Evidence map›Paper›PMID 32737739›Full record

SynthesisDrugs2020

Deprescribing Opioids in Chronic Non-cancer Pain: Systematic Review of Randomised Trials.

Stephanie Mathieson, Christopher G Maher, Giovanni E Ferreira, Melanie Hamilton, Jesse Jansen, Andrew J McLachlan, Martin Underwood, Chung-Wei Christine Lin

Erratum issuedOpen access · greenAbstract readSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Drugs, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 25 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
25citing papers in PubMed, 6 pooled it
5.6field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

25 citing papers in PubMed, 6 syntheses or guidelines pooled it, 47 citations in OpenAlex.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 2 institutions in 2 countries.

Stephanie MathiesonInstitute for Musculoskeletal Health, Level 10 North, King George V Building, Missenden Road, Camperdown, Sydney, Australia. stephanie.mathieson@sydney.edu.au.ORCID http://orcid.org/0000-0002-7335-8842
Christopher G MaherInstitute for Musculoskeletal Health, Level 10 North, King George V Building, Missenden Road, Camperdown, Sydney, Australia.ORCID http://orcid.org/0000-0002-1628-7857
Giovanni E FerreiraInstitute for Musculoskeletal Health, Level 10 North, King George V Building, Missenden Road, Camperdown, Sydney, Australia.ORCID http://orcid.org/0000-0002-8534-195X
Melanie HamiltonInstitute for Musculoskeletal Health, Level 10 North, King George V Building, Missenden Road, Camperdown, Sydney, Australia.ORCID http://orcid.org/0000-0002-9337-943X
Jesse JansenSydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.ORCID http://orcid.org/0000-0002-7739-0049
Andrew J McLachlanSydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.ORCID http://orcid.org/0000-0003-4674-0242
Martin UnderwoodWarwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK.ORCID http://orcid.org/0000-0002-0309-1708
Chung-Wei Christine LinInstitute for Musculoskeletal Health, Level 10 North, King George V Building, Missenden Road, Camperdown, Sydney, Australia.ORCID http://orcid.org/0000-0001-6192-7238
The University of Sydney · AUUniversity Hospitals Coventry and Warwickshire NHS Trust · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDeprescribing, the process of reducing or discontinuing unnecessary or harmful medicines is an essential part of clinical practice.

objectiveTo evaluate the efficacy of interventions designed to deprescribe opioid analgesics for pain relief in patients with chronic non-cancer pain.

methodsWe searched electronic databases, including clinical trial registries, from database inception to 13th January 2020 without restrictions, and conducted citation tracking. Our systematic review included randomised controlled trials (RCTs) evaluating interventions reducing the prescription, or use of opioid analgesics in patients with chronic pain versus control. Inventions could be aimed at the patient, clinician, or both. We excluded trials enrolling patients with cancer or illicit drug use. Two authors independently screened and extracted data. Outcome follow-up timepoints were short (≤ 3 months), intermediate (> 3 but < 12 months) or long (≥ 12 months) term. Primary outcome was the reduction in opioid dose [morphine milligram equivalent (MME) mg/day]. Methodological quality was assessed using the Cochrane Risk of Bias Tool.

resultsWe included ten patient-focused RCT interventions (n = 835; median 37 participants) and 2 testing clinician-focused interventions (n = 291 clinicians); none at low risk of bias. Patient-focused interventions did not reduce opioid dose in the intermediate term [e.g. dose reduction protocol, mean difference (MD) - 19.9 MME, 95% CI - 107.5 to 67.7], nor did they increase the number of participants who ceased their dose, or increase the risk of serious adverse events or adverse events. One clinician intervention of education plus decision tools versus decision tools alone reduced the number of opioid prescriptions (risk difference (RD) - 0.1, 95% CI - 0.2 to - 0.1), dose (MD - 5.3 MME, 95% CI - 6.2 to - 4.5) and use (RD - 0.1, 95% CI - 0.1 to - 0.0) in the long term. LIMITATIONS: Study heterogeneity prevented meta-analysis.

conclusionThe small number of studies and heterogeneity prevented firm conclusions to recommend any one opioid-analgesic-deprescribing strategy in patients with chronic pain. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42017068422.

Indexed as

DeprescriptionsAnalgesics, OpioidBuprenorphineChronic PainClinical Decision-MakingDrug PrescriptionsHumansMindfulnessNarcotic AntagonistsOpioid EpidemicPain ManagementRandomized Controlled Trials as TopicTreatment OutcomeAnalgesics, OpioidBuprenorphineNarcotic Antagonists

Identifiers

PMID32737739
OpenAlexW3042755581

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.