布洛芬是µ-阿片受体的部分激动剂和δ和κ阿片受体的拮抗剂，对µ-阿片受体具有高亲和力和低内源性活性。布洛芬在临床镇痛方面没有天花板效应，但在呼吸抑制和欣快感方面有天花板效应。它可能提供有效的镇痛效果，同时产生较少的不良反应，是一种有前途的阿片类镇痛药。进行了系统综述和荟萃分析，以检查布洛芬治疗慢性非癌症疼痛患者的镇痛效果。进行了PubMed、MEDLINE、Embase和Cochrane图书馆的搜索，截至2022年1月。如果比较了慢性非癌症疼痛患者中布洛芬和安慰剂或活性止痛药，其中疼痛评分是结果，就会包括随机对照试验。排除非随机对照试验、观察研究、定性研究、病例报告和评论。两名调查员独立进行了文献检索、研究选择和数据收集。使用随机效应模型。主要结果是布洛芬对慢性非癌症疼痛患者疼痛强度的影响，基于疼痛评分的标准化平均差异（SMD）。使用推荐评估、开发和评估（GRADE）方法评估证据质量。分别对使用和不使用阿片类物质障碍（OUD）的患者进行了两次文献搜索。符合使用OUD条件的只有一项研究。对不使用OUD的患者进行了14项随机对照试验。与安慰剂或活性止痛药相比，布洛芬与降低疼痛评分相关（SMD = -0.368，P < .001，I2 = 89.37%）。次分组荟萃分析显示，布洛芬与安慰剂相比（SMD = -0.404，P < .001），慢性腰背痛（SMD = -0.383，P < .001），透皮途径（SMD = -0.572，P = .001），口腔途径（SMD = -0.453，P < .001），随访时间<12周（SMD = -0.848，P < .05）及随访时间≥12周（SMD = -0.415，P < .001）的差异有统计学意义。与活性止痛药相比没有显著差异（SMD = 0.045，P > .05）。证据质量评估为低到中等。与安慰剂相比，布洛芬在减轻疼痛程度上具有统计学意义和微小的降低作用。透皮和口腔途径均可提供疼痛缓解。有更多的证据支持其用于慢性腰背痛。©2023国际麻醉研究学会版权所有。

Buprenorphine is a partial agonist at the µ-opioid receptor and an antagonist at the delta and kappa opioid receptors. It has high affinity and low intrinsic activity at the µ-opioid receptor. Buprenorphine demonstrates no ceiling effect for clinical analgesia, but demonstrates this for respiratory depression and euphoria. It may provide effective analgesia while producing less adverse effects, making it a promising opioid analgesic. A systematic review and meta-analysis were performed to examine the analgesic efficacy of buprenorphine for patients with chronic noncancer pain.PubMed, MEDLNE, Embase, and the Cochrane Library were searched up to January 2022. Randomized controlled trials were included if they compared buprenorphine versus placebo or active analgesic in patients with chronic noncancer pain, where pain score was an outcome. Nonrandomized controlled trials, observational studies, qualitative studies, case reports, and commentaries were excluded. Two investigators independently performed the literature search, study selection, and data collection. A random-effects model was used. The primary outcome was the effect of buprenorphine on pain intensity in patients with chronic noncancer pain based on standardized mean difference (SMD) in pain score. Quality of evidence was assessed using the Grade of Recommendations Assessment, Development, and Evaluation (GRADE) approach.Two separate literature searches were conducted for patients with and without opioid use disorder (OUD). Only one study met the search criteria for those with OUD. Fourteen randomized controlled trials were included for those without OUD. Buprenorphine was associated with reduced pain score (SMD = -0.368, P < .001, I2 = 89.37%) compared to placebo or active analgesic. Subgroup meta-analyses showed statistically significant differences in favor of buprenorphine versus placebo (SMD = -0.404, P < .001), for chronic low back pain (SMD = -0.383, P < .001), when administered via the transdermal route (SMD = -0.572, P = .001), via the buccal route (SMD = -0.453, P < .001), with length of follow-up lasting <12 weeks (SMD = -0.848, P < .05), and length of follow-up lasting 12 weeks or more (SMD = -0.415, P < .001). There was no significant difference when compared to active analgesic (SMD = 0.045, P > .05). Quality of evidence was low to moderate.Buprenorphine was associated with a statistically significant and small reduction in pain intensity compared to placebo. Both the transdermal and buccal routes provided pain relief. There was more evidence supporting its use for chronic low back pain.Copyright © 2023 International Anesthesia Research Society.