scholarly journals Is opioid therapy for chronic non‐cancer pain associated with a greater risk of all‐cause mortality compared to non‐opioid analgesics? A systematic review of propensity score matched observational studies

2021 ◽  
Author(s):  
Thomas Tölle ◽  
Mary‐Ann Fitzcharles ◽  
Winfried Häuser
Keyword(s):  
Systematic Review ◽  
Propensity Score ◽  
Cancer Pain ◽  
Observational Studies ◽  
Opioid Analgesics ◽  
Opioid Therapy ◽  
All Cause Mortality

scholarly journals All-cause mortality in patients with long-term opioid therapy compared with non-opioid analgesics for chronic non-cancer pain: a database study

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Winfried Häuser ◽  
Tino Schubert ◽  
Tobias Vogelmann ◽  
Christoph Maier ◽  
Mary-Ann Fitzcharles ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Opioid Analgesics ◽  
Opioid Therapy ◽  
Database Study ◽  
All Cause Mortality

scholarly journals A Systematic Review of Observational Studies on the Effectiveness of Opioid Therapy for Cancer Pain

2011 ◽  
Vol 3;14 (2;3) ◽  
pp. E85-E102
Author(s):  
James Colson
Keyword(s):  
Systematic Review ◽  
Cancer Pain ◽  
Quality Assessment ◽  
Observational Studies ◽  
Randomized Trials ◽  
Case Reports ◽  
The United States ◽  
Opioid Therapy ◽  
Strong Recommendation ◽  
Level Ii

Background: The prevalence of cancer-related pain and residual pain in cancer survivors is high. Opioids serve as the gold standard for treating moderate to severe cancer pain. The evaluation of the effectiveness of opioids in chronic non-cancer pain has shown a lack of effectiveness, or rather weak evidence for some of the drugs. In contrast, in cancer pain, opioids are expected to be very effective. Due to the nature of the disease, there is evidence of a paucity of randomized trials investigating opioid effectiveness in cancer pain on a long-term basis. Consequently, the effectiveness of opioids in managing cancer-related pain warrants further evidence-based review beyond randomized trials, including observational studies and case reports. Methods: The comprehensive literature search was conducted for the period 1996 through June 2010. Databases for the search included PubMed, EMBASE, Cochrane Reviews, and clinicaltrails.gov, along with reviews and cross references. Methodologic quality assessment of the observational studies managing chronic cancer pain with opioids was conducted utilizing the Agency for Healthcare Research and Quality (AHRQ) criteria for observational studies. Analysis of evidence included 5 levels of evidence developed by the United States Preventive Services Task Force (USPSTF) ranging from Level I to III with 3 subcategories in Level II. Grading recommendations were based on Guyatt et al’s recommendations with 6 levels: 3 in the strong category and 3 in the weak category. Results: This evaluation is of 18 manuscripts considered for inclusion; 7 manuscripts met the inclusion criteria based on AHRQ quality assessment. Level of evidence for opioid therapy in cancer pain was Level II-3, and recommendations were 1C/strong recommendation based on observational studies, which could change based on future evidence. Conclusion: This systematic review of observational studies indicates Level II3 evidence for effectiveness of opioids in cancer pain therapy, with 1C/strong recommendation based on observational studies, which could change based on future evidence. Key words: Chronic pain, cancer pain, non-cancer pain, randomized trials, observational studies, case reports, opioids, effectiveness

scholarly journals A Systematic Review of Randomized Trials of Long-Term Opioid Management for Chronic Non-Cancer Pain

2011 ◽  
Vol 3;14 (2;3) ◽  
pp. 91-121
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Systematic Review ◽  
Cancer Pain ◽  
Systematic Reviews ◽  
Randomized Trials ◽  
Opioid Therapy ◽  
Functional Improvement ◽  
Controlled Trials ◽  
Chronic Opioid Therapy ◽  
Level Of Evidence

Background: Even though opioids have been used for pain for thousands of years, opioid therapy for chronic non-cancer pain is controversial due to concerns regarding the long-term effectiveness and safety, particularly the risk of tolerance, dependance, or abuse. While the debate continues, the use of chronic opioid therapy for chronic non-cancer pain has increased exponentially. Even though evidence is limited, multiple expert panels have concluded that chronic opioid therapy can be effective therapy for carefully selected and monitored patients with chronic non-cancer pain. Study Design: A systematic review of randomized trials of opioid management for chronic noncancer pain. Objective: The objective of this systematic review is to evaluate the clinical efficacy of opioids in the treatment of chronic non-cancer pain. Methods: A comprehensive evaluation of the literature relating to opioids in chronic non-cancer pain was performed. The literature was evaluated according to Cochrane review criteria for randomized controlled trials (RCTs) and Jadad criteria. A literature search was conducted by using PubMed, EMBASE, Cochrane library, ECRI Institute Library, U.S. Food and Drug Administration (FDA) website, U.S. National Guideline Clearinghouse (NGC), Database of Abstracts of Reviews of Effectiveness (DARE), clinical trials, systematic reviews and cross references from systematic reviews. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the United States Preventive Services Task Force (USPSTF) and used by other systematic reviews and guidelines. Outcome Measures: Pain relief was the primary outcome measure. Other outcome measures were functional improvement, withdrawals, and adverse effects. Results: Based on the USPSTF criteria, the indicated level of evidence was fair for Tramadol in managing osteoarthritis. For all the drugs assessed, including Tramadol, for all other conditions, the evidence was poor based on either weak positive evidence, indeterminate evidence, or negative evidence. Limitations: A paucity of literature, specifically with follow-up beyond 12 weeks for all types of opioids with controlled trials for various chronic non-cancer pain conditions. Conclusions: This systematic review illustrated fair evidence for Tramadol in managing osteoarthritis with poor evidence for all other drugs and conditions. Thus, recommendations must be based on non-randomized studies. Key words: Chronic non-cancer pain, opioids, opioid efficacy, opioid effectiveness, significant pain relief, functional improvement, adverse effects, morphine, hydrocodone, hydromorphone, fentanyl, tramadol, buprenorphine, methadone, tapentadol, oxycodone, oxymorphone, systematic reviews, randomized trials

Obesity and mortality in patients with esophageal cancer: A systematic review and meta-analysis.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 20-20
Author(s):  
Arjun Gupta ◽  
Kaustav Majumder ◽  
Nivedita Arora ◽  
Preet Paul Singh ◽  
Siddharth Singh
Keyword(s):  
Systematic Review ◽  
Esophageal Cancer ◽  
Subgroup Analysis ◽  
Observational Studies ◽  
Meta Analysis ◽  
Asia Pacific ◽  
Limited Data ◽  
Inconsistency Index ◽  
All Cause Mortality ◽  
Never Smokers

20 Background: Obesity influences incidence of esophageal cancer (EC) with contrasting impact on esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESC). However, it is unclear whether it influences mortality in patients with EC. We performed a systematic review and meta-analysis to assess the association between obesity and EC mortality. Methods: Through a systematic search of major databases and conference proceedings, up to June 2015, we identified observational studies reporting the association between obesity (premorbid body mass index [BMI] ≥ 30 kg/m2) and all-cause mortality in patients with EC. We estimated summary adjusted hazard ratio (aHR) with 95% confidence intervals (CI), comparing highest BMI category with reference category in each study using random effects model; heterogeneity was measured using the inconsistency index (I2). Results: We identified 8 studies (including 1 pooled cohort study) with 2,784,027 people, of whom 18% were obese. On meta-analysis, compared with EC patients with reference BMI, obese EC patients had aHR for mortality of 0.97 (95% CI, 0.66-1.43), with high heterogeneity (I2 = 88%) after pooling maximally adjusted HRs. On analyzing patients with EAC alone (3 studies), mortality aHR was 1.10 (95% CI, 0.43-2.82), with high heterogeneity (I2 = 95%). Data to separately analyze ESC or to perform subgroup analysis in males vs females, smokers vs never smokers and Asia Pacific vs Western populations was limited. Conclusions: Based on meta-analysis, obesity does not appear to be associated with mortality in patients with EC. However, high heterogeneity and limited data for subgroup analysis limits the interpretation of this analysis. Further prospective studies evaluating mortality in patients with established EC are needed to answer this question. [Table: see text]

The role of valve surgery in infective endocarditis management: A systematic review of observational studies that included propensity score analysis

2008 ◽  
Vol 156 (5) ◽  
pp. 901-909 ◽  
Author(s):  
Imad M. Tleyjeh ◽  
Tarek Kashour ◽  
Valerie Zimmerman ◽  
James M. Steckelberg ◽  
Walter R. Wilson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Infective Endocarditis ◽  
Propensity Score ◽  
Observational Studies ◽  
Propensity Score Analysis ◽  
Valve Surgery ◽  
Score Analysis

scholarly journals Use of oral anticoagulation for people with atrial fibrillation post-stroke and associations with recurrent stroke and mortality: a systematic review

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M.Z Shahid ◽  
H Singh ◽  
D.A Lane ◽  
S.J.R.J Logantha ◽  
G.Y.H Lip ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Major Bleeding ◽  
Oral Anticoagulation ◽  
Observational Studies ◽  
Recurrent Stroke ◽  
Public Institution ◽  
Stroke Mortality ◽  
Post Stroke ◽  
All Cause Mortality

Abstract Introduction Current guidelines recommend oral anticoagulation (OAC) to reduce recurrent stroke risk for people with atrial fibrillation (AF); however, outcomes for post-stroke AF patients receiving different types of anticoagulants and optimal timing of anticoagulation in this population remains unclear. Purpose The objective of this systematic review was to summarise observational study data reporting associations between OAC use and risk of mortality, recurrent stroke, and major bleeding within post-stroke AF populations. Methods SCOPUS and OVID Medline databases were searched from inception to 02/11/2020. Studies were limited to publications in the English language post-2012. Observational studies, including case-control and cohort studies were eligible for inclusion. The outcomes examined were all-cause mortality, recurrent stroke and major bleeding. Screening and risk of bias assessment with the Newcastle-Ottawa scale were completed independently by two reviewers. Data extraction was completed by one reviewer and checked by a second. The review was registered on PROSPERO: CRD42020221105. Results Searches identified 3803 studies; 29 studies were eligible for inclusion. Variations between studies including time of OAC initiation, types of OACs used, and length of follow-up meant a meta-analysis was not possible. Four of six studies reporting effect measures of pre-admission or post-stroke OAC use found significant associations with reduced all-cause post-stroke mortality compared to no OAC use (Figure 1A). One study reported lower recurrent stroke rates in patients with no preadmission OAC use compared to preadmission OAC use (2.9% vs. 5.3%; adjusted hazard ratio (aHR) 1.50, 95% confidence interval [CI] 1.02–2.21). A separate study found post-stroke OAC use resulted in a non-significant lower stroke recurrence rate compared to no post-stroke OAC use (3.7% vs. 4.3%; p=0.9). Eight studies examined non-vitamin K antagonist OACs (NOACs) compared to warfarin; five demonstrated significant associations between post-stroke NOAC use and improved outcomes such as post-stroke mortality (Figure 1B). Two studies examined post-stroke OAC therapy timing; both suggested OAC initiation within 4 days of the index event was associated with reduced all-cause mortality (4.5% and 0.6% vs. 8.7% and 3.1%) and recurrent stroke rates (9.4% and 0.8% vs. 10.5% and 1.6%). One study reported non-significant increased major bleeding rates for earlier OAC initiation (2.7% vs. 2.2%; aHR 1.39, 95% CI 0.42–4.60). Overall, the results were consistent with previously published randomised controlled trials. Conclusions Evidence from observational studies suggest that the overall benefit of NOACs in reducing recurrent stroke and post-stroke mortality outweighs the risk of major bleeding in post-stroke AF patients. There is a need for further studies to evaluate the optimum timing of post-stroke anticoagulation initiation and management differences in patients with AF. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): The project is supported by the MRes programme in the Institute of Life Course and Medical Sciences at The University of Liverpool. All-Cause Mortality Forest Plots

Abstract 118: Right Bundle Branch Block and Clinical Outcomes in Patients with Heart Failure: A Systematic Review and Meta-analysis

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Ahmad Hazem ◽  
Sunita Sharma ◽  
Amit Sharma ◽  
Cameron Leitch ◽  
Roopalakshmi Sharadanant ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Clinical Outcomes ◽  
Cardiovascular Mortality ◽  
Observational Studies ◽  
Meta Analysis ◽  
Bundle Branch Block ◽  
Increased Risk ◽  
Patients With Heart Failure ◽  
All Cause Mortality

Importance: Right bundle branch block (RBBB) is observed in approximately 5-14% of patients with heart failure (HF). Multiple observational studies have reported the association of RBBB with clinical outcomes in patients with HF. We performed a systematic review and meta-analysis to determine the prognostic significance of RBBB for patients with HF. Data Sources: We have systematically searched MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science and Scopus through January 2014. Study Selection: Reviewers working independently and in duplicate screened all eligible abstracts that described all cause or cardiovascular mortality in patients with RBBB and HF. We excluded studies that reported unadjusted outcome, i.e.: unadjusted event rates. Knowledge synthesis: We pooled reported risk ratio and hazard ratio. Main Outcomes: All-cause mortality and cardiovascular mortality (death). Results: We found 12 relevant observational studies enrolling over 38,000 patients. Risk of bias was assessed using the Newcastle-Ottawa Scale. Included studies had at least a moderate quality. Seven of those evaluated prognosis of patients with RBBB and heart failure. After a mean follow up period of 2.5 years (range: 1-5 years), RBBB was associated with a statistically significant increased risk of all-cause mortality compared to patients with heart failure but no BBB, RR 1.27, 95% CI (1.08-1.50), Figure 1. The other 5 studies evaluated CHF patients receiving cardiac resynchronization therapy (CRT), comparing outcomes of patients with RBBB to those with LBBB. After a mean f/u period of 3 years, patients with RBBB were once again found to have an increased risk of all-cause mortality, RR 1.45, 95% CI 1.12-1.89. Conclusion and Relevance: RBBB in patients with HF is associated with higher all-cause mortality in comparison to patients without inter-ventricular conduction defects, as well as LBBB patients in patients undergoing CRT setting.

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