Deprescribing Opioids in Chronic Non-cancer Pain: Systematic Review of Randomised Trials.
Analgesics, Opioid
/ administration & dosage
Buprenorphine
/ administration & dosage
Chronic Pain
/ psychology
Clinical Decision-Making
Deprescriptions
Drug Prescriptions
/ statistics & numerical data
Humans
Mindfulness
Narcotic Antagonists
/ administration & dosage
Opioid Epidemic
/ etiology
Pain Management
/ methods
Randomized Controlled Trials as Topic
Treatment Outcome
Journal
Drugs
ISSN: 1179-1950
Titre abrégé: Drugs
Pays: New Zealand
ID NLM: 7600076
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
pubmed:
2
8
2020
medline:
13
7
2021
entrez:
2
8
2020
Statut:
ppublish
Résumé
Deprescribing, the process of reducing or discontinuing unnecessary or harmful medicines is an essential part of clinical practice. To evaluate the efficacy of interventions designed to deprescribe opioid analgesics for pain relief in patients with chronic non-cancer pain. We searched electronic databases, including clinical trial registries, from database inception to 13th January 2020 without restrictions, and conducted citation tracking. Our systematic review included randomised controlled trials (RCTs) evaluating interventions reducing the prescription, or use of opioid analgesics in patients with chronic pain versus control. Inventions could be aimed at the patient, clinician, or both. We excluded trials enrolling patients with cancer or illicit drug use. Two authors independently screened and extracted data. Outcome follow-up timepoints were short (≤ 3 months), intermediate (> 3 but < 12 months) or long (≥ 12 months) term. Primary outcome was the reduction in opioid dose [morphine milligram equivalent (MME) mg/day]. Methodological quality was assessed using the Cochrane Risk of Bias Tool. We included ten patient-focused RCT interventions (n = 835; median 37 participants) and 2 testing clinician-focused interventions (n = 291 clinicians); none at low risk of bias. Patient-focused interventions did not reduce opioid dose in the intermediate term [e.g. dose reduction protocol, mean difference (MD) - 19.9 MME, 95% CI - 107.5 to 67.7], nor did they increase the number of participants who ceased their dose, or increase the risk of serious adverse events or adverse events. One clinician intervention of education plus decision tools versus decision tools alone reduced the number of opioid prescriptions (risk difference (RD) - 0.1, 95% CI - 0.2 to - 0.1), dose (MD - 5.3 MME, 95% CI - 6.2 to - 4.5) and use (RD - 0.1, 95% CI - 0.1 to - 0.0) in the long term. Study heterogeneity prevented meta-analysis. The small number of studies and heterogeneity prevented firm conclusions to recommend any one opioid-analgesic-deprescribing strategy in patients with chronic pain. PROSPERO CRD42017068422.
Sections du résumé
BACKGROUND
BACKGROUND
Deprescribing, the process of reducing or discontinuing unnecessary or harmful medicines is an essential part of clinical practice.
OBJECTIVE
OBJECTIVE
To evaluate the efficacy of interventions designed to deprescribe opioid analgesics for pain relief in patients with chronic non-cancer pain.
METHODS
METHODS
We searched electronic databases, including clinical trial registries, from database inception to 13th January 2020 without restrictions, and conducted citation tracking. Our systematic review included randomised controlled trials (RCTs) evaluating interventions reducing the prescription, or use of opioid analgesics in patients with chronic pain versus control. Inventions could be aimed at the patient, clinician, or both. We excluded trials enrolling patients with cancer or illicit drug use. Two authors independently screened and extracted data. Outcome follow-up timepoints were short (≤ 3 months), intermediate (> 3 but < 12 months) or long (≥ 12 months) term. Primary outcome was the reduction in opioid dose [morphine milligram equivalent (MME) mg/day]. Methodological quality was assessed using the Cochrane Risk of Bias Tool.
RESULTS
RESULTS
We included ten patient-focused RCT interventions (n = 835; median 37 participants) and 2 testing clinician-focused interventions (n = 291 clinicians); none at low risk of bias. Patient-focused interventions did not reduce opioid dose in the intermediate term [e.g. dose reduction protocol, mean difference (MD) - 19.9 MME, 95% CI - 107.5 to 67.7], nor did they increase the number of participants who ceased their dose, or increase the risk of serious adverse events or adverse events. One clinician intervention of education plus decision tools versus decision tools alone reduced the number of opioid prescriptions (risk difference (RD) - 0.1, 95% CI - 0.2 to - 0.1), dose (MD - 5.3 MME, 95% CI - 6.2 to - 4.5) and use (RD - 0.1, 95% CI - 0.1 to - 0.0) in the long term.
LIMITATIONS
CONCLUSIONS
Study heterogeneity prevented meta-analysis.
CONCLUSION
CONCLUSIONS
The small number of studies and heterogeneity prevented firm conclusions to recommend any one opioid-analgesic-deprescribing strategy in patients with chronic pain.
SYSTEMATIC REVIEW REGISTRATION NUMBER
UNASSIGNED
PROSPERO CRD42017068422.
Identifiants
pubmed: 32737739
doi: 10.1007/s40265-020-01368-y
pii: 10.1007/s40265-020-01368-y
doi:
Substances chimiques
Analgesics, Opioid
0
Narcotic Antagonists
0
Buprenorphine
40D3SCR4GZ
Types de publication
Journal Article
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1563-1576Commentaires et corrections
Type : ErratumIn