Abstract
BACKGROUND AND AIM: While oral Chinese herbal medicine (OCHM) is frequently used for cancer pain (CP), its combined effects with opioids remain unclear. This study aims to evaluate the efficacy and safety of OCHM combined with opioids in patients with moderate to severe CP. EXPERIMENTAL PROCEDURE: We systematically searched five Chinese and English databases up to December 30th, 2024, for randomized controlled trials comparing OCHM plus opioids versus opioids alone. Primary outcomes were pain relief and pain intensity. Secondary outcomes included onset and duration of pain relief, Karnofsky Performance Status (KPS) score, and adverse events. RESULTS: Meta-analysis of 18 trials revealed that OCHM plus opioids had a lower pain intensity (standardized mean difference [SMD] = -1.70; 95 % CI = -2.31 to -1.08; P < 0.001), higher incidence of pain relief (risk ratio [RR] = 1.25; 95 % CI = 1.20 to 1.31; P < 0.001) and KPS score (mean difference [MD] = 11.32; 95 % CI = 7.17 to 15.47; P < 0.001), shorter onset time of pain relief (MD = -13.27 minutes; 95 % CI = -14.42 to -12.11; P < 0.001), longer duration of pain relief (MD = 2.67 hours; 95 % CI = 2.13 to 3.21; P < 0.001), lower incidence of nausea/vomiting (RR = 0.51; 95 % CI = 0.41 to 0.62; P < 0.001), and constipation (RR = 0.60; 95 % CI = 0.51 to 0.69; P < 0.001). CONCLUSION: OCHM plus opioids improved pain relief, enhanced the quality of life, reduced opioid-related adverse events in patients with moderate to severe CP compared to opioids alone.