Comparative benefits and harms of individual opioids for chronic non-cancer pain: a systematic review and network meta-analysis of randomised trials.

Autor:	Noori A; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada; The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada., Sadeghirad B; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada; The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada; Department of Anesthesia, McMaster University, Hamilton, ON, Canada., Wang L; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada; The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada; Department of Anesthesia, McMaster University, Hamilton, ON, Canada., Siemieniuk RAC; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada., Shokoohi M; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada., Kum E; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada., Jeddi M; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada., Montoya L; Krembil Research Institute-University Health Network-Orthopaedic Surgery Arthritis Program, Toronto, Ontario, Canada., Hong PJ; Department of Anesthesia, University of Toronto, Toronto, ON, Canada., Zhou E; Department of Family Medicine, McMaster University, Hamilton, ON, Canada., Couban RJ; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada., Juurlink DN; Department of Medicine, University of Toronto, Toronto, ON, Canada., Thabane L; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada., Bhandari M; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada., Guyatt GH; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada., Busse JW; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada; The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada; Department of Anesthesia, McMaster University, Hamilton, ON, Canada; The Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, ON, Canada. Electronic address: bussejw@mcmaster.ca.
Jazyk:	angličtina
Zdroj:	British journal of anaesthesia [Br J Anaesth] 2022 Sep; Vol. 129 (3), pp. 394-406. Date of Electronic Publication: 2022 Jul 09.
DOI:	10.1016/j.bja.2022.05.031
Abstrakt:	Background: Most systematic reviews of opioids for chronic pain have pooled treatment effects across individual opioids under the assumption they provide similar benefits and harms. We examined the comparative effects of individual opioids for chronic non-cancer pain through a network meta-analysis of randomised controlled trials. Methods: We searched MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials to March 2021 for studies that enrolled patients with chronic non-cancer pain, randomised them to receive different opioids, or opioids vs placebo, and followed them for at least 4 weeks. Certainty of evidence was evaluated using the GRADE approach. Results: We identified 82 eligible trials (22 619 participants) that evaluated 14 opioids. Compared with placebo, several opioids showed superiority to others for analgesia and improvement in physical function; however, when restricted to pooled-effect estimates supported by moderate certainty evidence, no differences between opioids were evident. Among opioids with moderate certainty evidence, all increased the risk of gastrointestinal adverse events compared with placebo, although no opioids were more harmful than others. Low to very low certainty evidence suggests that extended-release vs immediate-release opioids may provide similar benefits for pain relief and physical functioning, and gastrointestinal harms. Conclusions: Our findings support the pooling of effect estimates across different types and formulations of opioids to inform effectiveness for chronic non-cancer pain. (Copyright © 2022 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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