Lazaridou Asimina, Paschali Myrella, Edwards Robert R, Gilligan Christopher
Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, Chestnut Hill, Massachusetts, USA.
Pain Med. 2020 Dec 25;21(12):3691-3699. doi: 10.1093/pm/pnaa089.
The objective was to perform a systematic review and meta-analysis of the literature on the effects of buprenorphine on chronic pain outcomes (i.e., patient-reported pain intensity) in patients with and without opioid use disorder (OUD).
Ovid/Medline, PubMed, Embase, and the Cochrane Library were searched for studies that explored the effectiveness (in reducing pain) of buprenorphine treatment for chronic pain patients with and without a history of OUD. Randomized controlled trials and observational studies were included in the review.
Two separate searches were conducted to identify buprenorphine trials that included chronic pain patients either with or without OUD. Five studies used validated pain report measures and included a chronic pain population with OUD. Nine studies used validated report measures and included chronic pain patients without OUD. Meta-analysis was performed using the R, version 3.2.2, Metafor package, version 1.9-7.
The meta-analysis revealed that buprenorphine has a beneficial effect on pain intensity overall, with a small mean effect size in patients with comorbid chronic pain and OUD and a moderate- to large-sized effect in chronic pain patients without OUD.
Our results indicate that buprenorphine is modestly beneficial in reducing pain intensity in patients without OUD. Although informative, these findings should be carefully interpreted due to the small amount of data available and the variation in study designs.
对丁丙诺啡对有无阿片类药物使用障碍（OUD）患者慢性疼痛结局（即患者报告的疼痛强度）影响的文献进行系统评价和荟萃分析。
检索Ovid/Medline、PubMed、Embase和Cochrane图书馆，查找探讨丁丙诺啡治疗有无OUD病史慢性疼痛患者有效性（减轻疼痛方面）的研究。纳入综述的有随机对照试验和观察性研究。
进行了两项独立检索，以确定纳入有无OUD慢性疼痛患者的丁丙诺啡试验。五项研究使用了经过验证的疼痛报告测量方法，纳入了有OUD的慢性疼痛人群。九项研究使用了经过验证的报告测量方法，纳入了无OUD的慢性疼痛患者。使用R 3.2.2版的Metafor软件包1.9 - 7版进行荟萃分析。
荟萃分析显示，丁丙诺啡总体上对疼痛强度有有益影响，在合并慢性疼痛和OUD的患者中平均效应量较小，在无OUD的慢性疼痛患者中效应量为中度至较大。
我们的结果表明，丁丙诺啡在减轻无OUD患者的疼痛强度方面有一定益处。尽管这些发现提供了信息，但由于可用数据量少和研究设计存在差异，应谨慎解读。
