Opioids compared with placebo or other treatments for chronic low back pain: an update of the Cochrane Review / Luis Enrique Chaparro Gómez  

Público ISBD Título : Opioids compared with placebo or other treatments for chronic low back pain: an update of the Cochrane Review Tipo de documento : documento electrónico Autores : Luis Enrique Chaparro Gómez, Fecha de publicación : 2014 Títulos uniformes : Spine Idioma : Inglés (eng) Palabras clave : Analgesics  opioid/adverse effects  opioid/therapeutic use  buprenorphine/therapeutic use  Cochrane Review  hydromorphone/therapeutic use  low back pain/drug therapy  metaanalysis  morphine/therapeutic use  oxycodone/therapeutic use  oxymorphone/therapeutic use  sciatica/drug therapy  systematic review  tramadol/therapeutic use Resumen : Study Design: Systematic review and meta-analysis. Objective:To assess the efficacy of opioids in adults with chronic low back pain (CLBP). Summary of Background Data. Opioids for CLBP has increased dramatically. However, the benefits and risks remain unclear. Methods: We updated a 2007 Cochrane Review through October 2012 of randomized controlled trials from multiple databases. Use of noninjectable opioids in CLBP for at least 4 weeks was compared with placebo or other treatments; comparisons with different opioids were excluded. Outcomes included pain and function using standardized mean difference (SMD) or risk ratios with 95% confidence intervals (CIs), and absolute risk difference with 95% CI for adverse effects. Study quality was evaluated using Grading of Recommendations Assessment, Development, and Evaluation criteria. Results: Fifteen trials (5540 participants), including twelve new, met the criteria. Tramadol was better than placebo for pain (SMD, −0.55; 95% CI, −0.66 to −0.44) and function (SMD, −0.18; 95% CI, −0.29 to −0.07). Compared with placebo, transdermal buprenorphine decreased pain (SMD, −2.47; 95% CI, −2.69 to −2.25), but not function (SMD, −0.14; 95% CI, −0.53 to 0.25). Strong opioids (morphine, hydromorphone, oxycodone, oxymorphone, and tapentadol), were better than placebo for pain (SMD, −0.43; 95% CI, −0.52 to −0.33) and function (SMD, −0.26; 95% CI, −0.37 to −0.15). One trial demonstrated little difference with tramadol compared with celecoxib for pain relief. Two trials (272 participants) found no difference between opioids and antidepressants for pain or function. Reviewed trials had low to moderate quality, high drop-out rates, short duration, and limited interpretability of functional improvement. No serious adverse effects, risks (addiction or overdose), or complications (sleep apnea, opioid-induced hyperalgesia, hypogonadism) were reported. Conclusion. There is evidence of short-term efficacy (moderate for pain and small for function) of opioids to treat CLBP compared with placebo. The effectiveness and safety of long- term opioid therapy for treatment of CLBP remains unproven. Level of Evidence: 1 Mención de responsabilidad : Luis Enrique Chaparro, Andrea D Furlan, Amol Deshpande, Angela Mailis-Gagnon, Steven Atlas, Dennis C Turk Referencia : Spine (Phila Pa 1976). 2014 Apr 1;39(7):556-63. DOI (Digital Object Identifier) : 10.1097/BRS.0000000000000249 PMID : 24480962 En línea : https://insights.ovid.com/crossref?an=00007632-201404010-00010 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3786 Opioids compared with placebo or other treatments for chronic low back pain: an update of the Cochrane Review [documento electrónico] / Luis Enrique Chaparro Gómez,  . - 2014. Obra : Spine Idioma : Inglés (eng) Palabras clave : Analgesics  opioid/adverse effects  opioid/therapeutic use  buprenorphine/therapeutic use  Cochrane Review  hydromorphone/therapeutic use  low back pain/drug therapy  metaanalysis  morphine/therapeutic use  oxycodone/therapeutic use  oxymorphone/therapeutic use  sciatica/drug therapy  systematic review  tramadol/therapeutic use Resumen : Study Design: Systematic review and meta-analysis. Objective:To assess the efficacy of opioids in adults with chronic low back pain (CLBP). Summary of Background Data. Opioids for CLBP has increased dramatically. However, the benefits and risks remain unclear. Methods: We updated a 2007 Cochrane Review through October 2012 of randomized controlled trials from multiple databases. Use of noninjectable opioids in CLBP for at least 4 weeks was compared with placebo or other treatments; comparisons with different opioids were excluded. Outcomes included pain and function using standardized mean difference (SMD) or risk ratios with 95% confidence intervals (CIs), and absolute risk difference with 95% CI for adverse effects. Study quality was evaluated using Grading of Recommendations Assessment, Development, and Evaluation criteria. Results: Fifteen trials (5540 participants), including twelve new, met the criteria. Tramadol was better than placebo for pain (SMD, −0.55; 95% CI, −0.66 to −0.44) and function (SMD, −0.18; 95% CI, −0.29 to −0.07). Compared with placebo, transdermal buprenorphine decreased pain (SMD, −2.47; 95% CI, −2.69 to −2.25), but not function (SMD, −0.14; 95% CI, −0.53 to 0.25). Strong opioids (morphine, hydromorphone, oxycodone, oxymorphone, and tapentadol), were better than placebo for pain (SMD, −0.43; 95% CI, −0.52 to −0.33) and function (SMD, −0.26; 95% CI, −0.37 to −0.15). One trial demonstrated little difference with tramadol compared with celecoxib for pain relief. Two trials (272 participants) found no difference between opioids and antidepressants for pain or function. Reviewed trials had low to moderate quality, high drop-out rates, short duration, and limited interpretability of functional improvement. No serious adverse effects, risks (addiction or overdose), or complications (sleep apnea, opioid-induced hyperalgesia, hypogonadism) were reported. Conclusion. There is evidence of short-term efficacy (moderate for pain and small for function) of opioids to treat CLBP compared with placebo. The effectiveness and safety of long- term opioid therapy for treatment of CLBP remains unproven. Level of Evidence: 1 Mención de responsabilidad : Luis Enrique Chaparro, Andrea D Furlan, Amol Deshpande, Angela Mailis-Gagnon, Steven Atlas, Dennis C Turk Referencia : Spine (Phila Pa 1976). 2014 Apr 1;39(7):556-63. DOI (Digital Object Identifier) : 10.1097/BRS.0000000000000249 PMID : 24480962 En línea : https://insights.ovid.com/crossref?an=00007632-201404010-00010 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3786

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