Comprehensive Pain Program, Toronto Western Hospital, Krembil Neuroscience Center, 399 Bathurst St., Toronto, Ontario, Canada.
Clin J Pain. 2012 Jul;28(6):542-55. doi: 10.1097/AJP.0b013e3182385332.
The effect of opioids on driving performance has been much debated. Driving is a complex task requiring integration of psychomotor, cognitive, motor and decision-making skills, visual-spatial abilities, divided attention, and behavioral and emotional control. The objective of this systematic review was to assess the quality of studies and to revisit the concept that patients on stable opioids are safe to drive as it applies to everyday practice.
We searched MEDLINE, EMBASE, PSYCinfo, CENTRAL, TRANSPORT, CINAHL, reference lists of retrieved articles and narrative reviews, for studies on chronic cancer and noncancer pain patients on opioids, tested by driving, driving simulator, or cognitive/psychomotor tests. Methodological quality was assessed with Methodological Index for Nonrandomized Studies, cognitive/psychomotor tests were appraised regarding their sensitivity and validation, and whether confounding variables potentially affecting the study conclusions were recorded. The results were analyzed both quantitatively and qualitatively.
We included 35 studies (2044 patients, 1994 controls), 9% of the studies were of poor, 54% of fair, and 37% of high quality; 3 quarters of the studies used high sensitivity cognitive tests. Amount and dose of opioids varied largely in many studies. Mean number of possible but unreported confounders was 2.2 (range, 0 to 4), relating to failure of the studies to mention co-prescriptions with psychotropic effects, pain severity, sleep disorder or daytime somnolence, and/or significant depressive or anxiety-related problems.
The commonly held concept that "chronic pain patients on stable opioids are safe to drive" cannot be generalized to all such patients in everyday practice, but may be applicable only to a subset who meet certain criteria.
阿片类药物对驾驶表现的影响一直存在争议。驾驶是一项复杂的任务，需要整合心理运动、认知、运动和决策技能、视觉空间能力、注意力分散、行为和情绪控制。本系统评价的目的是评估研究的质量，并重新审视“稳定使用阿片类药物的慢性疼痛患者可以安全驾驶”这一概念，以适用于日常实践。
我们检索了 MEDLINE、EMBASE、PSYCinfo、CENTRAL、TRANSPORT、CINAHL 和检索文章及叙述性综述的参考文献列表，以获取关于慢性癌症和非癌症疼痛患者使用阿片类药物、通过驾驶、驾驶模拟器或认知/心理运动测试进行测试的研究。使用非随机研究方法学指数评估方法学质量，评估认知/心理运动测试的敏感性和有效性，以及记录可能影响研究结论的混杂变量。结果进行了定量和定性分析。
我们纳入了 35 项研究（2044 名患者，1994 名对照），9%的研究质量较差，54%的研究质量中等，37%的研究质量较高；3/4的研究使用了高灵敏度的认知测试。许多研究中阿片类药物的用量和剂量差异很大。可能但未报告的混杂因素的平均数量为 2.2（范围 0 至 4），涉及研究未提及具有精神作用的共处方、疼痛严重程度、睡眠障碍或白天嗜睡以及/或明显的抑郁或焦虑相关问题。
普遍认为“稳定使用阿片类药物的慢性疼痛患者可以安全驾驶”的概念不能推广到日常实践中的所有此类患者，但可能仅适用于符合某些标准的特定患者。
