背景:癌症疼痛显著影响个体的生活质量,阿片类药物被用作缓解疼痛的主要手段。然而,人们对吗啡等阿片类药物的不良反应和有效性仍然存在担忧.氢吗啡酮,被认为是一种有效的阿片类药物,是治疗癌症相关疼痛的可行替代方法。本系统评价和荟萃分析的目的是确定氢吗啡酮与其他阿片类药物相比的有效性和安全性。以及在癌症疼痛治疗范围内使用这种药物的不同方法。
方法:PubMed,Embase,科克伦图书馆,Scopus,12月25日搜索了WebofScience数据库,2023年。按照PRISMA准则,对数据库进行了系统的调查,并根据预定标准(PICO框架)选择合适的研究。使用随机效应模型进行荟萃分析。
结果:本综述包括18项RCT,其中2271例患者比较了氢吗啡酮和吗啡,羟考酮,或者芬太尼,以及其他类型的氢吗啡酮。氢吗啡酮在减轻癌症疼痛强度方面表现出与吗啡和羟考酮相似的功效,减少额外的镇痛剂消耗,提高生活质量。然而,吗啡在减轻突破性疼痛方面比氢吗啡酮稍有优势。氢吗啡酮和吗啡或羟考酮之间的不良事件相当。患者控制和临床医生控制的氢吗啡酮给药途径产生了相似的结果。
结论:这项研究的结果证实了氢吗啡酮在癌症相关疼痛治疗中的疗效。显示与吗啡和羟考酮相似的有效性和安全性。这些发现与先前的综合分析是一致的,表明氢吗啡酮是减轻癌症相关疼痛的可行选择。需要进行额外的研究以确定其在不同患者队列和不同给药模式中的功效。
背景:Prospero注册ID:CRD42024517513。链接:https://www.crd.约克。AC.uk/PROSPERO/#recordDetails.
BACKGROUND: Cancer pain significantly impacts individuals\' quality of life, with opioids being employed as the primary means for pain relief. Nevertheless, concerns persist regarding the adverse reactions and effectiveness of opioids such as morphine.
Hydromorphone, recognized as a potent opioid, is a viable alternative for managing cancer-related pain. The goal of this systematic review and meta-analysis was to determine the effectiveness and safety characteristics of hydromorphone in comparison to other opioids, as well as different methods of administering this medication within the scope of cancer pain treatment.
METHODS: The PubMed, Embase, Cochrane Library, Scopus, and Web of Science databases were searched on December 25th, 2023. Following the PRISMA guidelines, a systematic investigation of databases was carried out, and suitable studies were chosen according to predetermined criteria (PICO framework). The meta-analyses were performed using a random-effects model.
RESULTS: This review included 18 RCTs with 2271 patients who compared hydromorphone with morphine, oxycodone, or fentanyl, as well as other types of
hydromorphone.
Hydromorphone demonstrated efficacy similar to that of morphine and oxycodone in reducing cancer pain intensity, decreasing additional analgesic consumption, and improving quality of life. However, morphine showed slight superiority over
hydromorphone in reducing breakthrough pain. Adverse events were comparable between
hydromorphone and morphine or oxycodone. Patient-controlled and clinician-controlled hydromorphone administration routes yielded similar outcomes.
CONCLUSIONS: The outcomes of this study substantiate the efficacy of hydromorphone in the management of cancer-related pain, demonstrating similar levels of effectiveness and safety as morphine and oxycodone. These findings are consistent with prior comprehensive analyses, suggesting that hydromorphone is a feasible choice for alleviating cancer-associated pain. Additional investigations are warranted to determine its efficacy in distinct patient cohorts and for different modes of administration.
BACKGROUND: Prospero registration ID: CRD42024517513. Link: https://www.crd.york.ac.uk/PROSPERO/#recordDetails .