The Prevalence of Opioid Analgesic Use in People with Chronic Noncancer Pain: Systematic Review and Meta-Analysis of Observational Studies

Pain Medicine ◽  
2020 ◽  
Author(s):  
Graeme Wertheimer ◽  
Stephanie Mathieson ◽  
Christopher G Maher ◽  
Chung-Wei Christine Lin ◽  
Andrew J McLachlan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Observational Studies ◽  
Opioid Analgesic ◽  
Risk Of Bias ◽  
Opioid Use ◽  
Chronic Noncancer Pain ◽  
Moderate Quality ◽  
Meta Regression ◽  
Noncancer Pain ◽  
Quality Evidence

Abstract Objective To review studies examining the proportion of people with chronic noncancer pain who report consuming opioids and characteristics associated with their use. Design Systematic review. Methods We searched databases from inception to February 8, 2020, and conducted citation tracking. We included observational studies reporting the proportion of adults with chronic noncancer pain who used opioid analgesics. Opioids were categorized as weak (e.g., codeine) or strong (e.g., oxycodone). Study risk of bias was assessed, and Grading of Recommendations Assessment, Development and Evaluations provided a summary of the overall quality. Results were pooled using a random-effects model. Meta-regression determined factors associated with opioid use. Results Sixty studies (N=3,961,739) reported data on opioid use in people with chronic noncancer pain from 1990 to 2017. Of these 46, 77% had moderate risk of bias. Opioid use was reported by 26.8% (95% confidence interval [CI], 23.1–30.8; moderate-quality evidence) of people with chronic noncancer pain. The use of weak opioids (17.3%; 95% CI 11.9–24.4; moderate-quality evidence) was more common than the use of strong opioids (9.8%; 95% CI, 6.8–14.0; low-quality evidence). Meta-regression determined that opioid use was associated with geographic region (P=0.02; lower in Europe than North America), but not sampling year (P=0.77), setting (P=0.06), diagnosis (P=0.34), or disclosure of funding (P=0.77). Conclusions Our review summarized data from over 3.9 million people with chronic noncancer pain reporting their opioid use. Between 1990 and 2017, one-quarter of people with chronic noncancer pain reported taking opioids, and this proportion did not change over time.

scholarly journals What proportion of patients with chronic noncancer pain are prescribed an opioid medicine? Systematic review and meta‐regression of observational studies

2020 ◽  
Vol 287 (5) ◽  
pp. 458-474 ◽  
Author(s):  
S. Mathieson ◽  
G. Wertheimer ◽  
C.G. Maher ◽  
C.‐W. Christine Lin ◽  
A.J. McLachlan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Observational Studies ◽  
Chronic Noncancer Pain ◽  
Meta Regression ◽  
Noncancer Pain

scholarly journals Multifactorial interventions for preventing falls in older people living in the community: a systematic review and meta-analysis of 41 trials and almost 20 000 participants

2019 ◽  
Vol 54 (22) ◽  
pp. 1340-1350 ◽  
Author(s):  
Sally Hopewell ◽  
Bethan Copsey ◽  
Philippa Nicolson ◽  
Busola Adedire ◽  
Graham Boniface ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older People ◽  
Usual Care ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Moderate Quality ◽  
Recurrent Falls ◽  
Meta Regression ◽  
Quality Evidence

ObjectiveTo assess the longer term effects of multifactorial interventions for preventing falls in older people living in the community, and to explore whether prespecific trial-level characteristics are associated with greater fall prevention effects.DesignSystematic review with meta-analysis and meta-regression.Data sourcesMEDLINE, EMBASE, CINHAL, CENTRAL and trial registries were searched up to 25 July 2018.Study selectionWe included randomised controlled trials (≥12 months’ follow-up) evaluating the effects of multifactorial interventions on falls in older people aged 65 years and over, living in the community, compared with either usual care or usual care plus advice.Review methodsTwo authors independently verified studies for inclusion, assessed risk of bias and extracted data. Rate ratios (RaR) with 95% CIs were calculated for rate of falls, risk ratios (RR) for dichotomous outcomes and standardised mean difference for continuous outcomes. Data were pooled using a random effects model. The Grading of Recommendations, Assessment, Development and Evaluation was used to assess the quality of the evidence.ResultsWe included 41 trials totalling 19 369 participants; mean age 72–85 years. Exercise was the most common prespecified component of the multifactorial interventions (85%; n=35/41). Most trials were judged at unclear or high risk of bias in ≥1 domain. Twenty trials provided data on rate of falls and showed multifactorial interventions may reduce the rate at which people fall compared with the comparator (RaR 0.79, 95% CI 0.70 to 0.88; 20 trials; 10 116 participants; I2=90%; low-quality evidence). Multifactorial interventions may also slightly lower the risk of people sustaining one or more falls (RR 0.95, 95% CI 0.90 to 1.00; 30 trials; 13 817 participants; I2=56%; moderate-quality evidence) and recurrent falls (RR 0.88, 95% CI 0.78 to 1.00; 15 trials; 7277 participants; I2=46%; moderate-quality evidence). However, there may be little or no difference in other fall-related outcomes, such as fall-related fractures, falls requiring hospital admission or medical attention and health-related quality of life. Very few trials (n=3) reported on adverse events related to the intervention. Prespecified subgroup analyses showed that the effect on rate of falls may be smaller when compared with usual care plus advice as opposed to usual care only. Overall, heterogeneity remained high and was not explained by the prespecified characteristics included in the meta-regression.ConclusionMultifactorial interventions (most of which include exercise prescription) may reduce the rate of falls and slightly reduce risk of older people sustaining one or more falls and recurrent falls (defined as two or more falls within a specified time period).Trial registration numberCRD42018102549.

scholarly journals Outcomes Associated with Opioid Use in the Treatment of Chronic Noncancer Pain in Older Adults: A Systematic Review and Meta-Analysis

2010 ◽  
Vol 58 (7) ◽  
pp. 1353-1369 ◽  
Author(s):  
Maria Papaleontiou ◽  
Charles R. Henderson Jr ◽  
Barbara J. Turner ◽  
Alison A. Moore ◽  
Yelena Olkhovskaya ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Meta Analysis ◽  
Opioid Use ◽  
Chronic Noncancer Pain ◽  
Noncancer Pain

scholarly journals Periodontitis Impact in Interleukin-6 Serum Levels in Solid Organ Transplanted Patients: A Systematic Review and Meta-Analysis

Diagnostics ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. 184 ◽  
Author(s):  
Vanessa Machado ◽  
João Botelho ◽  
Joana Lopes ◽  
Mariana Patrão ◽  
Ricardo Alves ◽  
...  
Keyword(s):  
Systematic Review ◽  
Serum Levels ◽  
Case Control ◽  
Risk Of Bias ◽  
Solid Organ ◽  
Systemic Complications ◽  
Moderate Quality ◽  
Meta Analyses ◽  
The Impact ◽  
Quality Evidence

This systematic review aimed to investigate the influence of periodontitis on post-transplant IL-6 serum levels of solid organ transplanted patients as compared to healthy subjects. Four databases (PubMed, Scholar, EMBASE, and CENTRAL) were searched up to February 2020 (PROSPERO CRD42018107817). Case-control and cohort studies on the association of IL-6 serum levels with a periodontal status of patients after solid organ transplantation were included. The risk of bias of observational studies was assessed through the Newcastle-Ottawa Scale (NOS). Random effects meta-analyses were thoroughly conducted. GRADE assessment provided quality evidence. Four case-control studies fulfilled the inclusion criteria (274 transplant recipients and 146 healthy controls), all of low risk of bias. Meta-analyses revealed significantly higher IL-6 levels in transplanted patients than healthy individuals with low-quality evidence (Mean Difference (MD): 2.55 (95% confidence interval (CI): 2.07, 3.03)). Transplanted patients with periodontitis have higher serum IL-6 levels than transplanted patients without periodontitis with moderate quality evidence (MD: 2.20 (95% CI: 1.00, 3.39)). We found low-quality evidence of higher IL-6 levels than healthy patients in patients with heart and kidney transplant. In these transplanted patients, there was moderate quality evidence that periodontitis is associated with higher IL-6 serum levels. Future research should consider the impact of such a difference in organ failure and systemic complications.

scholarly journals 288What proportion of patients with chronic noncancer pain are prescribed an opioid medicine?

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Stephanie Mathieson ◽  
Graeme Wertheimer ◽  
Christopher G Maher ◽  
Christine Lin ◽  
Andrew J McLachlan ◽  
...  
Keyword(s):  
Cancer Pain ◽  
The United States ◽  
Geographic Region ◽  
Risk Of Bias ◽  
Chronic Noncancer Pain ◽  
Factors Associated ◽  
Opioid Prescribing ◽  
Meta Regression ◽  
Quality Evidence ◽  
Over Time

Abstract Background Guidelines now discourage opioid analgesics for chronic non-cancer pain because the benefits frequently do not outweigh the harms. This review determined the proportion of patients with chronic non-cancer pain who are prescribed an opioid, the types prescribed, and factors associated with prescribing. Methods Database searches were conducted from inception to 29th October 2018 without restrictions. We included observational studies of adults with chronic non-cancer pain measuring opioid prescribing. Opioids were categorised as weak (e.g. codeine) or strong (e.g. oxycodone). Risk of bias assessed study quality. Results were pooled using a random-effects model. Meta-regression investigated study-level factors associated with prescribing. The overall evidence quality was assessed using GRADE criteria. Results Of the 42 studies (5,059,098 participants) included, majority (n = 28) from the United States of America. Eleven studies were at low risk of bias. The pooled estimate of the proportion of patients with chronic non-cancer pain prescribed opioids was 30.7% (95%CI 28.7% to 32.7%, 42 studies, moderate-quality evidence). Strong opioids were more frequently prescribed than weak (18.4% (95%CI 16.0% to 21.0%, n = 15 studies, low-quality evidence), versus 8.5% (95%CI 7.2% to 9.9%, n = 15 studies, low-quality evidence)). Meta-regression determined opioid prescribing was associated with year of sampling (more prescribing in recent years) (p = 0.014) and not geographic region (p = 0.056). Conclusions Opioid prescribing for patients with chronic non-cancer pain is common and has increased over time. Key message Opioid prescribing for patients with chronic non-cancer pain and has increased over time. This review is the first systematic review to synthesized such data.

scholarly journals Effects of presurgical interventions on chronic pain after total knee replacement: a systematic review and meta-analysis of randomised controlled trials

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e033248 ◽  
Author(s):  
Jane Dennis ◽  
Vikki Wylde ◽  
Rachael Gooberman-Hill ◽  
AW Blom ◽  
Andrew David Beswick
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Moderate Quality ◽  
Total Knee ◽  
Randomised Controlled ◽  
Quality Evidence

ObjectiveNearly 100 000 primary total knee replacements (TKR) are performed in the UK annually. The primary aim of TKR is pain relief, but 10%–34% of patients report chronic pain. The aim of this systematic review was to evaluate the effectiveness of presurgical interventions in preventing chronic pain after TKR.DesignMEDLINE, Embase, CINAHL,The Cochrane Libraryand PsycINFO were searched from inception to December 2018. Screening and data extraction were performed by two authors. Meta-analysis was conducted using a random effects model. Risk of bias was assessed using the Cochrane tool and quality of evidence was assessed by Grading of Recommendations Assessment, Development and Evaluation.Primary and secondary outcomesPain at 6 months or longer; adverse events.InterventionsPresurgical interventions aimed at improving TKR outcomes.ResultsEight randomised controlled trials (RCTs) with data from 960 participants were included. The studies involved nine eligible comparisons. We found moderate-quality evidence of no effect of exercise programmes on chronic pain after TKR, based on a meta-analysis of 6 interventions with 229 participants (standardised mean difference 0.20, 95% CI −0.06 to 0.47, I2=0%). Sensitivity analysis restricted to studies at overall low risk of bias confirmed findings. Another RCT of exercise with no data available for meta-analysis showed no benefit. Studies evaluating combined exercise and education intervention (n=1) and education alone (n=1) suggested similar findings. Adverse event data were reported by most studies, but events were too few to draw conclusions.ConclusionsWe found low to moderate-quality evidence to suggest that neither preoperative exercise, education nor a combination of both is effective in preventing chronic pain after TKR. This review also identified a lack of evaluations of other preoperative interventions, such as multimodal pain management, which may improve long-term pain outcomes after TKR.PROSPERO registration numberCRD42017041382.

Iatrogenic addiction or dependence as a result of prescription oxycodone use in persons with chronic noncancer pain: A systematic review

2021 ◽  
Vol 17 (1) ◽  
pp. 79-96
Author(s):  
Megan Dol, BSc ◽  
Mark Oremus, PhD
Keyword(s):  
Systematic Review ◽  
Data Extraction ◽  
Cochrane Collaboration ◽  
Incidence Rates ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Eligibility Criteria ◽  
Chronic Noncancer Pain ◽  
Noncancer Pain

Objective: To determine the incidence of addiction and dependence in persons with chronic noncancer pain (CNCP) who are treated with oxycodone.Design: Systematic review following PRISMA guidelines.Methods: PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Library were searched from inception to January 2020. Of 1,320 retrieved citations screened by two independent raters at title and abstract and full-text screening, six articles fulfilled the eligibility criteria for the systematic review. Data extraction and risk of bias assessment followed article screening. The Cochrane Collaboration tool and the Newcastle-Ottawa Scale (NOS) were used to assess the risk of bias in individual studies.Results: Two of the six articles reported addiction and the remaining four reported dependence. The incidence rates of addiction were 2.91 percent and 1.72 percent, and the incidence rates of dependence were 0.00 percent, 0.44 percent, 0.45 percent, and 5.77 percent. In all articles, addiction and dependence were treated as secondary outcomes. Three randomized controlled trials (RCTs) had follow-up lengths of less than 31 days, which is insufficient to assess the incidence of addiction or dependence.Conclusions: The results of this systematic review show that oxycodone use leads to addiction and dependence in a small proportion of individuals with CNCP. However, one must exercise caution when drawing conclusions from the six included articles. Future studies in the area should examine addiction and dependence as primary outcomes using adequate follow-up periods.

scholarly journals A Systematic Review of the Effectiveness of Knowledge Translation Interventions for Chronic Noncancer Pain Management

2013 ◽  
Vol 18 (6) ◽  
pp. e129-e141 ◽  
Author(s):  
Maria B Ospina ◽  
Paul Taenzer ◽  
Saifee Rashiq ◽  
Joy C MacDermid ◽  
Eloise Carr ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pain Management ◽  
Knowledge Translation ◽  
Risk Of Bias ◽  
Care Providers ◽  
Chronic Noncancer Pain ◽  
Positive Effects ◽  
Interactive Education ◽  
Study Results ◽  
Noncancer Pain

BACKGROUND: Reliable evidence detailing effective treatments and management practices for chronic noncancer pain exists. However, little is known about which knowledge translation (KT) interventions lead to the uptake of this evidence in practice.OBJECTIVES: To conduct a systematic review of the effectiveness of KT interventions for chronic noncancer pain management.METHODS: Comprehensive searches of electronic databases, the gray literature and manual searches of journals were undertaken. Randomized controlled trials, controlled clinical trials and controlled before-and-after studies of KT interventions were included. Data regarding interventions and primary outcomes were categorized using a standard taxonomy; a risk-of-bias approach was adopted for study quality. A narrative synthesis of study results was conducted.RESULTS: More than 8500 titles and abstracts were screened, with 230 full-text articles reviewed for eligibility. Nineteen studies were included, of which only a small proportion were judged to be at low risk of bias. Interactive KT education for health care providers has a positive effect on patients’ function, but its benefits for other health provider- and patient-related outcomes are inconsistent. Interactive education for patients leads to improvements in knowledge and function. Little research evidence supports the effectiveness of structural changes in health systems and quality improvement processes or coordination of care.CONCLUSIONS: KT interventions incorporating interactive education in chronic noncancer pain led to positive effects on patients’ function and knowledge about pain. Future studies should provide implementation details and use consistent theoretical frameworks to better estimate the effectiveness of such interventions.

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