Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
Fam Pract. 2022 Mar 24;39(2):295-300. doi: 10.1093/fampra/cmab159.
Dealing with the opioid crisis, medical doctors are keen to learn how to best treat opioid dependency in patients with chronic non-cancer pain. Opioid replacement therapy is commonly used, but success rates vary widely. Since many patients still experience severe withdrawal symptoms, additional interventions are necessary.
To review the effectiveness of interventions in the treatment of withdrawal symptoms during opioid tapering or acute withdrawal in patients with long-term non-cancer pain.
A systematic review was conducted in Embase.com, MEDLINE, Web of Science, PsycINFO, and Cochrane CENTRAL register of trials. Studies eligible for inclusion were (non-)randomized controlled trials in adults with long-term opioid prescriptions for non-cancer pain. Included trials had to compare a non-opioid intervention to placebo, usual care, no treatment, or non-opioid drug and had to report on withdrawal symptoms as an outcome. Study quality was assessed with the 2.0 Cochrane risk of bias (RoB) tool. Evidence quality was rated following the GRADE approach.
One trial (n = 21, some concerns regarding RoB) compared Varenicline to placebo. There was no statistically significant between-group reduction of withdrawal symptoms (moderate-quality evidence).
Evidence from clinical trials on interventions reducing withdrawal symptoms is scarce. Based on one trial with a small sample size, no firm conclusion can be drawn. Meanwhile, doctors are in dire need for therapeutic options to tackle withdrawal symptoms while tapering patients with prescription opioid dependence. We hope this review draws attention to this unfortunate research gap so that future research can provide doctors with answers.
面对阿片类药物危机，医生渴望学习如何最好地治疗慢性非癌痛患者的阿片类药物依赖。阿片类药物替代疗法通常被使用，但成功率差异很大。由于许多患者仍经历严重的戒断症状，因此需要额外的干预措施。
综述在长期非癌痛患者的阿片类药物逐渐减少或急性戒断期间，干预措施治疗戒断症状的疗效。
在 Embase.com、MEDLINE、Web of Science、PsycINFO 和 Cochrane 对照试验中心注册库中进行系统评价。纳入的研究为接受长期阿片类药物处方治疗非癌痛的成年人的（非）随机对照试验。纳入的试验必须将非阿片类药物干预措施与安慰剂、常规护理、不治疗或非阿片类药物进行比较，并报告作为结果的戒断症状。使用 2.0 版 Cochrane 偏倚风险（RoB）工具评估研究质量。按照 GRADE 方法评估证据质量。
一项试验（n = 21，对 RoB 存在一些关注）比较了伐伦克林与安慰剂。两组之间戒断症状的减少没有统计学意义（中等质量证据）。
关于减少戒断症状的干预措施的临床试验证据很少。基于一项样本量较小的试验，无法得出明确的结论。与此同时，医生迫切需要治疗选择来解决接受处方阿片类药物依赖的患者逐渐减少药物的戒断症状问题。我们希望本综述引起人们对这一不幸的研究空白的关注，以便未来的研究能够为医生提供答案。
