative effects of individual opioids for chronic non-cancer pain through a network meta-analysis of randomised controlled trials.

Methods

We searched MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials to March 2021 for studies that enrolled patients with chronic non-cancer pain, randomised them to receive different opioids, or opioids vs placebo, and followed them for at least 4 weeks. Certainty of evidence was evaluated using the GRADE approach.

Results

We identified 82 eligible trials (22 619 participants) that evaluated 14 opioids. Compared with placebo, several opioids showed superiority to others for analgesia and improvement in physical function; however, when restricted to pooled-effect estimates supported by moderate certainty evidence, no differences between opioids were evident. Among opioids with moderate certainty evidence, all increased the risk of gastrointestinal adverse events compared with placebo, although no opioids were more harmful than others. Low to very low certainty evidence suggests that extended-release vs immediate-release opioids may provide similar benefits for pain relief and physical functioning, and gastrointestinal harms.

Conclusions

Our findings support the pooling of effect estimates across different types and formulations of opioids to inform effectiveness for chronic non-cancer pain.

中文翻译：

个体阿片类药物对慢性非癌性疼痛的比较益处和危害：随机试验的系统评价和网络荟萃分析

背景

大多数关于阿片类药物治疗慢性疼痛的系统评价都在假设它们提供相似的益处和危害的情况下汇总了各个阿片类药物的治疗效果。我们通过随机对照试验的网络荟萃分析检查了单个阿片类药物对慢性非癌症疼痛的比较效果。

方法

我们检索了截至 2021 年 3 月的 MEDLINE、EMBASE、CINAHL 和 Cochrane Central Register of Controlled Trials，以查找纳入慢性非癌症疼痛患者的研究，将他们随机分配接受不同的阿片类药物或阿片类药物与安慰剂，并跟踪他们至少 4周。使用 GRADE 方法评估证据的确定性。

结果

我们确定了评估 14 种阿片类药物的 82 项合格试验（22 619 名参与者）。与安慰剂相比，几种阿片类药物在镇痛和改善身体机能方面表现出优于其他药物的效果；然而，当仅限于由中等确定性证据支持的汇总效应估计时，阿片类药物之间没有明显差异。在具有中等确定性证据的阿片类药物中，与安慰剂相比，所有阿片类药物都增加了胃肠道不良事件的风险，尽管没有阿片类药物比其他阿片类药物更有害。低到极低确定性的证据表明，缓释与速释阿片类药物可能在缓解疼痛和身体机能以及胃肠道伤害方面提供相似的益处。