School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia.
Institute for Musculoskeletal Health, Sydney, New South Wales, Australia.
Pain Med. 2021 Feb 23;22(2):506-517. doi: 10.1093/pm/pnaa322.
To review studies examining the proportion of people with chronic noncancer pain who report consuming opioids and characteristics associated with their use.
Systematic review.
We searched databases from inception to February 8, 2020, and conducted citation tracking. We included observational studies reporting the proportion of adults with chronic noncancer pain who used opioid analgesics. Opioids were categorized as weak (e.g., codeine) or strong (e.g., oxycodone). Study risk of bias was assessed, and Grading of Recommendations Assessment, Development and Evaluations provided a summary of the overall quality. Results were pooled using a random-effects model. Meta-regression determined factors associated with opioid use.
Sixty studies (N=3,961,739) reported data on opioid use in people with chronic noncancer pain from 1990 to 2017. Of these 46, 77% had moderate risk of bias. Opioid use was reported by 26.8% (95% confidence interval [CI], 23.1-30.8; moderate-quality evidence) of people with chronic noncancer pain. The use of weak opioids (17.3%; 95% CI 11.9-24.4; moderate-quality evidence) was more common than the use of strong opioids (9.8%; 95% CI, 6.8-14.0; low-quality evidence). Meta-regression determined that opioid use was associated with geographic region (P=0.02; lower in Europe than North America), but not sampling year (P=0.77), setting (P=0.06), diagnosis (P=0.34), or disclosure of funding (P=0.77).
Our review summarized data from over 3.9 million people with chronic noncancer pain reporting their opioid use. Between 1990 and 2017, one-quarter of people with chronic noncancer pain reported taking opioids, and this proportion did not change over time.
综述研究慢性非癌症疼痛患者报告使用阿片类药物的比例以及与使用相关的特征。
系统评价。
我们从成立到 2020 年 2 月 8 日搜索数据库，并进行了引文追踪。我们纳入了报告慢性非癌症疼痛成人使用阿片类镇痛药比例的观察性研究。阿片类药物分为弱阿片类药物（如可待因）和强阿片类药物（如羟考酮）。评估了研究的偏倚风险，并采用推荐评估、制定与评估分级（Grading of Recommendations Assessment, Development and Evaluations）对整体质量进行了总结。使用随机效应模型汇总结果。元回归确定了与阿片类药物使用相关的因素。
1990 年至 2017 年间，60 项研究（N=3961739 人）报告了慢性非癌症疼痛患者使用阿片类药物的数据。其中 46 项研究的偏倚风险为 77%。26.8%（95%置信区间[CI]，23.1-30.8；中等质量证据）的慢性非癌症疼痛患者报告使用阿片类药物。弱阿片类药物（17.3%；95%CI 11.9-24.4；中等质量证据）的使用比强阿片类药物（9.8%；95%CI 6.8-14.0；低质量证据）更为常见。元回归确定阿片类药物的使用与地理位置有关（P=0.02；欧洲低于北美），但与采样年份（P=0.77）、环境（P=0.06）、诊断（P=0.34）或资金披露（P=0.77）无关。
我们的综述总结了来自超过 390 万例慢性非癌症疼痛患者报告其阿片类药物使用情况的数据。1990 年至 2017 年间，四分之一的慢性非癌症疼痛患者报告使用阿片类药物，且这一比例并未随时间而变化。
