Abstract
Background and Objective
This updated systematic review evaluated the efficacy, acceptability and safety of long‐term opioid therapy (LTOT) for chronic non‐cancer pain (CNCP).
Databases and Data Treatment
Clinicaltrials.gov, CENTRAL and MEDLINE were searched to June 2019. We included open‐label extension trials with a study duration ≥ 26 weeks of RCTs with ≥ two weeks duration. Pooled estimates of event rates of categorical data and standardized mean differences (SMD) of continuous variables were calculated using a random effects model.
Results
We added four new studies with 1154 participants for a total of 15 studies with 3590 participants. Study duration ranged between 26 and 156 weeks. Studies included patients with low back, osteoarthritis and neuropathic pain. The quality of evidence for every outcome was very low. 31.1% (95% Confidence interval [CI] 23.0% to 40.7%) of patients randomized at baseline finished the open label period. 14.1 % (95% CI 10.9% to 19.4%) of patients dropped out to due adverse events. In 6.3% (95 CI 3.9% to 10.1%) of patients serious adverse events and in 2.7% (95% CI 1.5% to 4.7%) aberrant drug behavior were noted. 0.5 % (95% CI 0.2% to 1.4%) of patients died.
Conclusions
Within the context of open‐label extension studies, opioids maintain reduction of pain and disability and are rather well tolerated and safe. LtOT can be considered in carefully selected and monitored patients with low back, osteoarthritis and neuropathic pain who experience a clinically meaningful pain reduction with at least tolerable adverse events in short‐term opioid therapy.
from Wiley: European Journal of Pain: Table of Contents https://ift.tt/2WqrQbm
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