Department of Medicine, Royal College of Surgeons in Ireland School of Medicine, Dublin, Ireland
Department of Medicine, Royal College of Surgeons in Ireland School of Medicine, Dublin, Ireland.
BMJ Support Palliat Care. 2022 Dec;12(e6):e730-e735. doi: 10.1136/bmjspcare-2018-001695. Epub 2019 Apr 4.
To summarise the current body of published evidence on the use of low-dose and/or adjuvant methadone in the palliative care setting.
The authors searched multiple databases (PubMED, SCORPUS, EMBASE and the Cochrane library) for relevant articles using the terms 'methadone', 'palliative', 'low dose' and 'adjuvant'. The review was restricted to articles published between 2003 and 2018. Paediatric and single-case studies were also excluded. Evidence quality was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) method.
Our search yielded 171 results, of which seven met the inclusion criteria. Four were retrospective chart reviews, one was a retrospective cohort study, one was a case series and one was a double-blind randomised control trial. The overall quality was found to be very low. Of the seven articles, all seven reported some improvement in pain with the addition of low-dose or adjuvant methadone. This improvement was statistically significant in four out of seven articles; statistical significance was not commented on in the remaining three articles.
While case series and chart reviews offer promising results about the utility of adjuvant and/or low-dose methadone in the management of complex pain, the very low evidence quality, relative dearth of studies and near absence of randomised controlled trials make it impossible to draw firm conclusions. Thus, while very preliminary evidence suggests methadone is a potentially effective and valuable agent, further research must be performed before such findings can be implemented into clinical practice.
总结目前已发表的关于在姑息治疗中使用低剂量和/或辅助美沙酮的证据。
作者使用“美沙酮”、“姑息治疗”、“低剂量”和“辅助”等术语，在多个数据库（PubMED、SCORPUS、EMBASE 和 Cochrane 图书馆）中搜索相关文章。本综述仅限于 2003 年至 2018 年期间发表的文章。还排除了儿科和单病例研究。使用推荐评估、制定与评价分级（GRADE）方法评估证据质量。
我们的搜索结果为 171 个，其中 7 个符合纳入标准。其中 4 个是回顾性图表回顾，1 个是回顾性队列研究，1 个是病例系列，1 个是双盲随机对照试验。总体质量被认为非常低。在这 7 篇文章中，所有 7 篇文章都报告了添加低剂量或辅助美沙酮后疼痛有所改善。其中 4 篇文章的改善具有统计学意义；另外 3 篇文章没有评论统计学意义。
虽然病例系列和图表回顾提供了关于辅助和/或低剂量美沙酮在复杂疼痛管理中的效用的有希望的结果，但非常低的证据质量、相对缺乏研究以及几乎没有随机对照试验使得不可能得出明确的结论。因此，虽然初步证据表明美沙酮是一种潜在有效和有价值的药物，但在这些发现可以应用于临床实践之前，必须进行进一步的研究。
