Acute Pain Management in People With Opioid Use Disorder : A Systematic Review.

IF 19.6 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

Annals of Internal Medicine Pub Date : 2025-04-01 Epub Date: 2025-03-18 DOI:10.7326/ANNALS-24-01917

Michele J Buonora, Katherine Mackey, Laila Khalid, Thomas R Hickey, Alyssa A Grimshaw, Max Moss, Joanna L Starrels, Daniel P Alford, William C Becker, Melissa B Weimer

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引用次数: 0

Abstract

Background: Guidance on acute pain management among people with opioid use disorder (OUD) is limited.

Purpose: To synthesize evidence on the benefits and harms of acute pain interventions among people with OUD.

Data sources: APA PsycArticles, APA PsycInfo, APA PsycExtra, Allied and Complementary Medicine Database, CINAHL, Cochrane Library, Google Scholar, Ovid Embase, Ovid MEDLINE, PubMed, Scopus, and the Web of Science Core Collection through 7 July 2024.

Study selection: Studies of any design that evaluated acute pain interventions among adults with OUD and included pain or OUD outcomes.

Data extraction: Independent dual screening, single-investigator data extraction with verification, and dual quality and strength of evidence assessment.

Data synthesis: Seventeen trials, 20 controlled observational studies, and 78 uncontrolled observational studies met eligibility criteria. Continuing use of buprenorphine during acute pain episodes may be associated with similar or improved pain-related outcomes versus discontinuing, based on cohort studies conducted primarily in perioperative settings. Single well-conducted randomized controlled trials in emergency department (ED) or perioperative settings in adults not prescribed medications for OUD suggest oral clonidine, intramuscular haloperidol and midazolam with intravenous (IV) morphine, and intraoperative IV lidocaine may improve pain outcomes and warrant study in diverse patient populations. Few studies evaluated methadone or the effect of interventions on OUD outcomes.

Limitations: Most evidence is observational and at risk of bias due to confounding. All studies were conducted in ED or hospital settings, most before widespread use of high-potency synthetic opioids or among non-U.S. populations using opium.

Conclusion: The overall evidence for pain outcomes in people with OUD is low. The effect of pain interventions on OUD outcomes is an important evidence gap.

Primary funding source: None. (Protocol registered a priori on Open Science Framework [https://osf.io/25hbs]).

查看原文本刊更多论文

阿片类药物使用障碍患者的急性疼痛管理：系统综述。

背景：阿片类药物使用障碍（OUD）患者急性疼痛管理的指导是有限的。目的：综合有关OUD患者急性疼痛干预的利与弊的证据。数据来源：APA PsycArticles， APA PsycInfo, APA PsycExtra, Allied and Complementary Medicine Database， CINAHL, Cochrane Library，谷歌Scholar， Ovid Embase, Ovid MEDLINE, PubMed， Scopus和Web of Science Core Collection，截止到2024年7月7日。研究选择：任何评估急性疼痛干预成人OUD患者的研究，包括疼痛或OUD结果。数据提取：独立的双重筛选，单一研究者的数据提取与验证，双重证据质量和强度评估。数据综合：17项试验、20项对照观察性研究和78项非对照观察性研究符合入选标准。基于主要在围手术期进行的队列研究，急性疼痛发作期间继续使用丁丙诺啡与停用丁丙诺啡相比，可能与相似或改善的疼痛相关结果相关。在急诊科（ED）或围手术期未开OUD处方药的成人中进行的单次随机对照试验表明，口服氯定、肌注氟哌啶醇和咪达唑仑联合静脉注射吗啡和术中静脉注射利多卡因可改善疼痛结局，值得在不同患者群体中进行研究。很少有研究评估美沙酮或干预措施对OUD结果的影响。局限性：大多数证据是观察性的，由于混淆存在偏倚风险。所有的研究都是在急诊科或医院环境中进行的，大多数是在高效合成阿片类药物广泛使用之前或在非美国。吸食鸦片的人口。结论：OUD患者疼痛结局的总体证据较低。疼痛干预对OUD结果的影响是一个重要的证据缺口。主要资金来源：无。（协议在开放科学框架上先验注册[https://osf.io/25hbs]]）。

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来源期刊

Annals of Internal Medicine 医学-医学：内科

CiteScore

23.90

自引率

1.80%

发文量

1136

审稿时长

3-8 weeks

期刊介绍： Established in 1927 by the American College of Physicians (ACP), Annals of Internal Medicine is the premier internal medicine journal. Annals of Internal Medicine’s mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. To achieve this mission, the journal publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to clinical practice, health care delivery, public health, health care policy, medical education, ethics, and research methodology. In addition, the journal publishes personal narratives that convey the feeling and the art of medicine.