可待因，单独和扑热息痛(对乙酰氨基酚)，用于癌症疼痛。

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Straube C, Derry S, Jackson KC, Wiffen PJ, Bell RF, Strassels S, Straube S

可待因，单独和扑热息痛(对乙酰氨基酚)，用于癌症疼痛。

Cochrane Database Syst Rev. 2014 9月19日;(9):CD006601。cd006601.pub4 doi: 10.1002/14651858.。

PubMed ID
25234029 (PubMed视图
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摘要

背景:疼痛在癌症患者中很常见。阿片类镇痛药，包括可待因，在癌症疼痛管理的主要指南中发挥着重要作用，特别是对轻度至中度疼痛。可待因随处可得且价格低廉，这可能是一个不错的选择，尤其是在资源匮乏的情况下。它的使用是有争议的，部分原因是可待因对少数患者无效，他们不能将可待因转化为其活性代谢物(吗啡)，也因为担心潜在的滥用，以及儿童的安全。目的:确定可待因单独使用或与对乙酰氨基酚联合使用缓解癌症疼痛的疗效和安全性。必威国际app检索方法:检索Cochrane Central Register of Controlled Trials (Central;Cochrane图书馆2014年第2期)，MEDLINE和EMBASE从成立到2014年3月5日，并辅以检索临床试验注册中心和筛选该领域已确定的研究和综述的参考文献列表。必威国际app选择标准:我们寻求随机、双盲、对照试验，使用单剂量或多剂量可待因，伴或不伴扑热息痛治疗癌症疼痛。试验可以采用平行或交叉设计，每个治疗组至少有10名参与者。研究对象为儿童或成人，报告任何类型、级别和阶段的癌症都是合格的。 We accepted any formulation, dosage regimen, and route of administration of codeine, and both placebo and active controls. DATA COLLECTION AND ANALYSIS: Two review authors independently read the titles and abstracts of all studies identified by the searches and excluded those that clearly did not meet the inclusion criteria. For the remaining studies, two authors read the full manuscripts and assessed them for inclusion. We resolved discrepancies between review authors by discussion. Included studies were described qualitatively, since no meta-analysis was possible because of the small amount of data identified, and clinical and methodological between-study heterogeneity. MAIN RESULTS: We included 15 studies including 721 participants with cancer pain due to diverse types of malignancy. All studies were performed on adults; there were no studies on children. The included studies were of adequate methodological quality, but all except for one were judged to be at a high risk of bias because of small study size, and six because of methods used to deal with missing data or high withdrawal rates. Three studies used a parallel group design; the remainder were cross-over trials in which there was an adequate washout period, but only one reported results for treatment periods separately.Twelve studies used codeine as a single agent and three combined it with paracetamol. Ten studies included a placebo arm, and 14 included one or more of 16 different active drug comparators or compared different routes of administration. Most studies investigated the effect of a single dose of medication, while five used treatment periods of one, seven or 21 days. Most studies used codeine at doses of 30 mg to 120 mg.There were insufficient data for any pooled analysis. Only two studies reported our preferred responder outcome of 'participants with at least 50% reduction in pain' and two reported 'participants with no worse than mild pain'. Eleven studies reported treatment group mean measures of pain intensity or pain relief; overall for these outcome measures, codeine or codeine plus paracetamol was numerically superior to placebo and equivalent to the active comparators.Adverse event reporting was poor: only two studies reported the number of participants with any adverse event specified by treatment group and only one reported the number of participants with any serious adverse event. In multiple-dose studies nausea, vomiting and constipation were common, with somnolence and dizziness frequent in the 21-day study. Withdrawal from the studies, where reported, was less than 10% except in two studies. There were three deaths, in all cases due to the underlying cancer. AUTHORS' CONCLUSIONS: We identified only a small amount of data in studies that were both randomised and double-blind. Studies were small, of short duration, and most had significant shortcomings in reporting. The available evidence indicates that codeine is more effective against cancer pain than placebo, but with increased risk of nausea, vomiting, and constipation. Uncertainty remains as to the magnitude and time-course of the analgesic effect and the safety and tolerability in longer-term use. There were no data for children.

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