Department of Orthopaedics, First People's Hospital of YunNan Province, YunNan, P.R. China.
Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Sci Rep. 2017 May 17;7(1):1995. doi: 10.1038/s41598-017-02209-x.
Aim of this study was to study the tolerability of opioid analgesia by performing a network meta-analysis (NMA) of randomized-controlled trials (RCTs) which investigated effectiveness of opioids for the management of chronic pain. Research articles reporting outcomes of RCT/s comparing 2 or more opioid analgesics for the management of chronic pain were obtained by database search. Bayesian NMAs were performed to combine direct comparisons between treatments with that of indirect simulated evidence. Study endpoints were: incidence of adverse events, incidence of constipation, trial withdrawal rate, and patient satisfaction with treatment. Outcomes were also compared with conventional meta-analyses. Thirty-two studies investigating 10 opioid drugs fulfilled the eligibility criteria. Tapentadol treatment was top-ranking owing to lower incidence of overall adverse events, constipation, and least trial withdrawal rate. Tapentadol was followed by oxycodone-naloxone combination in providing better tolerability and less trial withdrawal rate. Patient satisfaction was found to be higher with oxycodone-naloxone followed by fentanyl and tapentadol. These results were in agreement with those achieved with conventional meta-analyses. Tapentadol and oxycodone-naloxone are found to exhibit better tolerability characteristics in comparison with other opioid drugs for the management of chronic pain and are associated with low trial withdrawal rate and better patient satisfaction.
本研究旨在通过对评估阿片类药物治疗慢性疼痛的有效性的随机对照试验（RCT）进行网络荟萃分析（NMA），来研究阿片类药物镇痛的耐受性。通过数据库检索获得了比较两种或多种阿片类镇痛药治疗慢性疼痛的 RCT/s 的研究结果。采用贝叶斯 NMA 将直接比较治疗与间接模拟证据进行综合。研究终点为：不良事件发生率、便秘发生率、试验退出率和患者对治疗的满意度。还将结果与常规荟萃分析进行了比较。符合纳入标准的研究共 32 项，涉及 10 种阿片类药物。曲马多的治疗效果排名最高，因为它的总体不良事件、便秘和试验退出率较低。曲马多之后是羟考酮-纳洛酮联合用药，因为它的耐受性更好，试验退出率更低。阿片酮-纳洛酮和芬太尼的患者满意度较高，其次是曲马多。这些结果与常规荟萃分析的结果一致。与其他阿片类药物相比，曲马多和羟考酮-纳洛酮在治疗慢性疼痛方面表现出更好的耐受性特征，并且与较低的试验退出率和更好的患者满意度相关。
