世界上最大规模的关于治疗癌症疼痛的阿片类药物的综述发现，目前尚不清楚一些常用的阿片药物是否比安慰剂更好，并表明包括阿司匹林在内的非阿片类药品可能与阿片类药一样有效。 世界上最大规模的关于治疗癌症疼痛的阿片类药物的综述发现，目前尚不清楚一些常用的阿片药物是否比安慰剂更好，并表明包括阿司匹林在内的非阿片类药品可能与阿片类药一样有效。 研究人员通过检查阿片类药物治疗癌症引起的疼痛的数据，发现在这些药物治疗癌症疼痛的真正益处方面存在令人惊讶的巨大证据空白。 这项研究挑战了人们普遍认为阿片类药物是最有效的止痛药的观点。 悉尼大学的这项研究强调，对于癌症疼痛，没有“一刀切”的治疗方法，并敦促卫生专业人员和患者在决定合适的疼痛管理计划时仔细权衡证据。 阿片类止痛药是癌症疼痛管理最常见的治疗方法。 包括世界卫生组织在内的许多国际指南都建议使用阿片类药物来治疗背景癌症疼痛（持续疼痛）和突破性癌症疼痛（除了背景疼痛外，还有暂时性疼痛）。 然而，研究发现，很少有试验将常用的阿片类药物与安慰剂进行比较。 其中包括吗啡、羟考酮和美沙酮。 这项研究没有发现令人信服的证据表明，在临终关怀之外，吗啡治疗背景癌症疼痛比其他阿片类药物更好或更安全。 尽管吗啡被医生广泛视为癌症治疗的“金标准疗法”，并且由于其成本低和可获得性，许多国际临床指南都建议使用吗啡治疗中重度癌症疼痛。 该综述还发现，包括阿司匹林和双氯芬酸在内的非甾体抗炎药（nsaids）对于背景癌症疼痛可能与某些阿片类药物一样有效。 “缺乏将阿片类药物与治疗癌症疼痛的安慰剂进行比较的证据，这可能反映了进行此类试验所面临的道德和后勤方面的挑战。 然而，这些试验对于指导临床决策是必要的。 “在实践中，阿片类药物对生命末期顽固性疼痛和痛苦是必不可少的。 值得强调的是，非阿片类药物，特别是nsaids，对某些癌症疼痛效果惊人，并且可以避免依赖性和阿片类镇痛随时间减弱的问题。 英国华威大学的马丁·安德伍德教授说：“如果人们不太关注使用阿片类药物来减轻疼痛，患有癌症背景疼痛的人可能会有更好的生活体验。”。 来自澳大利亚利物浦医院癌症治疗中心的资深作者marksidhom博士说：“希望这些发现能够帮助医生和患者在癌症疼痛的不同阿片类药物治疗之间做出选择，并使个人在无法耐受阿片类药品或选择不服用阿片类药的情况下考虑替代方案。”。 研究结果发表在今天为临床医生出版的癌症杂志《ca》上。 缺乏将阿片类药物与治疗癌症疼痛的安慰剂进行比较的证据，这可能反映了与进行此类试验相关的伦理和后勤挑战。 然而，这些试验对于指导临床决策是必要的。 christinaabdelshaheedkey博士的发现：这项研究检查了150多项已发表的临床试验的数据。 ·很少有试验将阿片类药物与安慰剂进行比较。 ·在安慰剂对照试验中，有中度确定的证据表明，对于癌症引起的背景疼痛，他喷他多比安慰剂效果更好。 ·阿片类药物通常被认为是较弱的（如可待因），或nsaids，如阿司匹林、吡罗昔康、酮咯酸、双氯芬酸和抗抑郁药物丙咪嗪，对背景癌症疼痛可能与“强效”阿片类一样好，副作用更少。 ·对于突破性的癌症疼痛，芬太尼作为鼻喷雾剂、舌下、牙龈和脸颊之间或口服喷雾剂可能比安慰剂更有效（尽管不是经常使用）。 芬太尼的副作用也比安慰剂多。 ·吗啡和其他阿片类药物可能会影响身体对抗癌症的能力。 需要进行研究来确定阿片类药物与抗癌治疗或免疫系统之间是否存在负面相互作用，以确保疼痛管理不会对有效治疗癌症的能力产生负面影响。 ·需要更多的研究，特别是对癌症疼痛管理的非药物干预。 声明：中科院获得悉尼大学研究加速器奖。 cgm拥有nhmrc研究者资助研究奖学金（应用程序1194283）。 jcb作为bonica《疼痛管理》第4版和第5版的编辑获得版税，阿片类药物诉讼咨询费，《疼痛》杂志编辑费，负责任的阿片类处方医生（prop）和国际疼痛研究协会（iasp）的无偿领导角色。 穆是英国国家卫生研究所以前和现在多项研究资助的首席研究员或联合研究员，也是澳大利亚国家卫生研究中心和挪威国家卫生研究委员会资助的资助的联合研究员。 他是clinvivo有限公司的董事和股东，该公司为健康服务研究提供电子数据收集。 他是两项目前和一项已完成的、由nihr资助的研究的联合研究员，这些研究或已获得史崔克有限公司的额外支持。 悉尼药学院获得葛兰素史克公司资助的研究生奖学金，该奖学金的对象是一名在ajm指导下的学生。 所有其他作者声明没有利益冲突。
the worlds largest review on opioid medicines for cancer pain has found it is unclear whether some commonly used opioid medicines are better than a placebo and suggests that non-opioid medicines, including aspirin, may be as effective as opioids.the world’s largest review on opioid medicines for cancer pain has found it is unclear whether some commonly used opioid medicines are better than a placebo and suggests that non-opioid medicines, including aspirin, may be as effective as opioids.researchers examining the data on opioids for pain caused by cancer have found surprisingly large gaps in evidence regarding the true benefits of these medicines for cancer pain. the study challenges the commonly held view that opioids are the most powerful pain relievers.the university of sydney-led study highlights there is no ‘one size fits all’ treatment approach for cancer pain, urging health professionals and patients to carefully weigh up the evidence when deciding on a suitable pain management plan.opioid pain relievers are the most common treatment for cancer pain management. many international guidelines including the world health organization, recommend opioid medications to manage background cancer pain (constant pain) and breakthrough cancer pain (temporary flare-ups of pain in addition to background pain).however, the study found very few trials have compared commonly used opioid medicines with placebo. this included morphine, oxycodone and methadone.the study did not find convincing evidence that morphine was better or safer than other opioid medicines for background cancer pain outside of end-of-life care.this is despite morphine being widely viewed as the ‘gold standard treatment’ for cancer care by physicians and recommended in many international clinical guidelines for moderate to severe cancer pain because of its low cost and accessibility.the review also found non-steroidal anti-inflammatory drugs (nsaids) including aspirin and diclofenac may be as effective as some opioids for background cancer pain.“the lack of evidence comparing opioid medicines to placebo for cancer pain probably reflects the ethical and logistical challenges associated with carrying out such trials. yet these trials are necessary to guide clinical decision making,” says lead researcher dr christina abdel shaheed from the university of sydney school of public health, faculty of medicine and health and sydney musculoskeletal health which is an initiative of the university of sydney, sydney local health district and northern sydney local health district.“in practice, opioids are indispensable for intractable pain and distress at the end of life. what is worth highlighting is that non-opioids, particularly nsaids, are surprisingly effective for some cancer pain, and may avoid the problems of dependence and waning opioid analgesia over time,” says co-author professor jane ballantyne, from the university of washington school of medicine, usa.“people with background cancer pain may have an overall better life experience if there is less focus on using opioids to reduce their pain level,” says co-author professor martin underwood from the university of warwick, uk.“the hope is that the findings can help guide doctors and patients to choose between different opioid treatment for cancer pain and empower individuals to consider alternatives if they are unable to tolerate opioid medicines or choose not to take them,” said senior author dr mark sidhom, from the cancer therapy centre, liverpool hospital, australia.the results are published in ca: a cancer journal for clinicians today.the lack of evidence comparing opioid medicines to placebo for cancer pain probably reflects the ethical and logistical challenges associated with carrying out such trials. yet these trials are necessary to guide clinical decision making.dr christina abdel shaheedkey findings:the study examined data from more than 150 published clinical trials.· there were very few trials comparing opioid medicines to placebo.· of the placebo-controlled trials, there is moderate certainty evidence tapentadol works better than placebo for background pain caused by cancer.· opioids commonly thought of as weaker (eg codeine), or nsaids such as aspirin, piroxicam, ketorolac, diclofenac and the antidepressant medicine imipramine may be just as good as ‘powerful’ opioids for background cancer pain, with fewer side effects.· for breakthrough cancer pain, fentanyl used as a nasal spray, under the tongue, between the gum and cheek, or as an oral spray, may be more effective than placebo (although not for regular use). fentanyl was also associated with more side effects than placebo.· it is possible that morphine and other opioids may affect how well the body is able to fight cancer. research is needed to determine whether there are negative interactions between opioid medicines and anti-cancer treatments or the immune system, to ensure that pain management does not negatively impact the ability to effectively treat the cancer.· more research is needed, particularly on non-drug interventions for cancer pain management.declaration: cas is a recipient of the university of sydney research accelerator (soar) prize. cgm holds an nhmrc investigator grant research fellowship (app 1194283). jcb receives royalties as editor of 4 & 5 editions bonica’s “management of pain”, consultancy fees in opioid litigation, editor fees for the journal pain, unpaid leadership roles in physicians for responsible opioid prescribing (prop) and international association for the study of pain (iasp). mu is chief investigator or co-investigator on multiple previous and current research grants from the uk national institute for health research, and is a co-investigator on grants funded by the australian nhmrc and norwegian mrc. he is a director and shareholder of clinvivo ltd that provides electronic data collection for health services research. he is a co-investigator on two current, and one completed, nihr funded studies that or have had, additional support from stryker ltd. the sydney pharmacy school receives funding for a postgraduate scholarship from glaxosmithkline for a student under the supervision of ajm. all other authors declare no conflict of interest.
