M\u1ed9t t\u1ed5ng quan h\u1ec7 th\u1ed1ng v\u00e0 m\u1ed9t ph\u00e2n t\u00edch meta tr\u00ean t\u1ea1p ch\u00ed JAMA (2018, 320, 2448) \u0111\u00e3 cung c\u1ea5p c\u00e1c th\u00f4ng tin m\u1edbi cho m\u1ed9t ch\u1ee7 \u0111\u1ec1 c\u0169 \u0111ang \u0111\u01b0\u1ee3c tranh lu\u1eadn r\u1ed9ng r\u00e3i: hi\u1ec7u qu\u1ea3 c\u1ee7a nh\u00f3m opioid trong qu\u1ea3n l\u00fd \u0111au m\u1ea1n t\u00ednh kh\u00f4ng do ung th\u01b0.<\/strong><\/p>\n M\u1ed9t t\u1ed5ng quan h\u1ec7 th\u1ed1ng v\u00e0 m\u1ed9t ph\u00e2n t\u00edch meta tr\u00ean t\u1ea1p ch\u00ed JAMA (2018, 320, 2448) \u0111\u00e3 cung c\u1ea5p c\u00e1c th\u00f4ng tin m\u1edbi cho m\u1ed9t ch\u1ee7 \u0111\u1ec1 c\u0169 \u0111ang \u0111\u01b0\u1ee3c tranh lu\u1eadn r\u1ed9ng r\u00e3i: hi\u1ec7u qu\u1ea3 c\u1ee7a nh\u00f3m opioid trong qu\u1ea3n l\u00fd \u0111au m\u1ea1n t\u00ednh kh\u00f4ng do ung th\u01b0. M\u1ed9t nh\u00f3m chuy\u00ean gia qu\u1ed1c t\u1ebf \u0111\u00e3 l\u1ef1a ch\u1ecdn \u0111\u01b0\u1ee3c t\u1eeb y v\u0103n 96 th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng v\u1edbi 26000 ng\u01b0\u1eddi tham gia (61% ph\u1ee5 n\u1eef tham gia, \u0111\u1ed9 tu\u1ed5i trung b\u00ecnh l\u00e0 58 tu\u1ed5i). Trong \u0111\u00f3, c\u00f3 25 nghi\u00ean c\u1ee9u li\u00ean quan \u0111\u1ebfn \u0111au th\u1ea7n kinh, 32 nghi\u00ean c\u1ee9u v\u1ec1 \u0111au nh\u1eadn c\u1ea3m, 33 nghi\u00ean c\u1ee9u tr\u00ean t\u00ecnh tr\u1ea1ng \u0111au do “k\u00edch th\u00edch trung t\u00e2m” (c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u01a1n \u0111au m\u00e0 kh\u00f4ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng m\u00f4) v\u00e0 6 nghi\u00ean c\u1ee9u v\u1ec1 c\u00e1c lo\u1ea1i \u0111au kh\u00e1c nhau.<\/p>\n Khi so s\u00e1nh v\u1edbi nh\u00f3m s\u1eed d\u1ee5ng gi\u1ea3 d\u01b0\u1ee3c (placebo), nh\u00f3m s\u1eed d\u1ee5ng opioid gi\u00fap l\u00e0m gi\u1ea3m 6,9% t\u00ecnh tr\u1ea1ng \u0111au (ti\u00eau ch\u00ed nghi\u00ean c\u1ee9u ch\u00ednh) khi \u0111\u00e1nh gi\u00e1 theo thang \u0111i\u1ec3m quan s\u00e1t tr\u1ef1c quan v\u00e0 t\u0103ng 2% ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng theo thang \u0111i\u1ec3m SF 36 PCS (thang \u0111i\u1ec3m \u0111\u00e1nh gi\u00e1 t\u1ed5ng h\u1ee3p c\u00e1c ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng th\u1ec3 ch\u1ea5t, th\u01b0\u1eddng \u0111\u01b0\u1ee3c d\u00f9ng trong \u0111\u00e1nh gi\u00e1 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng). Tuy nhi\u00ean vi\u1ec7c s\u1eed d\u1ee5ng morphin v\u00e0 c\u00e1c d\u1eabn xu\u1ea5t l\u00e0m t\u0103ng 3,6% trong nguy c\u01a1 n\u00f4n so v\u1edbi s\u1eed d\u1ee5ng gi\u1ea3 d\u01b0\u1ee3c.<\/p>\n C\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng c\u00f3 ch\u1ea5t l\u01b0\u1ee3ng th\u1ea5p h\u01a1n c\u0169ng cho c\u00e1c k\u1ebft qu\u1ea3 t\u01b0\u01a1ng t\u1ef1 c\u1ee7a nh\u00f3m opioid trong gi\u1ea3m \u0111au: 6% so v\u1edbi NSAID, 1,3% so v\u1edbi thu\u1ed1c tr\u1ea7m c\u1ea3m 3 v\u00f2ng (imipraminin) v\u00e0 9% so v\u1edbi thu\u1ed1c ch\u1ed1ng co gi\u1eadt.<\/p>\n C\u00e1c t\u00e1c gi\u1ea3 k\u1ebft lu\u1eadn r\u1eb1ng :\u2018\u2018Trong c\u00e1c ph\u00e2n t\u00edch meta tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 \u0111au m\u1ea1n t\u00ednh kh\u00f4ng do ung th\u01b0, c\u00e1c nghi\u00ean c\u1ee9u ch\u1ea5t l\u01b0\u1ee3ng cao cho th\u1ea5y vi\u1ec7c s\u1eed d\u1ee5ng opioid li\u00ean quan \u0111\u1ebfn s\u1ef1 c\u1ea3i thi\u1ec7n y\u1ebfu nh\u01b0ng c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea trong gi\u1ea3m \u0111au v\u00e0 \u0111\u1ed1i v\u1edbi ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng, nh\u01b0ng \u0111\u1ed3ng th\u1eddi l\u00e0m gia t\u0103ng m\u1ea1nh nguy c\u01a1 n\u00f4n khi so s\u00e1nh v\u1edbi gi\u1ea3 d\u01b0\u1ee3c. C\u00e1c nghi\u00ean c\u1ee9u ch\u1ea5t l\u01b0\u1ee3ng th\u1ea5p ho\u1eb7c trung b\u00ecnh c\u0169ng cho th\u1ea5y k\u1ebft qu\u1ea3 t\u01b0\u01a1ng t\u1ef1 trong hi\u1ec7u qu\u1ea3 gi\u1ea3m \u0111au v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng khi so s\u00e1nh gi\u1eefa nh\u00f3m opioid v\u1edbi c\u00e1c l\u1ef1a ch\u1ecdn thay th\u1ebf kh\u00f4ng opioid\u2019\u2019.<\/p>\n Khi s\u1eed d\u1ee5ng tr\u00ean b\u1ec7nh nh\u00e2n v\u00e0 trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t, c\u1ea7n ph\u1ea3i c\u00f3 c\u00e1c th\u00f4ng tin ph\u00f9 h\u1ee3p, r\u00f5 r\u00e0ng, th\u1ef1c t\u1ebf v\u00e0 c\u00e2n nh\u1eafc l\u1ee3i \u00edch nguy c\u01a1 c\u1ee7a vi\u1ec7c s\u1eed d\u1ee5ng morphin. Tuy nhi\u00ean nguy c\u01a1 ph\u1ee5 thu\u1ed9c opioid v\u1eabn c\u00f2n ch\u01b0a \u0111\u01b0\u1ee3c t\u00ednh \u0111\u1ebfn trong \u0111i\u1ec1u tr\u1ecb. T\u1ea1p ch\u00ed BIP Occitanie tr\u01b0\u1edbc \u0111\u00e2y c\u0169ng t\u1eebng \u0111\u1ec1 c\u1eadp \u0111\u1ebfn v\u1ea5n n\u1ea1n l\u1ea1m d\u1ee5ng opioid \u1edf Hoa K\u1ef3 v\u00e0 \u0111\u00e3 lan sang khu v\u1ef1c ch\u00e2u \u00c2u.<\/p>\n T\u00e0i li\u1ec7u: JAMA (2018, 320, 2448) – Opioids for Chronic Noncancer Pain – A Systematic Review and Meta-analysis<\/p>\n