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Cited by 19Pain Management and Opioid UseOpioid Use Disorder TreatmentAnesthesia and Pain Management

Comparative benefits and harms of individual opioids for chronic non-cancer pain: a systematic review and network meta-analysis of randomised trials

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Noori, Atefeh, Sadeghirad, Behnam, Wang, Li, Siemieniuk, Reed A.C., Shokoohi, Mostafa, Kum, Elena, Jeddi, Mark, Montoya, Luis +8 more·2022·British Journal of Anaesthesia
DOI 10.1016/j.bja.2022.05.031
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Abstract

Background Most systematic reviews of opioids for chronic pain have pooled treatment effects across individual opioids under the assumption they provide similar benefits and harms. We examined the comparative effects of individual opioids for chronic non-cancer pain through a network meta-analysis of randomised controlled trials. Methods We searched MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials to March 2021 for studies that enrolled patients with chronic non-cancer pain, randomised them to receive different opioids, or opioids vs placebo, and followed them for at least 4 weeks. Certainty of evidence was evaluated using the GRADE approach. Results We identified 82 eligible trials (22 619 participants) that evaluated 14 opioids. Compared with placebo, several opioids showed superiority to others for analgesia and improvement in physical function; however, when restricted to pooled-effect estimates supported by moderate certainty evidence, no differences between opioids were evident. Among opioids with moderate certainty evidence, all increased the risk of gastrointestinal adverse events compared with placebo, although no opioids were more harmful than others. Low to very low certainty evidence suggests that extended-release vs immediate-release opioids may provide similar benefits for pain relief and physical functioning, and gastrointestinal harms. Conclusions Our findings support the pooling of effect estimates across different types and formulations of opioids to inform effectiveness for chronic non-cancer pain.

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    “This approach is often misleading, as it considers only the point estimate of effect and not the associated precision or certainty of evidence and ignores absolute differences between treatment alternatives.[56][57][58]”

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Cited by

Sorted by citations

Authors
Noori, A., Sadeghirad, B., Wang, L., Siemieniuk, R. A. C., Shokoohi, M., Kum, E., Jeddi, M., Montoya, L., Hong, P. J., Zhou, E., Couban, R. J., Juurlink, D. N., Thabane, L., Bhandari, M., Guyatt, G. H., & Busse, J. W.
Affiliations
  • McMaster University (CA)
  • University of Toronto (CA)
  • University Health Network (CA)
  • Chronic Pain Centre of Excellence for Canadian Veterans (CA)
Corresponding author
Busse, Jason W.
ORCID
Venue
British Journal of Anaesthesia
Publisher
Elsevier BV
Published
2022-09
Volume
129
Issue
3
Pages
394-406
ISSN
0007-0912 (ISSN-L)
DOI
10.1016/j.bja.2022.05.031
OpenAlex
W4284975635
Cited by
19
References
0
Citations by year
2026: 6 · 2025: 3 · 2024: 7 · 2023: 1 · 2022: 2
FWCI
0.89
Type
journal article
Language
en
Open access
Licence
Locations
  • British Journal of Anaesthesia (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
Keywords
opioids, chronic non-cancer pain, gastrointestinal adverse effects, analgesia, physical function, placebo comparison
MeSH terms
Network Meta-Analysis, Network Meta-Analysis as Topic, Analgesics, Opioid, Humans, Randomized Controlled Trials as Topic, Chronic Pain, Pain Management

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