Multimorbidity and analgesic-related harms: a systematic review

IF 9.2 1区医学 Q1 ANESTHESIOLOGY British journal of anaesthesia Pub Date : 2025-03-20 DOI:10.1016/j.bja.2025.02.012

Christopher H. Grant , Heather Walker , Karen N. Barnett , Patrick B. Mark , Lesley A. Colvin , Samira Bell

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Abstract

Background

Multimorbidity is the presence of two or more long-term medical conditions. Chronic pain affects more than half of people with multimorbidity, and optimal treatment strategies are unknown. We aimed to quantify the risk of adverse outcomes from the following analgesics: opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and gabapentinoids in adults with multimorbidity.

Method

The review was registered on PROSPERO (CRD42023462592). We searched Medline, CINAHL, Web of Science, Embase, and CENTRAL for studies reporting analgesic-related harms in people with multimorbidity or the impact of multimorbidity on harms in adults exposed to analgesics. Two researchers independently screened titles/abstracts, completed full-text reviews, extracted data, and assessed risk of bias using the Newcastle-Ottawa scale. Studies were synthesised narratively, grouping by analgesic class and direction of effect.

Results

We screened 6690 records and 344 full texts, with 27 studies included (n=2 671 958 patients). Studies were heterogenous, with variable quality (high risk of bias, n=11). Most studies on opioids reported adverse outcomes (12/16). Opioid use compared with non-use was associated with increased mortality in adults with multimorbidity. Multimorbidity was associated with opioid overdose and death among adults prescribed opioids for pain. Half of studies of NSAIDs reported adverse outcomes (6/11) including gastrointestinal bleeding. Only one study assessed gabapentinoids which found an association with delirium and pneumonia, but not mortality in people with multimorbidity.

Conclusions

There is evidence of harms associated with opioids in adults with multimorbidity, including overdose and increased mortality. There is a lack of evidence on gabapentinoids. Further research is required to understand optimal analgesic management in people with multimorbidity.

Systematic review protocol

PROSPERO (CRD42023462592).

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多病与镇痛相关的危害：系统综述。

背景：多病是指存在两种或两种以上的长期疾病。慢性疼痛影响超过一半的多病患者，最佳治疗策略尚不清楚。我们的目的是量化以下镇痛药的不良后果风险：阿片类药物、非甾体抗炎药（NSAIDs）和加巴喷丁类药物在患有多种疾病的成年人中的应用。方法：本综述在PROSPERO注册（CRD42023462592）。我们检索了Medline、CINAHL、Web of Science、Embase和CENTRAL，以获取有关多重疾病患者镇痛相关危害或多重疾病对暴露于镇痛药的成人危害影响的研究报告。两名研究人员独立筛选标题/摘要，完成全文综述，提取数据，并使用纽卡斯尔-渥太华量表评估偏倚风险。采用叙事法综合研究，按镇痛药类别和疗效方向进行分组。结果：我们筛选了6690条记录和344篇全文，包括27项研究（n=2 671 958例患者）。研究是异质性的，质量不同（高偏倚风险，n=11）。大多数关于阿片类药物的研究报告了不良后果（12/16）。与不使用阿片类药物相比，使用阿片类药物与多病成人死亡率增加有关。在处方阿片类药物治疗疼痛的成年人中，多发病与阿片类药物过量和死亡有关。一半的非甾体抗炎药研究报告了不良后果（6/11），包括胃肠道出血。只有一项研究评估了加巴喷丁类药物，发现它与谵妄和肺炎有关，但与多病患者的死亡率无关。结论：有证据表明阿片类药物对患有多种疾病的成年人有危害，包括过量服用和死亡率增加。关于加巴喷丁类药物缺乏证据。需要进一步的研究来了解多病患者的最佳镇痛管理。系统评价方案：PROSPERO （CRD42023462592）。

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来源期刊

British journal of anaesthesia 医学-麻醉学

CiteScore

13.50

自引率

7.10%

发文量

488

审稿时长

27 days

期刊介绍： The British Journal of Anaesthesia (BJA) is a prestigious publication that covers a wide range of topics in anaesthesia, critical care medicine, pain medicine, and perioperative medicine. It aims to disseminate high-impact original research, spanning fundamental, translational, and clinical sciences, as well as clinical practice, technology, education, and training. Additionally, the journal features review articles, notable case reports, correspondence, and special articles that appeal to a broader audience. The BJA is proudly associated with The Royal College of Anaesthetists, The College of Anaesthesiologists of Ireland, and The Hong Kong College of Anaesthesiologists. This partnership provides members of these esteemed institutions with access to not only the BJA but also its sister publication, BJA Education. It is essential to note that both journals maintain their editorial independence. Overall, the BJA offers a diverse and comprehensive platform for anaesthetists, critical care physicians, pain specialists, and perioperative medicine practitioners to contribute and stay updated with the latest advancements in their respective fields.