Hunter Integrated Pain Service, Hunter New England Local Health District, New Lambton, New South Wales, Australia.
School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia.
J Clin Nurs. 2022 Dec;31(23-24):3368-3389. doi: 10.1111/jocn.16235. Epub 2022 Feb 7.
Prescription opioid use is a global health issue. Previous systematic reviews have not identified that any specific intervention supports prescription opioid reduction effectively. In keeping with the nature of a scoping review, this review details an overview of the existing literature on this topic, with quality of evidence being discussed rather than formally analysed.
This review aimed to examine and describe outpatient interventions that support the reduction of prescription opioid medication for chronic non cancer pain.
Abstracts were reviewed against the inclusion criteria of outpatient clinical interventions, for the purpose of prescription opioid dose reduction, offered to adults with CNCP.
Following a structured review approach an electronic database search, of Medline, Embase, Cochrane, Cinahl, and Proquest and grey literature was undertaken. Search results were screened by title for relevance.
Two reviewers adhering to the PRISMA-ScR checklist charted and assessed studies for quality using Critical Appraisal Skills Programme checklist assessment tools. Extracted data were collated and synthesised for presentation as a tabular and narrative review.
From the initial search of 5089 papers, 19 underwent full-text review and quality appraisal. A variety of interventions were described to support reduction in prescription opioid use, however only one study of at least fair quality was able to demonstrate a demonstrated a statistically significant benefit in reducing measured opioid dose compared with a control group. Interventions were implemented in both specialist pain services and in primary care with multidisciplinary and interdisciplinary clinician care. Barriers and facilitators were observed in both settings.
Further rigorous research needs to be conducted to conclusively answer the question of what outpatient interventions support opioid reduction in chronic non cancer pain. This scoping review is the first step of inquiry in the development of a nursing intervention to support reduction of prescription opioids.
处方阿片类药物的使用是一个全球性的健康问题。之前的系统评价并未发现任何特定的干预措施能有效地支持减少处方阿片类药物的使用。由于这是一个范围综述，因此本综述详细介绍了关于这一主题的现有文献综述，讨论了证据的质量而不是正式分析。
本综述旨在检查和描述支持减少慢性非癌症疼痛患者处方阿片类药物的门诊干预措施。
对符合门诊临床干预条件的摘要进行了审查，目的是减少慢性非癌症疼痛患者的处方阿片类药物剂量。
采用结构化综述方法，对 Medline、Embase、Cochrane、Cinahl 和 Proquest 电子数据库以及灰色文献进行了检索。通过标题筛选搜索结果，以确定其相关性。
两名遵循 PRISMA-ScR 清单的审查员使用批判性评价技能计划清单评估工具对研究进行图表记录和质量评估。提取的数据被整理并综合为表格和叙述性综述。
从最初的 5089 篇论文中，有 19 篇经过了全文审查和质量评估。描述了各种干预措施来支持减少处方阿片类药物的使用，但只有一项至少为中等质量的研究能够证明与对照组相比，测量的阿片类药物剂量有统计学意义的减少。干预措施在专科疼痛服务和初级保健中实施，由多学科和跨学科临床医生提供护理。在这两种环境中都观察到了障碍和促进因素。
需要进一步进行严格的研究，才能最终回答什么门诊干预措施支持慢性非癌症疼痛患者减少阿片类药物的使用的问题。本范围综述是开发支持减少处方阿片类药物的护理干预措施的初步研究。
