Doctor of Physical Therapy, Duke University School of Medicine, Durham, North Carolina, USA.
Physical Therapy, Duke University, Durham, North Carolina, USA.
Br J Sports Med. 2020 Jun;54(11):664. doi: 10.1136/bjsports-2018-099805. Epub 2019 Mar 22.
Consequences of prescription opioid use involve harms, addiction, tolerance and death. Despite routine prescription, opioids are not recommended for initial intervention by any major multidisciplinary low back pain (LBP) guideline.
Our primary purpose was to improve overall understanding of the harms and benefits associated with oral opioid interventions prescribed for treatment of acute or chronic back pain. Our second goal was to evaluate pain intensity and to compare and contrast these data with the harms. Our last objective was to evaluate conflicts of interest among the study authors and the findings.
DESIGN/DATA/ELIGIBILITY CRITERIA: Studies incorporating oral prescription opioid management of non-surgical LBP were evaluated. After systematic assessment, no studies that met inclusion included participants with specifically acute LBP. Therefore, extracted data reflects only populations with subacute and chronic LBP. Data on reported harms, severe harms, pain outcomes and withdrawal rates were extracted and meta-analyses were completed for opioid versus placebo trials and opioids versus non-opioid trials.
Fourteen studies met inclusion/exclusion requirements. All trials involved short-term management with limited follow-up. A high percentage of harms were identified across most studies. Opioids were not shown to be superior to other medications, and only showed superiority to placebo comparators (at cost of additional harms).
This review identified trends of higher harms rates and higher percentages of severe harms in opioid arms for the management of subacute and chronic LBP. The majority of trials that demonstrated benefits with opioids also had potential conflicts of interest. Lastly, non-opioid medications demonstrated statistically significant pain improvement compared with opioids. We feel that the results of the trial are supportive of current LBP guidelines and do not condone the initial use of opioids in management of subacute or chronic LBP.
CRD42017070914.
处方类阿片的使用后果包括伤害、成瘾、耐受和死亡。尽管常规处方，但没有任何主要的多学科下腰痛 (LBP) 指南推荐将阿片类药物作为初始干预措施。
我们的主要目的是提高对口服阿片类药物干预治疗急性或慢性背痛相关危害和益处的整体认识。我们的第二个目标是评估疼痛强度，并比较和对比这些数据与危害。我们的最后一个目标是评估研究作者之间的利益冲突和研究结果。
设计/数据/纳入标准：评估了纳入口服处方类阿片药物治疗非手术性 LBP 的研究。经过系统评估，没有符合纳入标准的研究包括有特定急性 LBP 的参与者。因此，提取的数据仅反映了亚急性和慢性 LBP 的人群。提取了报告的危害、严重危害、疼痛结果和戒断率的数据，并对阿片类药物与安慰剂试验和阿片类药物与非阿片类药物试验进行了荟萃分析。
有 14 项研究符合纳入/排除标准。所有试验均涉及短期管理，随访时间有限。大多数研究都发现了较高比例的危害。阿片类药物并不优于其他药物，仅优于安慰剂对照（以增加额外危害为代价）。
本综述确定了在管理亚急性和慢性 LBP 时，阿片类药物组的危害发生率和严重危害发生率较高的趋势。大多数证明阿片类药物有获益的试验也存在潜在的利益冲突。最后，非阿片类药物与阿片类药物相比，在统计学上显著改善了疼痛。我们认为试验结果支持当前的 LBP 指南，并不支持在管理亚急性或慢性 LBP 时最初使用阿片类药物。
CRD42017070914。
