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IF 2.6 2区医学 Q2 ANESTHESIOLOGY

Pain physician Pub Date : 2025-01-01

Chuanbing Wen, Maoying Wang, Maotong Liu, Chenyu Zhu, Jinlong Zhao, Qing Jiang, RuRong Wang, Jun Li, Li Song

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引用次数: 0

摘要

背景：与癌症相关的神经性疼痛严重影响患者的生活质量。尽管有现有的治疗方法，但许多患者的疼痛控制仍然不足。普瑞巴林常用于治疗神经病理性疼痛，而阿片类药物则常用于治疗癌症相关神经病理性疼痛：本研究旨在通过高质量的证据分析，评估普瑞巴林联合阿片类药物治疗癌症相关神经病理性疼痛的镇痛效果和安全性：普瑞巴林联合阿片类药物治疗癌症相关神经病理性疼痛的系统综述和荟萃分析：我们系统地检索了 PubMed、Web of Science、Embase、Cochrane Library 和 Cochrane Central Register of Controlled Trials 数据库中从开始到 2023 年 10 月 5 日的内容。两名审稿人独立筛选研究，并摘录符合纳入和排除标准的文章。使用修改后的 Cochrane 协作工具对纳入的研究进行质量评估；使用 RevMan 5.4（The Nordic Cochrane Centre for The Cochrane Collaboration）进行数据分析：定性综合共纳入 8 项研究，荟萃分析共纳入 6 项研究（6 项研究共 757 例患者，其中实验组 342 例，对照组 415 例）。结果显示，普瑞巴林联合阿片类药物组与单用阿片类药物组在数值评定量表（NRS-11）疼痛评分方面存在显著差异（加权平均差 [WMD] = -1.00; 95% CI, -1.29 to -0.70; P < 0.001）。然而，普瑞巴林联合阿片类药物组与活性对比剂联合阿片类药物组之间的 NRS-11 评分没有明显差异（WMD = -0.47；95% CI，-1.05 至 0.11；P = 0.11）。就额外吗啡毫克当量而言，普瑞巴林联合阿片类药物组与活性对比剂联合阿片类药物组之间存在显著差异（相对风险 [RR] = 0.37；95% CI，0.20 至 0.70；P = 0.002）。在生活质量方面未观察到明显差异（WMD = -2.01；95% CI，-5.29 至 1.27；P = 0.23）。总体而言，普瑞巴林联合阿片类药物组的不良事件发生频率高于单用阿片类药物组，但普瑞巴林联合阿片类药物组与活性比较药联合阿片类药物组之间的不良事件发生频率尚不明确：文章数量和样本量有限是本荟萃分析的局限性：普瑞巴林联合阿片类药物可减轻癌症相关神经病理性疼痛，但会增加头晕、嗜睡和外周水肿，因此支持将其用于临床治疗癌症相关神经病理性疼痛。不过，还需要更多高质量的随机对照试验来证实这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Pregabalin Combined With Opioids for Managing Neuropathic Pain in Patients With Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Background: Cancer-related neuropathic pain significantly affects patients' quality of life. Despite existing treatments, pain control remains inadequate for many of these patients. There is a lack of strong evidence for the efficacy of the combination of pregabalin, which is often used to treat neuropathic pain, and opioids for treating cancer-related neuropathic pain.

Objective: This study aimed to evaluate the analgesic effects and safety of pregabalin combined with opioids for managing cancer-related neuropathic pain through high-quality evidence analysis.

Study design: A systematic review and meta-analysis of pregabalin combined with opioids for cancer-related neuropathic pain.

Methods: We systematically searched the PubMed, Web of Science, Embase, Cochrane Library and Cochrane Central Register of Controlled Trials databases from their inception through October 5, 2023. Two reviewers independently selected studies and extracted articles that met the inclusion and exclusion criteria. Quality assessments of the included studies were performed using the modified Cochrane Collaboration tool; data analysis was performed using RevMan 5.4 (The Nordic Cochrane Centre for The Cochrane Collaboration).

Results: A total of 8 studies were included in our qualitative synthesis, and 6 studies were included in the meta-analysis (6 studies with 757 patients, including 342 in the experimental group and 415 in the control group). The results showed a significant difference between the pregabalin combined with opioids group and the opioids alone group in terms of Numeric Rating Scale (NRS-11) pain scores (weighted mean difference [WMD] = -1.00; 95% CI, -1.29 to -0.70; P < 0.001). However, no significant difference in the NRS-11 score was observed between the pregabalin combined with opioids group and active comparator combined with opioids group (WMD = -0.47; 95% CI, -1.05 to 0.11; P = 0.11). There was a significant difference between the pregabalin combined with opioids group and the active comparator combined with opioids group in terms of extra morphine milligram equivalents (relative risk [RR] = 0.37; 95% CI, 0.20 to 0.70; P = 0.002). No significant difference was observed in quality of life (WMD = -2.01; 95% CI, -5.29 to 1.27; P = 0.23). In general, the frequency of adverse events in the pregabalin combined with opioids group was greater than that in the opioids alone group, but the frequency of adverse events between the pregabalin combined with opioids group and the active comparator combined with opioids group was unclear.

Limitations: The limited number of articles and sample size are the limitations of this meta-analysis.

Conclusions: Pregabalin combined with opioids reduces cancer-related neuropathic pain but increases dizziness, somnolence, and peripheral edema, thus supporting its use in the clinic for treating cancer-related neuropathic pain. However, further high-quality randomized controlled trials are needed to confirm these findings.

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来源期刊

Pain physician CLINICAL NEUROLOGY-CLINICAL NEUROLOGY

CiteScore

6.00

自引率

21.60%

发文量

234

期刊介绍： Pain Physician Journal is the official publication of the American Society of Interventional Pain Physicians (ASIPP). The open access journal is published 6 times a year. Pain Physician Journal is a peer-reviewed, multi-disciplinary, open access journal written by and directed to an audience of interventional pain physicians, clinicians and basic scientists with an interest in interventional pain management and pain medicine. Pain Physician Journal presents the latest studies, research, and information vital to those in the emerging specialty of interventional pain management – and critical to the people they serve.