Department of Neuroscience, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy.
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
BMC Cancer. 2018 May 18;18(1):568. doi: 10.1186/s12885-018-4478-3.
Inter-patient variability in response to opioids is well known but a comprehensive definition of its pathophysiological mechanism is still lacking and, more importantly, no studies have focused on children. The STOP Pain project aimed to evaluate the risk factors that contribute to clinical response and adverse drug reactions to opioids by means of a systematic review and a clinical investigation on paediatric oncological patients.
We conducted a systematic literature search in EMBASE and PubMed up to the 24th of November 2016 following Cochrane Handbook and PRISMA guidelines. Two independent reviewers screened titles and abstracts along with full-text papers; disagreements were resolved by discussion with two other independent reviewers. We used a data extraction form to provide details of the included studies, and conducted quality assessment using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.
Young age, lung or gastrointestinal cancer, neuropathic or breakthrough pain and anxiety or sleep disturbance were associated to a worse response to opioid analgesia. No clear association was identified in literature regarding gender, ethnicity, weight, presence of metastases, biochemical or hematological factors. Studies in children were lacking. Between June 2011 and April 2014, the Italian STOP Pain project enrolled 87 paediatric cancer patients under treatment with opioids (morphine, codeine, oxycodone, fentanyl and tramadol).
Future studies on cancer pain should be designed with consideration for the highlighted factors to enhance our understanding of opioid non-response and safety. Studies in children are mandatory.
CRD42017057740 .
患者对阿片类药物的反应存在个体差异，这是众所周知的，但对其病理生理学机制的全面定义仍缺乏，更重要的是，目前尚无研究关注儿童。STOP Pain 项目旨在通过系统评价和对儿科肿瘤患者的临床研究，评估导致阿片类药物临床反应和不良反应的风险因素。
我们按照 Cochrane 手册和 PRISMA 指南，在 EMBASE 和 PubMed 中进行了系统文献检索，截至 2016 年 11 月 24 日。两名独立的审查员筛选标题和摘要以及全文论文；有分歧的地方通过与另外两名独立审查员讨论来解决。我们使用数据提取表格提供纳入研究的详细信息，并使用观察性队列研究和横断面研究的质量评估工具进行质量评估。
年龄较小、肺癌或胃肠道癌、神经病理性或突破性疼痛以及焦虑或睡眠障碍与阿片类药物镇痛反应较差相关。文献中未明确确定性别、种族、体重、转移、生化或血液因素与阿片类药物反应之间的关联。儿童研究缺乏。2011 年 6 月至 2014 年 4 月，意大利 STOP Pain 项目纳入了 87 名正在接受阿片类药物（吗啡、可待因、羟考酮、芬太尼和曲马多）治疗的儿科癌症患者。
未来的癌症疼痛研究应考虑到强调的因素进行设计，以增强我们对阿片类药物无反应和安全性的理解。儿童研究是强制性的。
CRD42017057740。
