Manejo del dolor crónico en Atención Primaria, perfil de prescripción de opiáceos mayores: indicación, coste y efectos secundarios

Abstract

Objectives:The main objective of the study was to determine the characteristics of major opioids prescribing in Primary Care.Material and methods: A retrospective study was designed through the use of a historical cohort, assessing patients who have consumed major opiates in all Jaén city health centers during 2011, by systematic sampling, 215 patients, computing the sample size for a confidence level of 95 %, accuracy 5 %, 5 % losses (expanding the 5 % sample by reporting bias). Medical records were audited to collect the following data: Age, sex, medical history, social status, number of appointments and use of hospital resources, characteristics of opioids prescription (dose, duration, cost, adverse reaction) and use of other analgesics/adjuvants. Data were processed for a descriptive study and a subsequent comparison according to the prescribed opioid.Results: 215 patients were included (44 % of total population) those obtained 323 prescriptions for opiates in the study year (23 % of the sample with two prescriptions of opiates and 13 % with three). Most prescribed opioids were fentanyl (60 %) and buprenorphine (22 %) and the least prescribed is by 3 % morphine. Buprenorphine is the most used in monotherapy (70 %), preferably in older women and pensioners, especially for joint pain by the general practitioner. The fentanyl is mainly used in patches (95 % of prescriptions of fentanyl) and hydromorphone is used in younger patients (< 60 years), prescribed by the Pain and Rheumatology Departments (43 % and 20 % of total prescriptions, respectively). Oxycodone is used in patients from areas with social transformation needs (46 % of prescribed opioids in ZNTS) and exclusively for neuropathic and mixed pain (52 % and 48 % respectively of total prescriptions of oxycodone), especially by the Rheumatology and Pain Unit. Morphine is used orally in cancer patients (46 % of prescriptions for morphine), half in retard formulation (45 % of prescriptions for morphine), and these patients were who have a higher healthcare demands (91 % of totals patients prescribed morphine, go to the emergency department, and 46 % required hospital admission).Conclusions: As improvement measure, after contrasting the results, we should encourage the prescription of morphine as an analgesic of choice in both acute and chronic severe pain. An improvement in the measuring instruments specific to each type of pain considering its pathogenesis is required, as well as fostering a greater use of rating scales, both at the start of treatment and during the follow-up of each patient to assess the evolution of pain and treatment effectiveness. RESUMENObjetivos: el objetivo principal del estudio es conocer las características de la prescripción de opiáceos mayores en Atención Primaria.Material y métodos: se diseña un estudio retrospectivo mediante una cohorte histórica, valorando a los pacientes que hayan consumido opiáceos mayores en todos los centros de salud de Jaén capital durante 2011, mediante un muestreo sistemático, 215 pacientes, c...