E068 A systematic review assessing the comparative harms associated with opioids for musculoskeletal pain
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.017 | 0.078 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.010 | 0.015 |
| Bibliometrics | 0.009 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.010 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".