Meta-analysis Of TCM On Preventing And Treating Opioid-Related Constipation In Patients With Cancer Pain

ObjectiveTo discuss the effectiveness of traditional Chinese medicine in the treatment and prevention of opioid-related constipation(OIC)in patients with cancer pain,and to provide evidence-based medicine for clinical application.MethodsSearch the database of CNKI,Wanfang Data,VIP,CBM,PubMed.The searchdeadline:December 31,2018.According to the admission criteria,the clinical randomized controlled study literature on OIC intervention in patients with cancer pain was strictly screened.The Cochrane risk bias assessment tool was used to evaluate the quality of the included literature,and extract outcome indicators as follow,the efficiency,Karnofsky Performance Status(KPS),pain score,constipation symptom score,Motilin level(MTL),constipation incidence,first defecation time.Finally,use Review Manager 5.3 software to do meta-analysis.RESULTSA total of 39 studies were included in the treatment to compare the clinical efficacy of the main outcomes.The results showed that TCM was more advantageous than Western medicine in treating OIC,the internal and external treatments efficiency were similar,and these advantages did not change with the treatment cycle.(Treatment cycle:OR=4.74,95%CI=[3.84,5.84],P<0.05;route of administration:OR=4.74,95%CI=[3.84,5.84],P<0.05;treatment method:OR=4.71,95%CI=[3.51,6.33],P<0.05;opioid type:OR=4.95,95%Cl=[3.98,6.15],P<0.05);10 studies compared the KPS score after treatment,the results show that Chinese medicine can significantly improve the KPS score of cancer patients(treatment cycle:MD=4.78,95%CI=[2.57,6.98],P<0.05;route of administration:MD=4.37,95%CI=[2.65,6.08],P<0.05);a total of 5 studies compared the scores of constipation symptoms before and after treatment,and the results showed that TCM can improve the symptoms of constipation in patients with OIC(medication route:MD=-1.28,95%CI=[-1.62,-0.95],P<0.05);6 studies compared the pain scores before and after treatment,the results show that TCM can reduce cancer pain in OIC patients(MD=-0.49,95%CI[-0.62,-0.36],P<0.05).Comparison of MTL in 4 studies showed that TCM can increase motilin levels(MD=40.63,95%CI=[28.73,52.52],P<0.05).In the prevention study,7 cases were analyzed for the incidence of constipation.The results showed that Chinese medicine can significantly reduce the incidence of constipation(treatment period:OR=0.38,95%CI=[0.23,0.64],P<0.05,medication route OR=0.38,95%Cl=[0.23,0.64],P<0.05);there are t-oo few articles to do meta-analysis for the first defecation time index.Conclusion1.Meta-analysis shows significant efficacy in treating OIC of patients with cancer pain by TCM:the efficacy does not change with the treatment cycle and the route of administration;relieving constipation can also improve the quality of life of patients,reduce the degree of pain,and improve gastrointestinal motility;2.Oral opioids combined with TCM treatments can significantly reduce the incidence of constipation.