GENERAL ORTHOPAEDICS
Assessing the efficacy of opioids in management of chronic, noncancer pain
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original publication.
JAMA. 2018;320(23):2448–2460. doi:10.1001/jama.2018.18472
96 randomized controlled trials were included in this meta-analysis and systematic review which sought to evaluate the efficacy and safety of opioid analgesia for chronic, noncancer pain compared to placebo and active comparator treatment. When compared to placebo, opioid therapy was associated with statistically significant effects with respect to pain relief, increase in physical function, and improvement in sleep quality, though the effect estimates all fell below preset minimally important differences (MIDs) for each outcome. In contrast, opioid therapy was associated with significantly higher incidences of vomiting, nausea, constipation, dizziness, drowsiness, pruritus, and dry mouth when compared to placebo. When compared to active comparator treatment with nonsteroidal antiinflammatory drugs (NSAIDs), no significant differences between treatments were observed in analyses of pain reduction and physical functioning, while incidence of vomiting was significantly greater among opioid therapy groups.
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