Primary care-based interventions for secondary prevention of opioid dependence in chronic non-cancer pain patients on pharmaceutical opioids: systematic review.

IF 2.5 Q2 PRIMARY HEALTH CARE BJGP Open Pub Date : 2024-07-04 DOI:10.3399/BJGPO.2024.0122
Clare French, David M Troy, Sarah Dawson, Michael Dalili, Matthew Hickman, Kyla Thomas
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引用次数: 0

Abstract

Background: Globally almost one third of adults with chronic non-cancer pain (CNCP) are prescribed opioids. Prevention of opioid dependence among these patients is a public health priority.

Aim: Synthesise the evidence on the effectiveness of primary care-based interventions for secondary prevention of opioid dependence in CNCP patients on pharmaceutical opioids.

Design & setting: Systematic review of randomised controlled trials (RCTs) and comparative non-randomised studies of interventions from high-income countries.

Method: We searched five databases for studies on non-tapering secondary prevention interventions such as tools for predicting dependence, screening tools for early recognition of dependence, prescribing/medication monitoring, and specialist support. We examined multiple outcomes, including reduction in opioid dosage. Primary analyses were restricted to RCTs with data synthesised using an effect direction plot. Risk of bias was assessed using the Cochrane risk of bias (RoB2) tool.

Results: Of 7,102 identified reports, 18 studies were eligible (8 RCTs). Most used multiple interventions/components. Of the seven RCTs at low risk of bias or 'some concerns', five showed a positive intervention effect on at least one relevant outcome, four of which included a nurse care manager and/or other specialist support. The remaining two RCTs showed no positive effect of automated symptom monitoring and optimised analgesic management by a nurse care manager/physician pain specialist team, or of a mobile opioid management app.

Conclusion: We identify a clear need for further adequately powered high quality studies. The conclusions that can be drawn on intervention effectiveness are limited by the sparsity and inconsistency of available data.

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以初级保健为基础的干预措施,用于二级预防服用药物阿片类药物的慢性非癌症疼痛患者对阿片类药物的依赖:系统综述。
背景:全球近三分之一的慢性非癌性疼痛(CNCP)成人患者被处方阿片类药物。目的:综述以初级保健为基础的干预措施对使用药物阿片类药物的慢性非癌性疼痛(CNCP)患者进行阿片类药物依赖二级预防的有效性证据:对高收入国家的随机对照试验 (RCT) 和干预措施的非随机比较研究进行系统回顾:我们在五个数据库中搜索了有关非锥形类药物二级预防干预措施的研究,如预测依赖性的工具、早期识别依赖性的筛查工具、处方/用药监测以及专家支持。我们研究了多种结果,包括阿片类药物用量的减少。主要分析仅限于使用效应方向图综合数据的 RCT。使用科克伦偏倚风险(RoB2)工具评估偏倚风险:在 7102 份鉴定报告中,有 18 项研究符合条件(8 项 RCT)。大多数研究使用了多种干预措施/组成部分。在 7 项偏倚风险较低或 "存在一些问题 "的研究中,有 5 项研究显示至少对一项相关结果产生了积极的干预效果,其中 4 项研究包括护士护理经理和/或其他专家支持。其余两项研究表明,由护士护理经理/疼痛专科医师团队进行自动症状监测和优化镇痛管理,或使用移动阿片类药物管理应用,均无积极效果:我们发现,显然需要进一步开展有充分证据支持的高质量研究。由于现有数据的稀缺性和不一致性,我们只能就干预效果得出有限的结论。
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来源期刊
BJGP Open
BJGP Open Medicine-Family Practice
CiteScore
5.00
自引率
0.00%
发文量
181
审稿时长
22 weeks
期刊最新文献
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