慢性疼痛患者减量服用止痛药的效果：系统回顾与荟萃分析。

IF 9.1 1区医学 Q1 ANESTHESIOLOGY

British journal of anaesthesia Pub Date : 2024-10-02 DOI:10.1016/j.bja.2024.07.025

Elke Wuyts , Lisa Goudman , Cleo L. Crunelle , Maria Merlano Gomez , Koen Putman , Frenn Bultinck , Julie G. Pilitsis , Maarten Moens

{"title":"慢性疼痛患者减量服用止痛药的效果：系统回顾与荟萃分析。","authors":"Elke Wuyts , Lisa Goudman , Cleo L. Crunelle , Maria Merlano Gomez , Koen Putman , Frenn Bultinck , Julie G. Pilitsis , Maarten Moens","doi":"10.1016/j.bja.2024.07.025","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>This systematic review and meta-analysis aimed to inventory all outcome measures that are affected by tapering in chronic noncancer pain and to investigate the effectiveness of tapering.</div></div><div><h3>Methods</h3><div>A literature search was conducted from inception to April 2024 in MEDLINE via PubMed, Web of Science, SCOPUS, EMBASE, and PsycINFO.</div></div><div><h3>Results</h3><div>The initial database search identified 3969 articles, which were screened by two independent reviewers. Studies evaluating pain medication tapering in adults with chronic noncancer pain were eligible for inclusion. In total, 57 and 34 articles were included in the systematic review and meta-analysis, respectively. Risk of bias assessment demonstrated poor, fair, and good quality in 30, 24, and three studies, respectively. Pain intensity was the most reported outcome measure, as reported in 28 studies. Furthermore, a random-effect three-level meta-analysis was performed. An overall effect size of 0.917 (95% confidence interval 0.61–1.22; <em>P</em><0.001) was found, indicating a beneficial effect of tapering. In addition, a statistically significant improvement was demonstrated after tapering for pain intensity, headache disability, the number of headache days per month, anxiety, depression, the number of pills consumed per month, the number of days with medication intake per month, pain catastrophising, and pain interference. No statistically significant effect was observed for physical functioning, mental health-related quality of life, opioid use, pain self-efficacy, and physical health-related quality of life.</div></div><div><h3>Conclusions</h3><div>This systematic review revealed a broad range of outcome measures affected by tapering. Owing to the high risk of bias of the included articles, the results of this meta-analysis must be interpreted with caution.</div></div><div><h3>Systematic review protocol</h3><div>CRD42023416343 (PROSPERO).</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 5","pages":"Pages 998-1020"},"PeriodicalIF":9.1000,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effectiveness of pain medication tapering in chronic pain patients: a systematic review and meta-analysis\",\"authors\":\"Elke Wuyts , Lisa Goudman , Cleo L. Crunelle , Maria Merlano Gomez , Koen Putman , Frenn Bultinck , Julie G. Pilitsis , Maarten Moens\",\"doi\":\"10.1016/j.bja.2024.07.025\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>This systematic review and meta-analysis aimed to inventory all outcome measures that are affected by tapering in chronic noncancer pain and to investigate the effectiveness of tapering.</div></div><div><h3>Methods</h3><div>A literature search was conducted from inception to April 2024 in MEDLINE via PubMed, Web of Science, SCOPUS, EMBASE, and PsycINFO.</div></div><div><h3>Results</h3><div>The initial database search identified 3969 articles, which were screened by two independent reviewers. Studies evaluating pain medication tapering in adults with chronic noncancer pain were eligible for inclusion. In total, 57 and 34 articles were included in the systematic review and meta-analysis, respectively. Risk of bias assessment demonstrated poor, fair, and good quality in 30, 24, and three studies, respectively. Pain intensity was the most reported outcome measure, as reported in 28 studies. Furthermore, a random-effect three-level meta-analysis was performed. An overall effect size of 0.917 (95% confidence interval 0.61–1.22; <em>P</em><0.001) was found, indicating a beneficial effect of tapering. In addition, a statistically significant improvement was demonstrated after tapering for pain intensity, headache disability, the number of headache days per month, anxiety, depression, the number of pills consumed per month, the number of days with medication intake per month, pain catastrophising, and pain interference. No statistically significant effect was observed for physical functioning, mental health-related quality of life, opioid use, pain self-efficacy, and physical health-related quality of life.</div></div><div><h3>Conclusions</h3><div>This systematic review revealed a broad range of outcome measures affected by tapering. Owing to the high risk of bias of the included articles, the results of this meta-analysis must be interpreted with caution.</div></div><div><h3>Systematic review protocol</h3><div>CRD42023416343 (PROSPERO).</div></div>\",\"PeriodicalId\":9250,\"journal\":{\"name\":\"British journal of anaesthesia\",\"volume\":\"133 5\",\"pages\":\"Pages 998-1020\"},\"PeriodicalIF\":9.1000,\"publicationDate\":\"2024-10-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"British journal of anaesthesia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0007091224004720\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"British journal of anaesthesia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0007091224004720","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}

引用次数: 0

摘要

背景：本系统综述和荟萃分析旨在盘点慢性非癌性疼痛患者中受减量影响的所有结果指标，并研究减量的有效性：从开始到 2024 年 4 月，通过 PubMed、Web of Science、SCOPUS、EMBASE 和 PsycINFO 在 MEDLINE 上进行了文献检索：最初的数据库检索发现了 3969 篇文章，这些文章由两名独立审稿人进行了筛选。对患有慢性非癌症疼痛的成人进行止痛药减量评估的研究符合纳入条件。共有57篇和34篇文章分别被纳入系统综述和荟萃分析。偏倚风险评估显示，分别有 30 项、24 项和 3 项研究的质量较差、一般和良好。疼痛强度是报告最多的结果测量指标，有 28 项研究报告了这一指标。此外，还进行了随机效应三级荟萃分析。总体效应大小为 0.917（95% 置信区间为 0.61-1.22；PC 结论）：本系统综述揭示了受减量影响的一系列结果指标。由于纳入文章的偏倚风险较高，因此必须谨慎解释该荟萃分析的结果：CRD42023416343 (PROCROPERO)。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Effectiveness of pain medication tapering in chronic pain patients: a systematic review and meta-analysis

Background

This systematic review and meta-analysis aimed to inventory all outcome measures that are affected by tapering in chronic noncancer pain and to investigate the effectiveness of tapering.

Methods

A literature search was conducted from inception to April 2024 in MEDLINE via PubMed, Web of Science, SCOPUS, EMBASE, and PsycINFO.

Results

The initial database search identified 3969 articles, which were screened by two independent reviewers. Studies evaluating pain medication tapering in adults with chronic noncancer pain were eligible for inclusion. In total, 57 and 34 articles were included in the systematic review and meta-analysis, respectively. Risk of bias assessment demonstrated poor, fair, and good quality in 30, 24, and three studies, respectively. Pain intensity was the most reported outcome measure, as reported in 28 studies. Furthermore, a random-effect three-level meta-analysis was performed. An overall effect size of 0.917 (95% confidence interval 0.61–1.22; P<0.001) was found, indicating a beneficial effect of tapering. In addition, a statistically significant improvement was demonstrated after tapering for pain intensity, headache disability, the number of headache days per month, anxiety, depression, the number of pills consumed per month, the number of days with medication intake per month, pain catastrophising, and pain interference. No statistically significant effect was observed for physical functioning, mental health-related quality of life, opioid use, pain self-efficacy, and physical health-related quality of life.

Conclusions

This systematic review revealed a broad range of outcome measures affected by tapering. Owing to the high risk of bias of the included articles, the results of this meta-analysis must be interpreted with caution.

Systematic review protocol

CRD42023416343 (PROSPERO).

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

British journal of anaesthesia 医学-麻醉学

CiteScore

13.50

自引率

7.10%

发文量

488

审稿时长

27 days

期刊介绍： The British Journal of Anaesthesia (BJA) is a prestigious publication that covers a wide range of topics in anaesthesia, critical care medicine, pain medicine, and perioperative medicine. It aims to disseminate high-impact original research, spanning fundamental, translational, and clinical sciences, as well as clinical practice, technology, education, and training. Additionally, the journal features review articles, notable case reports, correspondence, and special articles that appeal to a broader audience. The BJA is proudly associated with The Royal College of Anaesthetists, The College of Anaesthesiologists of Ireland, and The Hong Kong College of Anaesthesiologists. This partnership provides members of these esteemed institutions with access to not only the BJA but also its sister publication, BJA Education. It is essential to note that both journals maintain their editorial independence. Overall, the BJA offers a diverse and comprehensive platform for anaesthetists, critical care physicians, pain specialists, and perioperative medicine practitioners to contribute and stay updated with the latest advancements in their respective fields.