肌肉松弛剂类风湿性关节炎疼痛管理。
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理查兹提单,惠特尔SL Buchbinder R
肌肉松弛剂类风湿性关节炎疼痛管理。
Cochrane数据库系统启2012年1月18日,1:CD008922。cd008922.pub2 doi: 10.1002/14651858.。
- PubMed ID
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22258993 (在PubMed]
- 文摘
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背景:疼痛管理是一个高优先级类风湿性关节炎(RA)患者。肌肉松弛剂包括药物,减少肌肉痉挛(例如苯二氮卓类地西泮(安定)等,阿普唑仑(阿普唑仑),氯羟去甲安定(安定)和卢如metaxalone (Skelaxin)或扑热息痛和orphenadrine (Muscol))和药物,防止肌肉张力增加(巴氯芬和丹曲洛林)。尽管缺乏证据支持他们使用,抗痉挛药和antispasticity肌肉松弛剂获得了广泛的临床接受佐剂在慢性肌肉骨骼疼痛患者的管理。目的:本文的目的是确定肌肉松弛剂的临床疗效和安全性在RA患者疼痛管理。的肌肉松弛剂包括综述是止痉挛的苯二氮卓类(阿普唑仑,bromazepam、利眠宁、cinolazepam,氯硝西泮,cloxazolam, clorazepate,安定、舒乐安定,flunitrazepam,安眠药,flutoprazepam, halazepam, ketazolam, loprazolam,氯羟去甲安定,lormetazepam, medazepam,咪达唑仑,nimetazepam,硝基安定,nordazepam,去甲羟基安定,pinazepam, prazepam, quazepam,羟基安定,tetrazepam,三唑仑),止痉挛的卢(环苯扎林、肌安宁chlorzoxazone、眠尔通、美索巴莫,metaxalone, orphenadrine, tizanidine和zopiclone),和antispasticity药物(巴氯芬和丹曲林钠)。搜索方法:我们执行一个搜索Cochrane中央注册的对照试验(中央)(Cochrane图书馆,2010年第四季度),MEDLINE(1950年至2010年11月第1周),EMBASE(星期44 2010),PsycINFO(1806年至2010年11月第2周)。我们还搜查了2008年到2009年美国风湿病学院(ACR)和欧洲联盟对风湿病(欧拉描述)摘要和执行handsearch参考相关文章列表。选择标准:我们包括随机对照试验相比,另一个治疗的肌肉松弛剂(活跃,包括后备疗法,或安慰剂)在成人RA患者,报告至少一个临床相关的结果。数据收集和分析:两个盲评论作者独立提取数据和试验评估偏差的风险。荟萃分析被用来检查肌肉松弛剂在疼痛的疗效,抑郁,睡眠和功能,以及他们的安全。 MAIN RESULTS: Six trials (126 participants) were included in this review. All trials were rated at high risk of bias. Five cross-over trials evaluated a benzodiazepine, four assessed diazepam (n = 71) and one assessed triazolam (n = 15). The sixth trial assessed zopiclone (a non-benzodiazepine) (n = 40) and was a parallel group study. No trial duration was longer than two weeks while three single dose trials assessed outcomes at 24 hours only. Overall the included trials failed to find evidence of a beneficial effect of muscle relaxants over placebo, alone (at 24 hrs, 1 or 2 weeks) or in addition to non-steroidal anti-inflammatory drugs (NSAIDs) (at 24 hrs), on pain intensity, function, or quality of life. Data from two trials of longer than 24 hours duration (n = 74) (diazepam and zopiclone) found that participants who received a muscle relaxant had significantly more adverse events compared with those who received placebo (number needed to harm (NNTH) 3, 95% CI 2 to 7). These were predominantly central nervous system side effects, including dizziness and drowsiness (NNTH 3, 95% CI 2 to 11). AUTHORS' CONCLUSIONS: Based upon the currently available evidence in patients with RA, benzodiazepines (diazepam and triazolam) do not appear to be beneficial in improving pain over 24 hours or one week. The non-benzodiazepine agent zopiclone also did not significantly reduce pain over two weeks. However, even short term muscle relaxant use (24 hours to 2 weeks) is associated with significant adverse events, predominantly drowsiness and dizziness.
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