From the Department of Anaesthesiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, The University of Hong Kong, Hong Kong, China.
Anesth Analg. 2023 Jul 1;137(1):59-71. doi: 10.1213/ANE.0000000000006467. Epub 2023 Jun 16.
Buprenorphine is a partial agonist at the µ-opioid receptor and an antagonist at the delta and kappa opioid receptors. It has high affinity and low intrinsic activity at the µ-opioid receptor. Buprenorphine demonstrates no ceiling effect for clinical analgesia, but demonstrates this for respiratory depression and euphoria. It may provide effective analgesia while producing less adverse effects, making it a promising opioid analgesic. A systematic review and meta-analysis were performed to examine the analgesic efficacy of buprenorphine for patients with chronic noncancer pain.
PubMed, MEDLNE, Embase, and the Cochrane Library were searched up to January 2022. Randomized controlled trials were included if they compared buprenorphine versus placebo or active analgesic in patients with chronic noncancer pain, where pain score was an outcome. Nonrandomized controlled trials, observational studies, qualitative studies, case reports, and commentaries were excluded. Two investigators independently performed the literature search, study selection, and data collection. A random-effects model was used. The primary outcome was the effect of buprenorphine on pain intensity in patients with chronic noncancer pain based on standardized mean difference (SMD) in pain score. Quality of evidence was assessed using the Grade of Recommendations Assessment, Development, and Evaluation (GRADE) approach.
Two separate literature searches were conducted for patients with and without opioid use disorder (OUD). Only one study met the search criteria for those with OUD. Fourteen randomized controlled trials were included for those without OUD. Buprenorphine was associated with reduced pain score (SMD = -0.368, P < .001, I 2 = 89.37%) compared to placebo or active analgesic. Subgroup meta-analyses showed statistically significant differences in favor of buprenorphine versus placebo (SMD = -0.404, P < .001), for chronic low back pain (SMD = -0.383, P < .001), when administered via the transdermal route (SMD = -0.572, P = .001), via the buccal route (SMD = -0.453, P < .001), with length of follow-up lasting <12 weeks (SMD = -0.848, P < .05), and length of follow-up lasting 12 weeks or more (SMD = -0.415, P < .001). There was no significant difference when compared to active analgesic (SMD = 0.045, P > .05). Quality of evidence was low to moderate.
Buprenorphine was associated with a statistically significant and small reduction in pain intensity compared to placebo. Both the transdermal and buccal routes provided pain relief. There was more evidence supporting its use for chronic low back pain.
丁丙诺啡是 µ-阿片受体的部分激动剂，也是 δ 和 κ 阿片受体的拮抗剂。它在 µ-阿片受体上具有高亲和力和低内在活性。丁丙诺啡对临床镇痛没有天花板效应，但对呼吸抑制和欣快有这种效应。它可能提供有效的镇痛作用，同时产生较少的不良反应，因此是一种有前途的阿片类镇痛药。对丁丙诺啡治疗慢性非癌性疼痛患者的镇痛疗效进行了系统评价和荟萃分析。
检索了 PubMed、MEDLNE、Embase 和 Cochrane 图书馆，检索时间截至 2022 年 1 月。如果将丁丙诺啡与慢性非癌性疼痛患者的安慰剂或活性镇痛药进行比较，且疼痛评分是结局，则纳入随机对照试验。排除非随机对照试验、观察性研究、定性研究、病例报告和评论。两名研究者独立进行文献检索、研究选择和数据收集。使用随机效应模型。主要结局是根据疼痛评分的标准化均数差（SMD）评估丁丙诺啡对慢性非癌性疼痛患者疼痛强度的影响。使用推荐评估、制定与评价（GRADE）方法评估证据质量。
对有和没有阿片类药物使用障碍（OUD）的患者进行了两次单独的文献检索。只有一项研究符合 OUD 患者的检索标准。纳入了 14 项无 OUD 患者的随机对照试验。与安慰剂或活性镇痛药相比，丁丙诺啡与疼痛评分降低相关（SMD=-0.368，P<0.001，I 2=89.37%）。亚组荟萃分析显示，丁丙诺啡与安慰剂相比有统计学意义（SMD=-0.404，P<0.001），慢性腰痛（SMD=-0.383，P<0.001），经皮途径给药（SMD=-0.572，P=0.001），颊粘膜途径给药（SMD=-0.453，P<0.001），随访时间<12 周（SMD=-0.848，P<0.05），随访时间 12 周或更长时间（SMD=-0.415，P<0.001）。与活性镇痛药相比，差异无统计学意义（SMD=0.045，P>0.05）。证据质量为低到中度。
与安慰剂相比，丁丙诺啡与疼痛强度的统计学显著和小幅度降低相关。经皮和颊粘膜途径均可缓解疼痛。有更多证据支持其用于慢性腰痛。
