From the, Institute for Musculoskeletal Health, Sydney, NSW, Australia.
Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
J Intern Med. 2020 May;287(5):458-474. doi: 10.1111/joim.13026. Epub 2020 Feb 25.
Guidelines now discourage opioid analgesics for chronic noncancer pain because the benefits frequently do not outweigh the harms. We aimed to determine the proportion of patients with chronic noncancer pain who are prescribed an opioid, the types prescribed and factors associated with prescribing. Database searches were conducted from inception to 29 October 2018 without language restrictions. We included observational studies of adults with chronic noncancer pain measuring opioid prescribing. Opioids were categorized as weak (e.g. codeine) or strong (e.g. oxycodone). Study quality was assessed using a risk of bias tool designed for observational studies measuring prevalence. Individual study results were pooled using a random-effects model. Meta-regression investigated study-level factors associated with prescribing (e.g. sampling year, geographic region as per World Health Organization). The overall evidence quality was assessed using Grading of Recommendations Assessment, Development and Evaluation criteria. Of the 42 studies (5,059,098 participants) identified, the majority (n = 28) were from the United States of America. Eleven studies were at low risk of bias. The pooled estimate of the proportion of patients with chronic noncancer pain prescribed opioids was 30.7% (95% CI 28.7% to 32.7%, n = 42 studies, moderate-quality evidence). Strong opioids were more frequently prescribed than weak (18.4% (95% CI 16.0-21.0%, n = 15 studies, low-quality evidence), versus 8.5% (95% CI 7.2-9.9%, n = 15 studies, low-quality evidence)). Meta-regression determined that opioid prescribing was associated with year of sampling (more prescribing in recent years) (P = 0.014) and not geographic region (P = 0.056). Opioid prescribing for patients with chronic noncancer pain is common and has increased over time.
目前的指南不鼓励将阿片类镇痛药用于慢性非癌痛，因为其益处常常并不超过危害。我们旨在确定开处阿片类药物的慢性非癌痛患者的比例、所开处方的类型以及与处方相关的因素。数据库检索从创建至 2018 年 10 月 29 日进行，无语言限制。我们纳入了评估慢性非癌痛成人患者阿片类药物处方的观察性研究。阿片类药物分为弱阿片类（如可待因）和强阿片类（如羟考酮）。使用专门用于评估流行率的观察性研究的偏倚风险工具评估研究质量。使用随机效应模型汇总个别研究结果。Meta 回归分析了与处方相关的研究水平因素（例如采样年份、世界卫生组织的地理区域）。使用推荐评估、制定与评价标准评估整体证据质量。在确定的 42 项研究（5059098 名参与者）中，大多数（n=28）来自美利坚合众国。11 项研究的偏倚风险较低。开处阿片类药物的慢性非癌痛患者比例的汇总估计值为 30.7%（95%CI 28.7%至 32.7%，n=42 项研究，中等质量证据）。与弱阿片类药物相比，强阿片类药物更常被开处（18.4%（95%CI 16.0-21.0%，n=15 项研究，低质量证据），而 8.5%（95%CI 7.2-9.9%，n=15 项研究，低质量证据））。Meta 回归确定，阿片类药物处方与采样年份有关（近年来处方更多）（P=0.014），与地理区域无关（P=0.056）。慢性非癌痛患者的阿片类药物处方很常见，且随着时间的推移而增加。
