Department of Anesthesiology, Centro Hospitalar de São João, Porto, Portugal.
Faculty of Medicine, University of Porto, Porto, Portugal.
Pain Pract. 2021 Jul;21(6):715-729. doi: 10.1111/papr.13001. Epub 2021 Mar 23.
Opioid prescription for chronic noncancer pain is associated with problematic use. We aimed to review and summarize the evidence on the prevalence of problematic use of opioids in adults with chronic noncancer pain and investigate whether the prevalence rates were changing over time.
A systematic review of the literature was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We systematically searched the literature in the electronic databases MEDLINE, SCOPUS, and Web of Science and studies with adult participants with chronic noncancer pain using opioids with indication of one or more of the following terms about problematic opioid use: abuse, misuse, addiction, dependence, problematic use, and aberrant behavior/use were eligible for data extraction. Meta-analysis was performed to estimate the pooled prevalence rates using a random-effects model, and subanalysis was conducted.
Our search identified a total of 784 potentially relevant studies. After a thorough evaluation, 19 papers, mostly from the United States, were included in our qualitative and quantitative synthesis. The majority of the data came from speciality pain clinics. The estimated prevalence of problematic use of opioids in adults with chronic noncancer pain was 36.3% (95% confidence interval: 27.4 to 45.2%; I = 99.64%). Problematic opioid use was mostly identified using the questionnaire method. Thirteen studies (68%) presented a low risk of bias.
Our study presents an alarming estimate regarding the prevalence of problematic use of opioids among patients with noncancer pain. These results deserve special attention from health care professionals and health authorities.
慢性非癌痛患者开具阿片类药物处方与药物滥用有关。本研究旨在回顾和总结慢性非癌痛成人患者中阿片类药物滥用的流行情况，并探讨其流行率是否随时间变化。
按照系统评价和荟萃分析的首选报告项目声明，我们对文献进行了系统综述。我们在电子数据库 MEDLINE、SCOPUS 和 Web of Science 中系统地搜索了文献，并对使用阿片类药物治疗慢性非癌痛的成年参与者进行了研究，这些研究使用了以下一个或多个与阿片类药物问题使用相关的术语：滥用、误用、成瘾、依赖、问题使用和异常行为/使用。合格的研究进行数据提取。使用随机效应模型进行荟萃分析以估计汇总流行率，并进行了亚组分析。
我们的搜索共确定了 784 篇潜在相关研究。经过仔细评估，19 篇主要来自美国的论文被纳入定性和定量综合分析。大多数数据来自专门的疼痛诊所。慢性非癌痛成人阿片类药物滥用问题的估计流行率为 36.3%（95%置信区间：27.4%至 45.2%；I²=99.64%）。阿片类药物滥用问题主要通过问卷法确定。13 项研究（68%）的偏倚风险较低。
本研究报告了慢性非癌痛患者中阿片类药物滥用问题的流行率令人震惊。这些结果值得医疗保健专业人员和卫生当局的特别关注。
