Lauche R, Klose P, Radbruch L, Welsch P, Häuser W
Abteilung für Naturheilkunde und Integrative Medizin, Kliniken Essen-Mitte, Medizinische Fakultät, Universität Duisburg-Essen, Essen, Deutschland.
Schmerz. 2015 Feb;29(1):73-84. doi: 10.1007/s00482-014-1432-4.
We updated a systematic review on the comparative efficacy, tolerability and safety of opioids and of their routes of application in chronic noncancer pain (CNCP).
We screened MEDLINE, Scopus and the Cochrane Central Register of Controlled Trials (CENTRAL) up until October 2013, as well as the reference sections of original studies and systematic reviews of randomized controlled trials (RCTs) of opioids in CNCP. We included randomized head-to-head comparisons of opioids (opioid of the sponsor of the study versus standard opioid) of at least 4 week's duration. Using a random effects model, absolute risk differences (RD) were calculated for categorical data and standardized mean differences (SMD) for continuous variables. The quality of evidence was rated by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.
We included 13 RCTs with 6748 participants. Median study duration was 15 weeks (range 4-56 weeks). Hydromorphone, morphine, oxymorphone and tapentadol were compared to oxycodone; fentanyl to morphine and buprenorphine to tramadol. In pooled analysis, there were no significant differences between the two groups of opioids in terms of mean pain reduction (low-quality evidence), the patient global impression to be much or very much improved outcome (low-quality evidence), physical function (very low-quality evidence), serious adverse events (moderate-quality evidence) or mortality (moderate-quality evidence). There was no significant difference between transdermal and oral application of opioids in terms of mean pain reduction, physical function, serious adverse events, mortality (all low-quality evidence) or dropout due to adverse events (very low-quality).
Pooled head-to-head comparisons of opioids (opioid of the sponsor of the study versus standard opioid) provide no rational for preferring one opioid and/or administration route over another in the therapy of patients with CNCP. The English full-text version of this article is freely available at SpringerLink (under "Supplemental").
我们更新了一项关于阿片类药物及其应用途径在慢性非癌性疼痛（CNCP）中的比较疗效、耐受性和安全性的系统评价。
我们检索了截至2013年10月的MEDLINE、Scopus和Cochrane对照试验中央注册库（CENTRAL），以及阿片类药物在CNCP中的原始研究和随机对照试验（RCT）系统评价的参考文献部分。我们纳入了至少为期4周的阿片类药物随机头对头比较（研究主办方的阿片类药物与标准阿片类药物）。使用随机效应模型，计算分类数据的绝对风险差异（RD）和连续变量的标准化均值差异（SMD）。证据质量采用推荐分级、评估、制定与评价（GRADE）方法进行评级。
我们纳入了13项RCT，共6748名参与者。研究的中位持续时间为15周（范围4 - 56周）。将氢吗啡酮、吗啡、羟吗啡酮和曲马多与羟考酮进行比较；芬太尼与吗啡比较，丁丙诺啡与曲马多比较。在汇总分析中，两组阿片类药物在平均疼痛减轻（低质量证据）、患者总体印象为明显或非常明显改善的结局（低质量证据）、身体功能（极低质量证据）、严重不良事件（中等质量证据）或死亡率（中等质量证据）方面无显著差异。在平均疼痛减轻、身体功能、严重不良事件、死亡率（均为低质量证据）或因不良事件导致的退出率（极低质量）方面，阿片类药物的经皮给药和口服给药之间无显著差异。
阿片类药物（研究主办方的阿片类药物与标准阿片类药物）的汇总头对头比较结果表明，在CNCP患者的治疗中，没有理由优先选择一种阿片类药物和/或给药途径而不是另一种。本文的英文全文版本可在SpringerLink（在“补充材料”下）免费获取。
