促进睡眠药物治疗对慢性疼痛患者的镇痛效果:一项系统综述和荟萃分析。

IF 3.4 Q2 NEUROSCIENCES
Emelie Andersson, Thomas Kander, Mads U Werner, Joshua H Cho, Eva Kosek, Martin F Bjurström
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引用次数: 1

摘要

睡眠失调会增加疼痛敏感性,并可能导致疼痛的慢性化。巩固和延长睡眠的干预措施有可能改善疼痛控制。本系统综述的主要目的是研究促进睡眠的药物治疗对慢性疼痛患者疼痛强度的影响。检索自成立至2022年1月的多个电子数据库,以确定相关的随机对照试验(rct)。两名独立审稿人筛选标题、摘要和全文文章;提取的数据;并评估每个纳入研究的偏倚风险。GRADE方法用于确定证据的强度。搜索确定了624篇文章。全文筛选后,纳入10项随机对照试验(n = 574名随机受试者),涉及3种药物干预(褪黑激素、佐匹克隆和艾司佐匹克隆)和7种不同的慢性疼痛人群。4项研究报告了至少有临床意义的疼痛减轻≥30%。有低质量的证据(由于不一致和不精确而降低)表明,与安慰剂或单独使用相同的镇痛药相比,单独使用促进睡眠药物或联合使用镇痛药治疗2至8周可降低疼痛强度(SMD -0.58[95%置信区间-1.00,-0.17],P = 0.006)。只有两篇文章分析了睡眠变化和疼痛结果之间的关系,结果不一致。值得注意的是,缓解疼痛的效果在褪黑素试验中最为一致。只有3项研究使用了多导睡眠图来获得客观的睡眠测量。低质量的证据表明,药物睡眠促进可能会降低慢性疼痛人群的疼痛强度。需要更多的研究来充分了解睡眠目标干预对疼痛控制的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Analgesic efficacy of sleep-promoting pharmacotherapy in patients with chronic pain: a systematic review and meta-analysis.

Analgesic efficacy of sleep-promoting pharmacotherapy in patients with chronic pain: a systematic review and meta-analysis.

Analgesic efficacy of sleep-promoting pharmacotherapy in patients with chronic pain: a systematic review and meta-analysis.

Analgesic efficacy of sleep-promoting pharmacotherapy in patients with chronic pain: a systematic review and meta-analysis.

Dysregulation of sleep heightens pain sensitivity and may contribute to pain chronification. Interventions which consolidate and lengthen sleep have the potential to improve pain control. The main objective of this systematic review was to examine the effects of sleep-promoting pharmacotherapy on pain intensity in patients with chronic pain. Multiple electronic databases were searched from inception to January 2022 to identify relevant randomized controlled trials (RCTs). Two independent reviewers screened titles, abstracts, and full-text articles; extracted data; and assessed risk of bias for each included study. The GRADE approach was used to determine the strength of evidence. The search identified 624 articles. After full-text screening, 10 RCTs (n = 574 randomized participants) involving 3 pharmacologic interventions (melatonin, zopiclone, and eszopiclone) and 7 different chronic pain populations were included. Minimum clinically significant pain reduction ≥30% was reported in 4 studies. There is low-quality evidence (downgraded due to inconsistency and imprecision) that 2 to 8 weeks treatment with a sleep-promoting medication alone or in combination with an analgesic (6 trials, n = 397) decreases pain intensity compared with placebo or the same analgesic treatment alone (SMD -0.58 [95% confidence interval -1.00, -0.17], P = 0.006). Analyses of associations between changes in sleep and pain outcomes were only provided in 2 articles, with inconsistent findings. Notably, pain-relieving effects were most consistent in melatonin trials. Only 3 studies implemented polysomnography to obtain objective sleep measures. Low-quality evidence indicates that pharmacologic sleep promotion may decrease pain intensity in chronic pain populations. More research is needed to fully understand the influence of sleep-targeting interventions on pain control.

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来源期刊
Pain Reports
Pain Reports Medicine-Anesthesiology and Pain Medicine
CiteScore
7.50
自引率
2.10%
发文量
93
审稿时长
8 weeks
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