Department of Oncology, City Hospital, Italy.
Palliat Med. 2011 Jul;25(5):410-23. doi: 10.1177/0269216311405090.
To analyse the evidence supporting the widespread use of modified analgesic ladders or oral tramadol as alternatives to codeine/paracetamol for mild to moderate cancer pain.
A systematic review of the literature was independently performed by two authors. The level of evidence and risk/benefit ratio were assessed in all the selected trials. A comprehensive analysis of the level of evidence, risk/benefit ratio and strength of the recommendations was carried out. The analysis was performed using the GRADE system.
Eighteen papers were included into the analysis. The level of evidence was low or very low for all the trials, and as a result the risk/benefit ratio was uncertain. Likewise, the strength of the final recommendations was considered weak negative for either the use of modified analgesic ladders (by-passing the second step of the World Health Organization (WHO) analgesic ladder) or the use of oral tramadol as an alternative to codeine/paracetamol in the second step of the WHO analgesic ladder.
Data supporting the role of modified two-step analgesic ladders or oral tramadol as an alternative to codeine/paracetamol are insufficient to recommend their routine use in cancer patients with mild to moderate cancer pain.
分析广泛使用改良镇痛阶梯或口服曲马多替代可待因/扑热息痛治疗轻度至中度癌痛的证据。
两名作者独立进行了文献系统评价。对所有入选试验均进行了证据水平和风险/获益比评估。对证据水平、风险/获益比和推荐强度进行了全面分析。分析采用 GRADE 系统进行。
纳入分析的论文有 18 篇。所有试验的证据水平均为低或极低，因此风险/获益比不确定。同样，对于绕过世界卫生组织（WHO）镇痛阶梯第二步而使用改良镇痛阶梯，或在 WHO 镇痛阶梯第二步中使用口服曲马多替代可待因/扑热息痛的最终建议强度也被认为是弱负向。
支持改良两步镇痛阶梯或口服曲马多替代可待因/扑热息痛用于治疗轻度至中度癌痛的癌症患者的证据不足，不足以推荐常规使用。
