1 Institute of Genetics and Molecular Medicine, University of Edinburgh , Edinburgh, United Kingdom .
2 St. Columba's Hospice , Edinburgh, United Kingdom .
J Palliat Med. 2019 Jan;22(1):90-97. doi: 10.1089/jpm.2018.0260. Epub 2018 Sep 21.
Opioids are the foundation of treatment for cancer pain but can cause side-effects, one of the most common being nausea and vomiting, which can impair quality of life.
To evaluate the evidence for the management of opioid-induced nausea and vomiting. This systematic review was undertaken as part of an update of the European Association for Palliative Care's opioid guidelines.
Searches of MEDLINE (1966-2017) and EMBASE (1980-2017) were done. Key eligibility criteria were: randomized controlled trials conducted in patients with cancer. The Grading of Recommendations Assessment Development and Evaluations system was applied to formulate recommendations.
Fifteen studies were eligible (1524 patients). The studies were grouped as follows: opioid switching (n = 8); the use of antiemetics to treat opioid-induced nausea and vomiting (n = 4); and change of route of administration of the opioid (n = 3). Three recommendations were formulated: A weak recommendation for switching from morphine to oxycodone in cancer patients with nausea (quality D); a weak recommendation for switching from tramadol to either codeine or hydrocodone for pain in cancer patients with nausea (quality D); and a weak recommendation for switching from morphine/oxycodone to methadone using the three-day switch method in patients with increasing pain considered untreatable with further opioid titration and/or with opioid-related side effects (quality C).
This systematic review can make only weak recommendations for the management of opioid-induced nausea and vomiting. There remains a need for high-quality studies before strong recommendations on the management of opioid-induced nausea and vomiting can be made.
阿片类药物是治疗癌痛的基础，但会引起副作用，其中最常见的是恶心和呕吐，这会降低生活质量。
评估阿片类药物引起的恶心和呕吐的治疗证据。这项系统评价是作为欧洲姑息治疗协会阿片类药物指南更新的一部分进行的。
对 MEDLINE（1966-2017 年）和 EMBASE（1980-2017 年）进行了检索。主要入选标准为：在癌症患者中进行的随机对照试验。采用推荐分级的评估、制定与评价系统制定推荐意见。
有 15 项研究符合入选标准（1524 例患者）。这些研究分为以下几类：阿片类药物转换（n=8）；用止吐药治疗阿片类药物引起的恶心和呕吐（n=4）；以及改变阿片类药物的给药途径（n=3）。制定了 3 项推荐意见：对于恶心的癌症患者，从吗啡转换为羟考酮的弱推荐（质量 D）；对于恶心的癌症患者，从曲马多转换为可待因或氢可酮的弱推荐（质量 D）；以及对于疼痛增加且认为无法通过进一步增加阿片类药物滴定或阿片类药物相关副作用来治疗的患者，从吗啡/羟考酮转换为美沙酮的弱推荐（使用三天转换法，质量 C）。
这项系统评价只能对阿片类药物引起的恶心和呕吐的治疗提出弱推荐。在能够对阿片类药物引起的恶心和呕吐的治疗提出强有力的推荐意见之前，仍需要高质量的研究。
