National Competence Centre for Complex Symptom Disorders, Institute of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Acta Anaesthesiol Scand. 2014 Apr;58(4):390-401. doi: 10.1111/aas.12279.
In selected patients with chronic non-malignant pain, chronic opioid therapy is indicated. Published guidelines recommend long-acting over short-acting opioids in these patients. The aim of this systematic review was to investigate whether long-acting opioids in chronic non-malignant pain are superior to short-acting opioids in pain relief, physical function, sleep quality, quality of life or adverse events. This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. PubMed, Embase and Cochrane Central Register of Controlled Trials were searched for relevant trials up to July 2012. Reference lists of included trials and relevant reviews were in addition searched by hand. Of the 1168 identified publications, 6 randomised trials evaluating efficacy and safety filled the criteria for inclusion. None of them found a significantly better pain relief, significantly less consumption of rescue analgesia, improved quality of sleep or improved physical function from long-acting opioids. None of the trials investigated quality of life. None of the trials investigated adverse events properly nor addiction, tolerance or hyperalgesia. Three trials in healthy volunteers with a recreational drug use, found no difference in abuse potential between long- and short-acting opioids. While long term, comparative data are lacking, there is fair evidence from short-term trials that long-acting opioids provide equal pain relief compared with short-acting opioids. Contrary to several guidelines, there is no evidence supporting long-acting opioids superiority to short-acting ones in improving functional outcomes, reducing side effects or addiction.
在某些慢性非恶性疼痛患者中，需要进行慢性阿片类药物治疗。发表的指南建议在这些患者中使用长效阿片类药物而非短效阿片类药物。本系统评价的目的是调查慢性非恶性疼痛中长效阿片类药物是否在缓解疼痛、身体功能、睡眠质量、生活质量或不良事件方面优于短效阿片类药物。本综述按照系统评价和荟萃分析的首选报告项目进行。截至 2012 年 7 月，在 PubMed、Embase 和 Cochrane 对照试验中心注册库中搜索了相关试验。此外，还通过手工搜索纳入试验的参考文献列表和相关综述。在 1168 篇确定的出版物中，有 6 项随机试验评估了疗效和安全性，符合纳入标准。没有一项试验发现长效阿片类药物在缓解疼痛、减少急救止痛药物的使用、改善睡眠质量或改善身体功能方面有显著改善。没有一项试验调查生活质量。没有一项试验恰当地调查了不良反应、成瘾、耐受或痛觉过敏。在 3 项有娱乐性药物使用的健康志愿者中进行的试验发现，长效和短效阿片类药物之间的滥用潜力没有差异。虽然缺乏长期的比较数据，但短期试验有一定证据表明长效阿片类药物在缓解疼痛方面与短效阿片类药物相当。与一些指南相反，没有证据支持长效阿片类药物在改善功能结果、减少副作用或成瘾方面优于短效阿片类药物。
