曲马多有或没有扑热息痛(对乙酰氨基酚)对癌症疼痛。

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Wiffen PJ,德里摩尔RA

曲马多有或没有扑热息痛(对乙酰氨基酚)对癌症疼痛。

科克伦数据库系统启2017年5月16日;5:CD012508。cd012508.pub2 doi: 10.1002/14651858.。

PubMed ID
28510996 (在PubMed
]
文摘

背景:曲马多的镇痛的许可使用在中度到重度的疼痛。它被认为是低风险,所以控制法规不一样严格的‘强大’阿片类药物如吗啡。它有一个潜在作用作为第二步选择世界卫生组织(世卫组织)镇痛梯子。目的:评估的好处和不利影响曲马多有或没有扑热息痛(对乙酰氨基酚)癌症相关疼痛。必威国际app搜索方法:我们搜索以下数据库使用各种搜索条件:Cochrane中央登记的对照试验(中央)、MEDLINE、Embase,和紫丁香。我们还搜查了三个必威国际app临床试验注册表数据库。最后搜索的日期是2016年11月2日。必威国际app随机的选择标准:我们选择的研究,与安慰剂或主动控制,或者两者都是,包括至少10参与者/治疗手臂。我们感兴趣尤其是失明的研究,但还包括开放的研究。我们排除了non-randomised研究,研究实验疼痛,案例报告和临床观察。 DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data using a standard form and checked for agreement before entry into Review Manager 5. We included information about the number of participants treated and demographic details, type of cancer, drug and dosing regimen, study design (placebo or active control) and methods, study duration and follow-up, analgesic outcome measures and results, withdrawals, and adverse events. We collated multiple reports of the same study, so that each study, rather than each report, was the unit of interest in the review. We assessed the evidence using GRADE and created a 'Summary of findings' table.The main outcomes of interest for benefit were pain reduction of 30% or greater and 50% or greater from baseline, participants with pain no worse than mild, and participants feeling much improved or very much improved. MAIN RESULTS: We included 10 studies (12 reports) with 958 adult participants. All the studies enrolled participants with chronic malignant tumour-related pain who were experiencing pain intensities described as moderate to severe, with most experiencing at least 4/10 with current treatment. The mean ages were 59 to 70 years, with participants aged between 24 and 87 years. Study length ranged from one day to six months. Five studies used a cross-over design. Tramadol doses ranged from 50 mg as single dose to 600 mg per day; doses of 300 mg per day to 400 mg per day were most common.Nine studies were at high risk of bias for one to four criteria (only one high risk of bias for size). We judged all the results to be very low quality evidence because of widespread lack of blinding of outcome assessment, inadequately described sequence generation, allocation concealment, and small numbers of participants and events. Important outcomes were poorly reported. There were eight different active comparators and one comparison with placebo. There was little information available for any comparison and no firm conclusions could be drawn for any outcome.Single comparisons of oral tramadol with codeine plus paracetamol, of dihydrocodeine, and of rectal versus oral tramadol provided no data for key outcomes. One study used tramadol combined with paracetamol; four participants received this intervention. One study compared tramadol with flupirtine - a drug that is no longer available. One study compared tramadol with placebo and a combination of cobrotoxin, tramadol, and ibuprofen, but the dosing schedule poorly explained.Two studies (191 participants) compared tramadol with buprenorphine. One study (131 participants) reported a similar proportion of no or mild pain at 14 days.Three studies (300 participants) compared tramadol with morphine. Only one study, combining tramadol, tramadol plus paracetamol, and paracetamol plus codeine as a single weak-opioid group reported results. Weak opioid produced reduction in pain of at least 30% from baseline in 55/117 (47%) participants, compared with 91/110 (82%) participants with morphine. Weak opioid produced reduction in pain of at least 50% in 49/117 (42%) participants, compared with 83/110 (75%) participants with morphine.There was no useful information for any other outcome of benefit or harm. AUTHORS' CONCLUSIONS: There is limited, very low quality, evidence from randomised controlled trials that tramadol produced pain relief in some adults with pain due to cancer and no evidence at all for children. There is very low quality evidence that it is not as effective as morphine. This review does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different is very high. The place of tramadol in managing cancer pain and its role as step 2 of the WHO analgesic ladder is unclear.

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