Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
J Pain Res. 2013 Jul 4;6:513-29. doi: 10.2147/JPR.S47182. Print 2013.
For the past 30 years, opioids have been used to treat chronic nonmalignant pain. This study tests the following hypotheses: (1) there is no strong evidence-based foundation for the conclusion that long-term opioid treatment of chronic nonmalignant pain is effective; and (2) the main problem associated with the safety of such treatment - assessment of the risk of addiction - has been neglected.
Scientometric analysis of the articles representing clinical research in this area was performed to assess (1) the quality of presented evidence (type of study); and (2) the duration of the treatment phase. The sufficiency of representation of addiction was assessed by counting the number of articles that represent (1) editorials; (2) articles in the top specialty journals; and (3) articles with titles clearly indicating that the addiction-related safety is involved (topic-in-title articles).
Not a single randomized controlled trial with opioid treatment lasting >3 months was found. All studies with a duration of opioid treatment ≥6 months (n = 16) were conducted without a proper control group. Such studies cannot provide the consistent good-quality evidence necessary for a strong clinical recommendation. There were profound differences in the number of addiction articles related specifically to chronic nonmalignant pain patients and to opioid addiction in general. An inadequate number of chronic pain-related publications were observed with all three types of counted articles: editorials, articles in the top specialty journals, and topic-in-title articles.
There is no strong evidence-based foundation for the conclusion that long-term opioid treatment of chronic nonmalignant pain is effective. The above identified signs indicating neglect of addiction associated with the opioid treatment of chronic nonmalignant pain were present.
在过去的 30 年中，阿片类药物一直被用于治疗慢性非恶性疼痛。本研究检验了以下假设：（1）长期使用阿片类药物治疗慢性非恶性疼痛是否有效，并无强有力的循证医学基础；（2）与该治疗安全性相关的主要问题（成瘾风险评估）被忽视了。
对该领域的临床研究文章进行了科学计量学分析，以评估（1）所呈现证据的质量（研究类型）；（2）治疗阶段的持续时间。通过计算以下文章数量来评估成瘾的代表性：（1）社论；（2）顶级专业期刊中的文章；（3）标题明确表明涉及成瘾相关安全性（标题主题文章）的文章。
未发现任何持续时间超过 3 个月的阿片类药物治疗随机对照试验。所有持续时间≥6 个月的阿片类药物治疗研究（n=16）均未设置适当的对照组。此类研究无法提供用于强烈临床推荐的一致高质量证据。与慢性非恶性疼痛患者和阿片类药物成瘾相关的成瘾文章数量存在明显差异。从社论、顶级专业期刊文章和标题主题文章这三种类型的文章来看，观察到与慢性疼痛相关的出版物数量均不足。
长期使用阿片类药物治疗慢性非恶性疼痛是否有效，并无强有力的循证医学基础。上述与慢性非恶性疼痛的阿片类药物治疗相关的成瘾忽视迹象明显。
