E068 A systematic review assessing the comparative harms associated with opioids for musculoskeletal pain
Notice bibliographique
Résumé
Abstract Background/Aims Opioids are prescribed commonly for the management of musculoskeletal (MSK) pain, however they may be associated with several adverse events that vary between the type, drug dose and potency. The aim of this study was to systematically review the evidence to assess the comparative adverse events associated with opioids for both inflammatory and non-inflammatory MSK conditions. Methods A systematic review of the literature was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework (PRISMA). MEDLINE, OVID and Cochrane databases were searched up to 16th June 2022. Randomised controlled trials, open label trials and observational studies in patients who were aged 18 years and older, without cancer and on opioids for a musculoskeletal condition were included. Results Of the 1,091 studies extracted, 782 studies underwent titles and abstract review, 185 studies were assessed for full-text eligibility of which 11 studies were met inclusion criteria. These studies included 28,828 participants, of which 9,162 were male and 19,666 were female. The average age of participants was 69 years of age. Conditions in 10 studies were for chronic pain related to osteoarthritis (generalised, hip and knee). One study included a population with both osteoarthritis and rheumatoid arthritis. Using the Cochrane Collaboration’s risk of bias tool and the Newcastle-Ottawa scales the quality of the 11 articles ranged from low, moderate and high quality. The review highlighted a high risk of gastrointestinal (nausea, constipation, vomiting), neurological adverse events (dizziness, headache, fatigue and somnolence) and increased falls. Only one study quantified risk of adverse events comparing different drugs in the form of a relative risk or absolute risk. Whilst all opioids were associated with adverse events, oxycodone and buprenorphine were associated with a higher proportion of adverse events within the populations studied. There was insufficient evidence to conclude a differential risk with specific opioids with the available literature. Conclusion The systematic review highlighted a lack of scientific evidence quantifying the risk of potential harms of different opioids in patients with MSK conditions. There was also a large heterogenicity across the cohorts and poor methodological design that made comparisons difficult. It highlighted the need for high-quality studies to quantify the risk of adverse events that incorporate aspects of dose and potency, to better aid shared decision making with patients. Disclosure C. McCarthy: None.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,017 | 0,078 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,010 | 0,015 |
| Bibliométrie | 0,009 | 0,008 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,004 | 0,003 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,010 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».