慢性非癌性疼痛患者长期使用阿片类药物的神经心理学效应的系统评价与荟萃分析

Systematic Review and Meta-Analysis on Neuropsychological Effects of Long-Term Use of Opioids in Patients With Chronic Noncancer Pain.

作者信息

Allegri Nicola, Mennuni Simona, Rulli Eliana, Vanacore Nicola, Corli Oscar, Floriani Irene, De Simone Irene, Allegri Massimo, Govoni Stefano, Vecchi Tomaso, Sandrini Giorgio, Liccione Davide, Biagioli Elena

机构信息

Department of Brain and Behavioral Science, University of Pavia, Pavia, Italy.

Pavia-Vigevano Neuropsychological Center, Vigevano, Italy.

出版信息

Pain Pract. 2019 Mar;19(3):328-343. doi: 10.1111/papr.12741. Epub 2018 Dec 10.

DOI:10.1111/papr.12741

PMID:30354006

Abstract

BACKGROUND AND OBJECTIVE

Opioid treatments are often prolonged because of the pathology causing pain. We focused on the cognitive functions in patients with chronic pain treated with opioids. This topic is currently controversial, but in practice, the consequences are important in patients' daily lives, social interactions, working ability, and driving.

DATABASE AND DATA TREATMENT

Medline and Embase databases were searched for eligible articles. We included studies that enrolled patients with chronic noncancer pain, studies with patients receiving opioid treatment, studies with a control group not using opioids, and studies in which cognitive functions were evaluated with specific tests. The cognitive areas examined were as follows: attention, reaction time, executive functions, psychomotor speed, memory, and working memory. From 356 abstracts screened, 9 articles satisfied eligibility criteria and were included in our review: 7 observational and 7 experimental studies. We classified the pain treatments as follows: opioids, other drugs active on the central nervous system (CNS) (antidepressants/anticonvulsants), and treatments not specifically targeted to the CNS.

RESULTS

Statistically significant differences were seen only with regard to attention between opioids alone and no centrally acting treatment (standardized mean difference [SMD]: -0.53, 95% confidence interval [CI] : -0.91, -0.15; P = 0.007; I = 23%) and between opioids combined with antidepressants and/or anticonvulsants and no centrally acting treatment (SMD: -0.62, 95% CI: -1.04, -0.20; P = 0.004; I = 0%). No other significant differences were observed.

CONCLUSIONS

Opioids reduce attention when compared with treatments not targeted on the CNS. If opioids are used together with antidepressants and/or anticonvulsants, this effect increases.

SIGNIFICANCE

These findings on the neuropsychological effects of opioids could be used to generate strategies to refine pain treatments.

摘要

背景与目的

由于导致疼痛的病理原因，阿片类药物治疗常常会持续很长时间。我们关注接受阿片类药物治疗的慢性疼痛患者的认知功能。这个话题目前存在争议，但在实际中，其后果对患者的日常生活、社交互动、工作能力和驾驶都很重要。

数据库与数据处理

检索Medline和Embase数据库以查找符合条件的文章。我们纳入了招募慢性非癌性疼痛患者的研究、患者接受阿片类药物治疗的研究、有未使用阿片类药物的对照组的研究，以及通过特定测试评估认知功能的研究。所检查的认知领域如下：注意力、反应时间、执行功能、心理运动速度、记忆和工作记忆。在筛选的356篇摘要中，9篇文章符合纳入标准并被纳入我们的综述：7项观察性研究和2项实验性研究。我们将疼痛治疗分类如下：阿片类药物、对中枢神经系统（CNS）有活性的其他药物（抗抑郁药/抗惊厥药），以及未专门针对CNS的治疗。

结果

仅在单独使用阿片类药物与未进行中枢作用治疗之间（标准化均值差[SMD]：-0.53，95%置信区间[CI]：-0.91，-0.15；P = 0.007；I² = 23%）以及阿片类药物与抗抑郁药和/或抗惊厥药联合使用与未进行中枢作用治疗之间（SMD：-0.62，95% CI：-1.04，-0.20；P = 0.004；I² = 0%）观察到统计学上的显著差异。未观察到其他显著差异。